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Good morning, Mr. Chairman. I am Dr. Henry Falk, Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR) and Assistant US Surgeon General. I am accompanied today by Kerry Weems, Acting Deputy Assistant Secretary for Budget, Department of Health and Human Services (DHHS).

I am pleased to appear before you again this year. Much has happened in the past year to affect the public and the public health service--including ATSDR. We have had success in answering key health questions at a number of sites this year including Toms River, New Jersey, and Libby, Montana; we have had success in reaching our goal of establishing pediatric environmental health specialty units in all 10 regions of the country; and we have been challenged by the horrific events of September 11 and anthrax bioterrorism. To answer some of these new challenges, we are not only working harder within our agency, but also pursuing expanded partnerships with key federal agencies, particularly the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), the National Institute of Environmental Health Sciences (NIEHS), and the Federal Emergency Management Agency (FEMA).

In fiscal year 2002, ATSDR is meeting its Superfund mandate with an operating budget of approximately $78 million. Though we anticipate no new initiatives with the fiscal year 2003 appropriations, we will continue to deliver a meritorious return on the investment you have made in this agency.

Targeting activities at affected communities

The work in Toms River, New Jersey, represents a considerable effort that has not only addressed citizen concerns, but also advanced the field of environmental public health science. Citizens in the Toms River area have been concerned about the documented excess number of children in their township with leukemia and brain cancer. To address these concerns, ATSDR worked closely with dedicated community members and staff members of the New Jersey Department of Health and Senior Services (NJDHSS) to apply its expertise in toxicology, environmental assessment, epidemiology, and public health education--and broke new ground in using exposure modeling to assess exposures going back several decades.

ATSDR and NJDHSS designed a study to test the hypothesis that the cases of childhood cancer in the area were associated with environmental exposures. The NJDHSS staff members interviewed citizens and reviewed birth records to determine the health of children born in the area. ATSDR developed computer models to reconstruct the distribution pattern of drinking water from dozens of wells in the Dover Township area over a 35-year period. Among other conclusions, the study found a statistically significant association between prenatal exposure to the Parkway well field in the years of 1982-1996 and leukemia in girls.

Our findings from ATSDR's medical screening program in Libby, Montana, in 2000 and 2001 were also significant. Many persons who formerly worked in facilities involving vermiculite, as well as their families and others with no occupational exposure, were diagnosed with asbestos-related pulmonary abnormalities.

From July 5 through November 2, 2000, 6,149 persons participated in asbestos medical testing sponsored by ATSDR; 1,158 more were seen in the summer of 2001 (July 29-September 7). We found that 18% of those x-rayed in 2000 had asbestos-related abnormalities in the outer lining of their lungs (pleural abnormalities). The risk of pleural abnormalities increased with increasing age and length of residence in the Libby area. The rate of pleural abnormalities found in groups within the United States who have no known asbestos exposures ranges from 0.2% to 2.3%. This means that residents of Libby had at least a ninefold to ninetyfold higher incidence of such asbestos-related pulmonary problems than expected.

This year in Libby, ATSDR will focus on several key areas: providing technical support as the medical testing program moves to operation at the state/local level; establishing the registry of former workers and their families; and conducting detailed epidemiologic studies to establish links between routes of exposure and illness.

Other key sites where we have started work this year include the following.

• In Fallon, Nevada, in coordination with CDC, we are looking into an increased incidence of leukemia in children. ATSDR is evaluating potential environmental exposures including arsenic in drinking water, pesticide use, and emissions from the Fallon Naval Air Station.
• At Camp Lejeune, North Carolina, ATSDR is currently conducting a study to answer questions about the possible health impact from exposure to TCE (trichloroethylene) in drinking-water wells. ATSDR is investigating childhood leukemia and birth defects among children exposed prenatally to TCE-contaminated drinking water.

Focus on Programs

Since 1987, ATSDR funding to State health agencies has supported the conduct of public health assessments, health education activities, and epidemiologic studies. During the past 5 years, the program awarded more than $10 million annually to 28 states. Recently, ATSDR expanded the program to include three new states, Puerto Rico, and the Gila River Indian Community. In FY 2001, 33 awards will be made for a total funding of more than $11 million.

ATSDR estimates that about 3 million children younger than 18 years old live within 1 mile of a National Priorities List (NPL) hazardous waste site. The Pediatric Environmental Health Specialty Unit (PEHSU) program blends the medical and environmental sciences, with a concentration on children, to provide a resource for parents and health care providers. From a modest beginning--3 units in 1998 (Boston, New York City, and Seattle)--the PEHSU program now includes a national network of 11 operating units. We continue to be committed to this program.

ATSDR has, over nearly a decade, awarded millions in grants to research the effects that toxic chemicals have had on the health of people near the Great Lakes. The Great Lakes Human Health Effects Research Program studies known at-risk populations to further define the human health consequences of exposure to persistent toxic substances identified in the Great Lakes basin.

The Minority Health Professions Foundation's Environmental Health and Toxicology Research Program is a partnership that involves minority health professions schools located throughout the nation. This research program provides ATSDR with a critical mechanism for filling gaps in knowledge about the effects of hazardous substances on human health.

Response to domestic terrorism

The events on and after September 11, 2001, had far-reaching impacts. ATSDR leveraged its own unique skills to respond to this national emergency.

ATSDR has worked from the beginning to provide technical support the response efforts of the New York City Department of Health (NYCDOH) in response to the attacks on the World Trade Center. ATSDR is the lead from the DHHS on the federal Environmental Assessment Working Group, which is co-chaired by EPA and the Occupational Safety and Health Administration. The working group has coordinated public health and occupational sampling and data review among the federal agencies in support of the New York City and State departments of health. ATSDR continues to provide technical support.

An area of continuing concern has been the effect of the dust, debris, and associated contamination from the World Trade Center towers on nearby residents, and the efficacy of clean-up activities. With assistance from FEMA, EPA, and the Commissioned Corps Readiness Force, ATSDR worked with the NYCDOH to analyze dust and air samples for asbestos, fibrous glass, and other key substances found in the original debris in 30 residential buildings in lower Manhattan.

Based on preliminary sampling results, ATSDR and the NYCDOH have made appropriate follow-up recommendations to city and state health and environmental officials. A significant finding was that fibrous glass was detected in settled dust samples taken in residential units and common areas, and outside. Exposure to fibrous glass is known to cause rashes and upper respiratory irritation. The fibrous glass in the dust can become airborne if disturbed. Therefore, ATSDR is recommending that people continue to conduct frequent cleaning with HEPA vacuums and damp cloths and mops to reduce the potential for exposure.

ATSDR's expertise in environmental sampling and assessment also was called upon to help unravel the perplexing questions about anthrax contamination. ATSDR sent staff members to sites in Florida, New Jersey, Connecticut, Kansas, and Washington, DC, to assist in the public health response. Also, as a result of ATSDR's longstanding working partnership with EPA, the agency was able to effectively facilitate communication with CDC regarding environmental sampling, assessment, and cleanup at affected sites.

New Partnerships

ATSDR has been working with the National Institute of Environmental Health Sciences (NIEHS) to further our collaborative efforts regarding the health effects from toxic exposures in the environment. I am convinced that maintaining strong links with the Superfund basic research program at NIEHS can only enhance services that we provide to communities.

In the past year, ATSDR embarked upon establishing a new relationship with the FEMA. Several months ago, we established working groups to improve emergency medical preparedness, share database and GIS capabilities, and identify mechanisms for future collaboration.

In the past year we have also worked to reinvigorate our relationship with our sister agency, the CDC. We worked with CDC's National Center for Environmental Health (NCEH) to develop a "shared vision" for the future of environmental health at CDC and ATSDR. We sought to define our individual strengths and find out how we can best complement each other's programs. Also with NCEH, we helped initiate plans for instituting an environmental public health tracking network. ATSDR believes that this program will benefit Superfund communities concerned about high rates of chronic disease.

We continue to maintain a very effective partnership with our EPA colleagues in the Superfund program; I view this as essential to all of our work under Superfund.

Last, I want to mention a particular concern for us at ATSDR--planning for chemical, non-infectious terrorism events. We are working closely with our colleagues at CDC, EPA, FEMA and NIEHS to explore how we can effectively work with them and with our State partners.

Mr. Chairman, we are very sensitive to the need for meeting all of our mandates under the Superfund legislation. I assure you and the members of this subcommittee that you can take pride in the responsiveness of our public health agency and our continued commitment to Superfund as well as to State and Federal partners and others in addressing the environmental public health needs related to terrorist attacks on this country.

Mr. Chairman, this completes my testimony. I would be pleased to respond to any questions you or the other members may have.

Good morning, Mr. Chairman. I am Dr. Henry Falk, Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR) and Assistant Surgeon General of the United States. I am accompanied today by Kerry Weems, Acting Deputy Assistant Secretary for Budget at the Department of Health and Human Services (DHHS).

I am pleased to appear before you again this year. Much has happened in the past year to affect the public as well as the public health service--including ATSDR. I would like to share with you today some of our successes, and some of our challenges for the future. We have had success in answering key health questions at a number of sites this year including Toms River, New Jersey, and Libby, Montana; we have had success in reaching our goal of establishing pediatric environmental health specialty units in all 10 regions of the country; and we have been challenged as never before by the horrific events of September 11 and anthrax bioterrorism. To answer some of these new challenges, we are not only working harder within our agency, but also pursuing expanded partnerships with key federal agencies, particularly the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), the National Institute of Environmental Health Sciences (NIEHS), and the Federal Emergency Management Agency (FEMA).

In fiscal year 2002, ATSDR is meeting its Superfund mandate with an operating budget of approximately $78 million. Though we anticipate no new initiatives with the fiscal year 2003 appropriations, we will continue to deliver a meritorious return on the investment you have made in this agency. We will target our activities for the greatest impact and advance the field of environmental public health through service to the communities we work with and through good science built on applied research and surveillance.

Targeting activities at affected communities

The work in Toms River, New Jersey, represents a considerable effort that has not only addressed citizen concerns, but also advanced the field of environmental public health science. As many of you know, citizens in the Toms River area have been greatly concerned about the documented excess number of children in their township with leukemia and brain cancer. To address these concerns, ATSDR worked closely with dedicated community members and staff members of the New Jersey Department of Health and Senior Services (NJDHSS) to apply its expertise in toxicology, environmental assessment, epidemiology, and public health education--and broke new ground in using exposure modeling to recreate the distant past.

ATSDR and NJDHSS designed a study to test the hypothesis that the cases of childhood cancer in the area were associated with environmental exposures. The NJDHSS staff members interviewed citizens and reviewed birth records to determine the health of children born in the area. ATSDR developed computer models to reconstruct the distribution pattern of drinking water in the Dover Township area over a 35-year period. This information was used in the case-control study to derive exposure estimates to different water sources (some of which were contaminated). This ground-breaking methodology has spurred international public health interest on five continents.

Additionally, ATSDR and NJDHSS funded the Environmental and Occupational Health Sciences Institute of University of Medicine and Dentistry of New Jersey, an NIEHS sponsored research center, to develop computer models to reconstruct air pollution distribution from two nearby emission sources. This information was used in the case control study to derive estimates of exposure to air pollution point sources.

Following are some of the findings from the study.

• A statistically significant association was found between prenatal exposure to the Parkway well field in the years of 1982-1996 and leukemia in girls.

• Leukemia in girls diagnosed before the age of 5 years was found to be associated with prenatal exposure to Ciba-Geigy ambient air.
• No single factor appears to be solely responsible for the overall increased rate of childhood cancer in Dover Township.
• Other environmental factors did not show a consistent pattern of association.

Due to a number of methodological challenges, in only a few cases has an association between and environmental pathway and a cancer cluster been documented. With few exceptions, the cause of childhood cancer (which, in the US, has increased about 30% in the last decade) is not well understood. We do know that, unlike adult cancer, cancer in children is not significantly related to lifestyle risk factors. Hence, studies like this which examine the association between childhood exposures to environmental pollutants and the risk of developing cancer are very important to our work. The association documented in New Jersey could not have been found without the sophisticated water modeling program that we developed and--equally as important--the full support and participation of the community and the state health department.

Our findings from ATSDR's medical screening program in Libby, Montana, in 2000 and 2001 were also significant. Many persons who formerly worked in facilities involving vermiculite were diagnosed with asbestos-related pulmonary impairment. ATSDR's asbestos medical testing in the Libby area documented cases of nonoccupational asbestos-related lung and chest wall scarring among family members of former vermiculite mine employees and other persons in the community with no connection to the mining operations. Three potentially fatal diseases--asbestosis, mesothelioma, and lung cancer--are associated with asbestos exposure.

From July 5 through November 2, 2000, 6,149 persons participated in asbestos medical testing sponsored by ATSDR; 1,158 more were seen in the summer of 2001 (July 29-September 7). Those eligible for testing included former W.R. Grace workers from Libby and people who lived, worked, or played in Libby for at least 6 months prior to December 31, 1990. The testing program consisted of specialized chest x-rays, lung-function testing, and a detailed questionnaire designed to assess exposure histories of screening participants.

We found that 18% of those x-rayed in 2000 had asbestos-related abnormalities in the outer lining of their lungs (pleural abnormalities). The risk of pleural abnormalities increased with increasing age and length of residence in the Libby area. The rate of pleural abnormalities found in groups within the United States who have no known asbestos exposures ranges from 0.2% to 2.3%. This means that residents of Libby had at least a ninefold to ninetyfold higher incidence of such asbestos-related pulmonary problems than expected.

Additional Findings

• Forty-eight percent (159 of 328) of former W.R. Grace employees had pleural abnormalities.
• Most participants reported multiple routes of exposure (household contact, occupational, recreational, and other). For example, 24% of participants who reported six or more routes of exposure had pleural abnormalities.
• Five percent (6 of 122) of those participants who reported no apparent exposure had pleural abnormalities.

In light of these findings, ATSDR, EPA, DHHS Region 8, and other federal agencies are committed to providing support for the Libby community. Recently the Health Resources Services Administration of the Department of Health and Human Services funded a community health clinic for medically underserved individuals. This clinic focuses on providing primary care services. People with asbestos-related disease who are medically underserved are eligible for any of the services provided.

In the coming year, ATSDR will focus on several key areas: transitioning the medical testing program to be conducted at the state and local level with ATSDR technical support; establishing the registry of former workers and their families; and conducting detailed epidemiologic studies to establish links between routes of exposure and illness.

Our work on the Isla de Vieques, Puerto Rico, led to findings in a different direction. The US Navy has been conducting bombing exercises on and off the coast of Vieques for more than 50 years. Bombing was suspended in April 1999 after a civilian Puerto Rican security guard was killed in a bombing accident. Concerns over continued bombing on the island had reached the White House and had gained national and international media attention.

In May 1999, ATSDR received a letter from a resident of Vieques, petitioning ATSDR to investigate the health concerns of residents; our work on Vieques fit with our mandate to work at federal facilities and was funded by the US Department of the Navy. ATSDR has assessed water (both drinking water and groundwater) and dust and soil, and is currently assessing air and the marine biota food chain to determine if the residents of Vieques are being exposed to potentially hazardous materials. In October 2001, ATSDR released findings for drinking water/groundwater and soil. We found that the drinking water on Vieques is safe and is not affected by the bombing range activities. ATSDR also found that the chemicals and metals in the soil are at levels too low to cause health effects in either adults or children.

To address concern raised by a study of heart disease in Vieques fishermen conducted by faculty of the Ponce School of Medicine in Puerto Rico, ATSDR sent experts to review the findings and later convened an international peer review panel to evaluate the study. The panel was made up of experts in echocardiography, cardiology, and environmental epidemiology from the United States, Mexico, and Spain. The study had found a small but statistically significant difference between the thickness of the lining around the heart (pericardium) in the Vieques residents as compared with a similar group (control population) from Ponce Playa. The concern was that the pericardia of Vieques residents were thicker due to vibration and noise from target exercises conducted on the island by the US Navy. As part of the peer review, the echocardiography laboratory at the Mayo Clinic was selected to re-read the echocardiograms taken by the Ponce School of Medicine scientists. The peer review panel made the following findings.

• Neither the Ponce nor the Mayo data indicated heart problems in either the Vieques residents or the Ponce Plaza residents.
• None of the study subjects had an abnormally thick heart lining. Panel members thought the difference in the thickness of the heart lining between the Vieques and the Ponce Plaza residents could be due to error inherent in the measurement technique.
• No further studies of the thickness of the heart lining (pericardial thickness) were recommended.

There are many other key sites where we have started work this year, including the following.

• In Fallon, Nevada, in coordination with CDC, we are looking into an increased incidence of leukemia in children. ATSDR is evaluating a variety of potential environmental exposures including arsenic in drinking water, pesticide use, and emissions from the Fallon Naval Air Station. ATSDR, along with CDC, is committed to continued support of the Nevada State health officials in their investigation. ATSDR is working with local community and healthcare providers to respond to their information and education needs.

• At Camp Lejeune, North Carolina, ATSDR is currently conducting a study to answer questions about the possible health impact from exposure to TCE (trichloroethylene) in drinking-water wells. ATSDR is investigating childhood leukemia and birth defects among children exposed prenatally to TCE-contaminated drinking water.
• The lead smelter in Herculaneum, Missouri, is the largest and oldest smelter operating in the United States. With ATSDR's assistance, more than 600 residents were recently tested by the Missouri Department of Health Services, ATSDR's cooperative agreement partner, during two voluntary, communitywide blood lead screening events. The screening found 33 (28%) of the 118 children younger than 6-years of age tested had blood lead levels that were at or above 10 micrograms per deciliter of blood, the level of health concern. Numerous health education activities were provided to residents, local physicians, and community officials during fiscal year 2001. State and federal regulators have intensified their efforts to address the areas where exposures have occurred and to prevent future exposures. State and federal regulators have also focused on quickly addressing remediation of the contaminated residential yards and home interiors.

Focus on Programs

State health agencies have been important partners in helping ATSDR carry out its mission of preventing exposure to contaminants at hazardous waste sites and preventing adverse health effects. ATSDR has been funding environmental public health activities in states since 1987. The cooperative agreements provide assistance to conduct public health assessments, health education activities, and epidemiologic studies. During the past 5 years, the combined state cooperative agreement program awarded more than $10 million annually to 28 states for conducting public health activities at waste sites. Recently, ATSDR expanded the program with an award to three new states, Puerto Rico, and the Gila River Indian Community, bringing the total number of awards to 33 for FY 2001 and the total funding level to more than $11 million.

ATSDR estimates that about 3 million children younger than 18 years old live within 1 mile of a National Priorities List (NPL) hazardous waste site. We consider those children to be a particularly vulnerable population.

The Pediatric Environmental Health Specialty Unit (PEHSU) program was designed to promote children's health. The program blends the medical and environmental sciences, with a concentration on children, to provide a resource for parents and health care providers. These units focus on conducting medical education and training, providing clinical consultation and outreach, and providing evaluation of children referred because of exposure to hazardous substances in the environment.

From a modest beginning--3 units in 1998 (Boston, New York City, and Seattle)--the PEHSU program has grown to include

• a national network of 11 operating units;
• the addition of EPA as a partner in supporting the units;
• the establishment of PEHSUs by agencies in Mexico and Canada using the ATSDR PEHSU model;
• opportunities to link these clinical centers with the NIEHS/EPA Centers for Children's Environmental Health and Disease Prevention Research;
• an impact on the emerging field of pediatric environmental medicine and with the development of a body of published articles, curricula, and educational materials.

ATSDR has, over nearly a decade, awarded millions in grants to research the effects that toxic chemicals have had on the health of people near the Great Lakes. The Great Lakes Human Health Effects Research Program is intended to evaluate the potential health effects of past and ongoing consumption of fish from the Great Lakes basin. This ATSDR-supported research program studies known at-risk populations to further define the human health consequences of exposure to persistent toxic substances identified in the Great Lakes basin. Findings from this research program are important to the millions of people living along the nearly 11,000-mile Great Lakes shoreline. The research findings also have implications for other exposures to similar chemicals.

Significant research findings during fiscal year 2001 include the following.

• Children who were born to mothers consuming more than the median number of fish meals before their pregnancy were 5.4 times more likely to have low birth weight.
• Only maternal serum PCBs (polychlorinated biphenyls) were significantly associated with low birth weight.
• Paternal exposure to PCBs is associated with a higher proportion of male offspring.

The Minority Health Professions Foundation's Environmental Health and Toxicology Research Program is a partnership that involves minority health professions schools located throughout the nation. This research program provides ATSDR with a critical mechanism for filling gaps in knowledge about the effects of hazardous substances on human health.

New research findings from this program are incorporated into updated toxicological profiles and result in filling priority data needs and fulfilling the agency's congressional mandate to assure the initiation of research when available information is inadequate. In addition to being a primary mechanism to address data gaps for hazardous substances at ATSDR, the Environmental Health and Toxicology Research Program has had an extraordinary impact on developing toxicology programs at these colleges. Last month I visited Florida A & M University in Tallahassee and was able to see these benefits firsthand.

The Hazardous Substances Emergency Events Surveillance System (HSEES) is a tool for both prevention and surveillance. HSEES was established by ATSDR in 1990 to collect and analyze information about the public health impact of emergency releases of hazardous substances. The goal of HSEES is to help reduce the morbidity and mortality experienced by first responders, employees, and the general public as a result of hazardous substances emergencies. A total of 16 state health departments (Alabama, Colorado, Iowa, Louisiana, Minnesota, Mississippi, Missouri, North Carolina, New Jersey, New York, Oregon, Rhode Island, Texas, Utah, Washington, and Wisconsin) are currently participating in this cooperative agreement program.

From 1993 through 2000 there were 44,164 events with 49,256 separate releases or threatened releases that qualified for inclusion in the system. In 8% (3,703) of the events, there were 15,575 injured or ill persons, including 222 deaths. Employees continue to be the most commonly reported victims of emergency events; however, there are substantial numbers of persons from the general public, students at schools, and first responders who also have been affected by emergency events.

Participating states used the HSEES data analysis to identify and implement prevention outreach activities that were geared to preventing spills, releases, and resulting injuries. Prevention activities were focused on counties and industries (for example, chlorine users and transportation and agricultural industries) with the most frequent releases, and the most frequently spilled chemicals (such as ammonia, chlorine, mercury, pesticides, and illicit methamphetamine chemicals). Other prevention activities have targeted population groups that are frequently injured, such as employees, first responders, and students.

The HSEES system has streamlined the data-entry process with the advent of the new web-based data entry system. (The system is also streamlining efforts by adding an automated geographic information system and investigating the electronic transfer of new records directly into the web-based system from the various notification sources.)

Response to domestic terrorism

The events on and after September 11, 2001, had far-reaching impacts. ATSDR leveraged its own unique skills to respond to this national emergency.

Along with other federal emergency response organizations following the terrorist attacks on the World Trade Center and the Pentagon, ATSDR mobilized operations immediately and began around-the-clock support of our public health partners. In particular, our relationships with EPA and CDC have taken on new dimensions in the past 5 months as we have been called upon to take a major role in determining the potential health effects of environmental contamination in the areas surrounding the World Trade Center and in assessing the environmental dispersal of anthrax spores.

The agency provided staff to the Emergency Operations Center at CDC as they began 24-hour operations. Additionally, ATSDR operated its own emergency operations center for extended hours to support and respond to public health and environmental officials. We also provided Commissioned Corps Officers for US Public Health Service emergency response teams.

At the World Trade Center, ATSDR has collaborated with federal, state and local health and environmental entities since September 11. ATSDR's emergency response coordinators and scientists worked with their counterparts from the National Institute for Occupational Safety and Health (NIOSH) and the National Center for Environmental Health (NCEH) at CDC to provide critical recommendations for the health and safety of rescue workers as these operations developed in New York City.

ATSDR has worked from the beginning to support the response efforts of the NYCDOH. In addition to direct technical support, ATSDR is the lead from the Department of Health and Human Services on the federal Environmental Assessment Working Group, which is CO-chaired by EPA and the Occupational Safety and Health Administration (OSHA). The working group has coordinated public health and occupational sampling and data review among the federal agencies in support of the NYCDOH and the New York State Department of Health. Through these efforts, ATSDR has provided an initial hazard analysis of the potential contaminants in the dust from the collapse of the World Trade Center towers, worked with the NYCDOH to recommend protective measures for the general public and drafted educational materials, developed summary information on potential contaminants and comparison values based on extensive literature reviews, and developed guidance levels for asbestos. ATSDR continues today with technical support on a variety of issues.

An area of particular, and continuing, concern has been the effect of the dust, debris, and associated contamination from the World Trade Center towers on nearby residents, and the efficacy of cleanup activities. With assistance from FEMA, EPA, and the Commissioned Corps Readiness Force, ATSDR worked with the NYCDOH to conduct an analysis of dust and air exposure for asbestos, fibrous glass, and other key substances found in the original debris in 30 residential buildings in lower Manhattan.

The sampling plan was designed to obtain samples from locations across the lower Manhattan area. Because of the time urgency associated with the need to obtain results, the plan was not designed to garner samples statistically representative of the area, but rather to give public health officials and citizens relatively quick, overall feedback regarding contaminants present. Samples collected under the plan included 117 air samples taken from the 30 residential buildings; 98 dust samples taken from residential units, residential common areas, and adjacent outdoor areas; and background samples of both dust and air taken from four buildings north of 59th Street (upper Manhattan).

Preliminary results, which have been provided to city and state health and environmental officials, as well as to residents and building landlords and owners, include the following.

Asbestos findings

• No asbestos was found in air samples.
• Low levels of asbestos were found in settled dust, primarily below Chambers Street, in 10 (17.5%) of the residential units dust sampled; in 5 (19.2%) of the common area samples; and in 5 (33%) of the outdoor area samples.
• Asbestos was detected in areas previously cleaned.
• No asbestos was detected in the background dust samples taken north of 59th Street.

Fibrous glass findings

• Fibrous glass was detected in settled dust samples from 23 (40.4%) of the residential units sampled; 11 (42.3%) of the common area samples; and in 9 (64.3%) of the outside samples.
• No fibrous glass was detected in background dust samples.
• Fibrous glass was detected in locations previously cleaned.
• Air data on fibrous glass are pending.

ATSDR and the NYCDOH have made appropriate follow-up recommendations to city and state health and environmental officials.

• Exposure to fibrous glass is known to cause rashes and upper respiratory irritation. These sampling results suggest that fibrous glass should be considered in choosing the mode and frequency of cleanup.
• The negative air data and low levels of asbestos in dust suggest that cleanup practices seem to be largely effective in eliminating asbestos exposure.
• Although both asbestos and fibrous glass were found in dust, both types of particles can become airborne if disturbed. Therefore, ATSDR is recommending that people continue to conduct frequent cleaning with HEPA vacuums and damp cloths and mops to reduce the potential for exposure in accordance with the NYCDOH guidance.

ATSDR and CDC continue to work with the NYCDOH and other federal and state agencies to provide information on the sampling results to citizens of New York and to help interpret the possible health effects of contaminants found.

Anthrax

ATSDR's expertise in environmental sampling and assessment was called upon to help unravel the perplexing questions about anthrax contamination. ATSDR sent staff members to sites in Florida, New Jersey, Connecticut, Kansas, and Washington, DC, to assist in the public health response. As a result of ATSDR's longstanding working partnership with EPA, the agency was able to effectively facilitate communication between CDC and the EPA On-Scene Coordinators who were responsible for directing environmental sampling, assessment, and cleanup at affected sites. Some of the activities in which ATSDR staff members were involved include the following.

• At the urgent request of EPA, ATSDR convened occupational health and safety medical experts from NIOSH and ATSDR to provide On-Scene Coordinators with guidance on protecting environmental sampling and cleanup workers involved in the anthrax response. A consultation letter detailing these recommendations was provided to EPA within 3 working days of the conference call.
• ATSDR staff members provided emergency on-scene technical expertise, public health assessment, and consultative support to EPA, the Senate Sergeant-at-Arms, and the Capitol's Attending Physician as they addressed anthrax concerns at the Congressional office buildings.
• A team of ATSDR industrial hygienists and sanitarians and NIOSH staff members repeatedly sampled the regional mail sorting facility in Connecticut, employing improved sampling strategies and techniques. Consequently, the team was successful in detecting anthrax contamination at the mail facility where several previous rounds of sampling had failed to find any anthrax spores.
• ATSDR staff members used geographic information systems (GIS) to plot locations where anthrax was found in anthrax-contaminated buildings.
• ATSDR staff members have been a continuous part of the CDC/ATSDR Emergency Operations Center Occupational/Environmental Team, which is responsible for preparing guidance documents for medical providers, exposed workers, the public, and the public health community.

New Partnerships

ATSDR has been working with the National Institute of Environmental Health Sciences (NIEHS) to further our collaborative efforts regarding the health effects from toxic exposures in the environment. Dr. Kenneth Olden (Director of NIEHS) and I have met on several occasions this year to facilitate further collaborations among our staffs. Five workgroups that represent areas of common interest were identified. The five workgroups are (1) children's health, (2) minority health programs, (3) research, ( 4) health education and community outreach, and (5) bioterrorism. The workgroups, which include representatives from NIEHS and ATSDR, jointly developed more than a dozen proposals for collaborative work. Dr. Olden and I are going to select at least three or four that our agencies can jointly pursue. I am convinced that maintaining strong links with the Superfund basic research program at NIEHS can only enhance services that we provide to communities.

In the past year, ATSDR has embarked upon establishing a new relationship with the Federal Emergency Management Agency (FEMA). Several months ago, we established three working groups with FEMA to focused on joint efforts to improve emergency medical preparedness; share database and GIS capabilities; and identify mechanisms for future collaboration. As a first step in that process, ATSDR and FEMA are piloting the partnership at three Local Emergency Preparedness Committees (LEPCs). The three LEPCs are in Carlisle, Pennsylvania; Ithaca, New York; and the Tri-Town area (New London, East Lyme, and Waterford) of Connecticut.

In the past year we have also worked to reinvigorate our relationship with our sister agency, the Centers for Disease Control and Prevention (CDC). This work has been ongoing in a number of important areas. First, we worked with CDC's National Center for Environmental Health to come up with a "shared vision" for the future of environmental health at CDC and ATSDR. We sought to define our individual strengths and find out how we can best complement each other's programs.

Also with the National Center for Environmental Health, as well as other parts of CDC such as the National Center for Chronic Disease Prevention and Health Promotion and the Center and the Public Health Practice Program Office, we helped initiate plans for instituting an environmental public health tracking network. Staff from ATSDR are currently working not only with CDC, but with a significant number of State and outside experts to develop detailed guidelines for a CDC-funded environmental health tracking network grant program. (ATSDR received $2.5 million and CDC received $17.5 million for this purpose in fiscal year 2002.) CDC intends to make the announcement for these grant awards in late March or early April. ATSDR believes that this program would benefit Superfund communities concerned about high rates of chronic disease.

And, as I have stated to you previously, we continue to maintain a very effective partnership with our EPA colleagues in the Superfund program; I view this as essential to all of our work under Superfund.

As I've already described, clearly we've had new and intensified relationships with many of our counterparts at CDC in responding to the horrific events of September 11 and the subsequent anthrax contamination issues. We have learned that our expertise in toxic substances, as well as our expertise in environmental assessment and decontamination, is needed in responding to infectious disease-terrorism episodes.

Last, I want to mention a particular concern for us at ATSDR--planning for chemical, noninfectious terrorism events. We are working closely with our colleagues at CDC, EPA, FEMA and NIEHS to fully explore how we can work with them and with our State partners in the most effective and useful way. We are assessing our internal capabilities to deal with terroristic threats--not only at headquarters, but also in our regional offices.

Mr. Chairman, we are very sensitive to the need for meeting all of our mandates under the Superfund legislation. Because of the extraordinary emergency response efforts this year to the events of September 11 and anthrax contamination, a good number of our people answered the need for assistance. We have done so in the spirit of the emergency response provisions of Superfund--and for the greater public health good. At the same time, we have attempted to fulfill our Superfund program needs to the best of our abilities. It has been a difficult balance to maintain, but I assure you and the members of this subcommittee that you can take pride in the responsiveness of our public health agency and our continued commitment to Superfund as well as to State and Federal partners and others in addressing the environmental public health needs related to terrorist attacks on this country.

Mr. Chairman, this completes my testimony. I would be pleased to respond to any questions you or the other members may have.

This page last updated on March 7, 2002

Contact Name: Joanne Cox/ vzc6@cdc.gov

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