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Mr. Mollohan: ATSDR was very active and very helpful in the immediate aftermath of the September 11th attacks at the World Trade Center. Describe your role at the Trade Center site.

Dr. Falk: ATSDR assisted the response to the World Trade Center tragedy in the immediate aftermath of September 11th and continues to be involved at the site 18 months later through a project with the New York City Department of Health and Mental Hygiene to establish a registry that will track the health of people who were exposed to smoke, dust, and airborne contaminants from the site. In the days and weeks immediately following the collapse of the towers, ATSDR deployed staff to New York City to work with the New York City Department of Health and Mental Hygiene and other health and environmental agencies. ATSDR staff assisted with environmental sampling, provided expertise in environmental medicine, spoke with residents and workers in response to concerns they raised about air quality, and provided other technical assistance. ATSDR provided substantial on-site assistance to the Environmental Protection Agency and co-chaired the Interagency Task Force as the official lead for the Department of Health and Human Services (HHS). ATSDR also provided staff to the CDC Emergency Operations Center, which was activated immediately following the attacks. The ATSDR desk at the Emergency Operations Center was staffed 24 hours a day, and provided quick answers to health questions about asbestos fibers and particulates present in the dust cloud from the World Trade Center, as well as assistance in answering calls on many other issues. ATSDR used its expertise in geographic information systems to assist in summarizing and displaying various environmental data for Lower Manhattan (including locations of sampling sites, levels of contaminants measured, etc.)

ATSDR also provided assistance to the New York City Department of Health and Mental Hygiene in sampling air and dust in residences in lower Manhattan, and issued a report on its findings in September 2002. It was published in a recent CDC Morbidity and Mortality Weekly Report and may be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5207a3.htm. Most recently, ATSDR has been involved in assisting the New York City Department of Health and Mental Hygiene in creating a registry of people who lived or worked near the World Trade Center site. In fiscal year 2002, the Federal Emergency Management Agency (FEMA) provided ATSDR start-up funds for the registry through an interagency agreement. These funds will be available through fiscal year 2003. The registry will help track the health of these people to see whether they experience any long-term health problems as a result of their exposure to contaminants from the collapse of the towers. The registry will also help evaluate the psychological impact of the disaster. Future health studies could be done using the registry to further define health outcomes and possible prevention and/or treatment interventions. The registry is anticipated to be the largest of all exposure registries, with a potential enrollment of up to 200,000 people.

Mr. Mollohan: What has ATSDR spent on World Trade Center related activities so far, and how much of this has been reimbursed?

Dr. Falk: ATSDR spent $595,630 on World Trade Center response activities in fiscal year 2001 and fiscal year 2002, for personnel and travel. ATSDR was reimbursed for these World Trade Center expenses in the fiscal year 2003 appropriation. (This figure does not include fund expenditures associated with the World Trade Center registry, which were funded through FEMA.)

Mr. Mollohan: The House supported a role in both the 2002 Supplemental and the 2003 final bill for ATSDR in training States to handle toxic substances which might be a part of any terrorist attacks. The $9.5 million proposed by the House was impounded by the President in 2002, and the 2003 funds were unfortunately dropped in conference. In your opinion, is there still a need for training State health departments to deal with these threats?

Dr. Falk: ATSDR strives to work closely with our sister agency the Centers for Disease Control and Prevention (CDC), our own Department of Health and Human Services (DHHS), and with the new Department of Homeland Security (DHS). The CDC provided ATSDR 3 FTEs and $2.2 million in fiscal year 2002 to support the terrorism preparedness and response program, and for fiscal year 2003 ATSDR is slated to continue to receive similar funding from CDC.

DHS and DHHS, particularly through funds from CDC to states, are providing considerable state and local health department support. Inevitably, the largest portions of these funds are for urgent bioterrorism threats, such as anthrax and smallpox. At the ATSDR Partners in Public Health Meeting held in March of this year, ATSDR heard from representatives of 31 state health departments that attended the conference about their continued need for help, including training, to prepare to deal with the threats posed by chemical terrorism.

Mr. Hobson: I am interested in the research you have done concerning the effects exposure to contaminated Great Lakes fish has on humans. I know this has been an ongoing research effort, but I would like to know what the expected duration is for the Great Lakes Health Effects Research Program. In addition, what percentage of your annually appropriated funds goes toward this effort? How specifically you disseminate your findings to the at-risk populations such as the elderly, Native Americans, sports anglers, and children.

Dr. Falk: The ATSDR Great Lakes Human Health Effects Research Program (GLHHERP) supports ten cohort studies of vulnerable populations. These cohorts, which include approximately 15,000 individuals, consist of young children first studied at birth, subsistence anglers, American Indians, Asian Americans, reproductive-aged men and women, the urban poor, and the elderly. The ATSDR=s GLHHERP has made significant progress over the years in evaluating and reporting findings that address public health issues related to from exposure to contaminants in the basin. One important reason for this progress is that the program has focused its research efforts on assessing health outcomes in vulnerable (at-risk) populations by virtue of their intrinsic physiologic sensitivity and/or elevated exposure to toxic chemicals in Great Lakes sport fish. Secondly, ATSDR works with various partners such as Great Lakes state health departments, academic institutions, and federally recognized tribal governments, by providing them grants to conduct epidemiologic research to identify and address this public health issue.

Key research findings from this program include:

1. Susceptible populations in the Great Lakes basin are still being exposed to persistent toxic substances such as polychlorinated biphenyls (PCBs), dioxins, and mercury;
2. Body burden levels are two to eight times higher than in the general U.S. population;
3. Women and minorities are highly vulnerable populations in the basin. In general, these groups are less knowledgeable about fish advisories than are other segments of the population;
4. Neurodevelopmental deficits and cognitive deficits are present in newborns and children, and adults, respectively;
5. Disturbances in reproductive parameters (e.g., delay in conception) have been observed in women who consumed contaminated fish for more than seven years;
6. Paternal exposure to PCBs may alter the normal human sex ratio of males to female children born (i.e., higher proportion of males); and
7. Serum PCB levels and consumption of Great Lakes fish are significantly associated with changes in thyroid hormones in women and men.

Because of the public health significance of these findings, ATSDR has been proactive in sharing these results with the citizens of the Great Lakes basin and initiating culturally appropriate risk communication messages and public health intervention strategies (especially with Great Lakes state health departments) to interdict future exposures.

One of the funded research grants of the ATSDR GLHHERP involves a consortium of seven Great Lakes state health departments - one of which is the Ohio Department of Health. These state health departments assess the potential for adverse health outcomes from consumption of Great Lakes sport fish and develop risk communication messages for vulnerable populations. It is essential that the Ohio Department of Health be involved in this research effort because there are 80 fish consumption advisories in place in the State of Ohio. In addition, Ohio is one of 28 states that currently have statewide fish advisories. Ohio is one of 18 states that currently have 100 percent of their lake acres under fish advisories (US EPA, 2002).

Fiscal year 2003 begins the 3rd year of a 3-year project period (or cycle). Fiscal year 2003 also represents the 4th 3-year project period of funding for the Great Lakes program. One or two additional cycles are needed to bring closure to the key public health questions or follow ups as identified below. This depends, however, upon the research findings, which may dictate further investigation.

• Determining the levels of chemical contaminants in biological samples (serum) presently in storage;
• Continuing critical assessments of neurodevelopmental and behavioral deficits in newborns and children exposed in utero to low levels of chemical contaminants from maternal ingestion of contaminated sport-caught Great Lakes fish (early signs of diminished reflexes have been observed);
• Additional research to validate the association seen between alterations in male reproductive function and exposure to endocrine disrupting chemicals found in sport-caught Great Lakes fish;
• Additional research to validate the association seen between serum concentrations of PCBs detected in Great Lakes fish and nervous system function in older adult fish eaters (early signs of memory deficits have been observed);
• Completing efforts to elucidate key biomarkers for exposure (e.g., serum levels of contaminants), effect (delays in reproduction), and disease (reduced sperm count) to estimate risk to public health from contaminants in sport-caught Great Lakes fish; and
• Completing other studies examining the potential for health effects associated with consumption of contaminated Great Lakes fish in vulnerable populations including Native Americans, Asians, African Americans, Hispanic and other minorities.

Further cycles will also continue to follow the 10 cohorts in order to: validate earlier detected developmental, reproductive, and neurotoxic effects and monitor for emerging health issues not previously detected; continue outreach efforts and evaluate the efficacy of existing outreach efforts for safe fish consumption; complete analysis of biological samples; and analyze data and submit findings for publication.

Appropriated Funds

In fiscal year 2003, ATSDR received $82,261,800 million from Congress. The fiscal year 2003 projected funding level for the Great Lakes Program is $1.187 million.

ATSDR works with local, state (especially health departments), federal agencies, and the affected communities to develop culturally-appropriate risk communication messages about consuming contaminated fish. These risk communication messages and public health intervention methods take various forms, such as --

• organizing health fairs and public meetings,
• involving community and tribal representatives in focus groups to develop risk communication messages,
• providing workshops to demonstrate and share information on cooking practices to reduce exposures to toxic chemicals in fish,
• developing newsletters and other media material to distribute,
• educating health care providers about the potential for adverse health effects from consuming contaminated fish, and
• publishing findings in peer-reviewed journals.

By using various methods and working with multiple partners over time, ATSDR's Great Lakes Program is helping to reduce elevated body burden levels of toxic chemicals in vulnerable populations.

Mr. Hobson: I was surprised to read in your justification that more than 14 million people live within one mile of the 1,613 National Priority List (NPL) sites and 76 million live within four miles of hazardous waste sites. I am interested in any figures you may have on what percentage of those people are aware of their proximity to an NPL site, and what the ATSDR has available for the interested public. How many NPL sites are located in Ohio, and are there any in Ohio's 7th District?

Dr. Falk: In addition to the data provided above, ATSDR estimates that more than 1.7 million people live within one mile of the 371 sites that were assessed in fiscal year 2002. Of the sites assessed in ATSDR public health assessment documents, 28.5% were found to pose a public health hazard.

We do not have data on how many people are aware of their proximity to an NPL site. However, from our continued work with communities, we know that there is a great deal of community concern and, therefore, ATSDR has extensive information available for the interested public. ATSDR conducts a variety of community outreach and education activities to make the public aware of these resources. For example, ATSDR has produced numerous fact sheets that cover topics such as exposure, public health hazard categories, public health assessments, and community assistance panels to name a few. Many of these fact sheets are available on our web site in addition to printed copy. ATSDR has electronic search capabilities on its web site for anyone who is interested in finding out if any sites are in or near their community. Before issuing final public health assessments for NPL sites, ATSDR announces the availability of the report and provides the public an opportunity to comment, and frequently hosts public meetings in the community to explain findings and address questions and concerns. Public health assessment reports are available to the public in published format and in many cases electronically via the web. ATSDR also has published more than 200 Toxicological Profiles and ToxFAQs (Frequently Asked Questions) on hazardous substances most commonly found at NPL sites. Anyone interested in obtaining information from ATSDR can contact our toll-free information line (888-42-ATSDR).

There are currently 40 NPL sites in the State of Ohio. In Ohio's 7th District, there are three NPL sites. These sites are: Bowers Landfill (Circleville, Pickaway County), Lammers Barrel Factory (Beavercreek, Greene County), and Wright-Patterson Air Force Base (Fairborn, Greene County, and Dayton). ATSDR conducted a public health assessment for the Bowers Landfill in 1989. This site was found to pose an indeterminate public health hazard. Lammers Barrel Factory was recently added to the NPL. Now a vacant lot as a result of a fire in 1969, the facility formerly bought, reclaimed, and sold many types of solvents. The main concern is groundwater contamination with volatile organic compounds (VOCs) identified through sampling of soil, sediment, and groundwater (including residential wells). ATSDR is conducting a public health assessment and plans to release the first draft of the report in the fall of 2003. A health consultation conducted for this site in 1996 recommended the sampling of nearby private wells and determination of surface soil and groundwater contamination. ATSDR conducted a public health assessment at Wright-Patterson Air Force Base in 1999 and a health consultation there in 2000. Wright-Patterson Air Force Base (WPAFB) is an active military facility located between the cities of Fairborn and Dayton. In October of 1989, the United States Environmental Protection Agency placed WPAFB on the NPL because of the potential for hazardous substances in groundwater to contaminate drinking water supplies. Based on a review of the available information, ATSDR concluded in the public health assessment that WPAFB poses no apparent public health hazards.

ATSDR has worked at four other sites in Ohio's 7th District that are not listed on the NPL. The most recent activity has been at Yellow Springs Instruments (Yellow Springs, Greene County). ATSDR conducted a health consultation for this site in 2002. ATSDR also conducted a health consultation for the Armentrout Excavating site (Xenia, Greene County) in 1999. Other non-NPL sites in the district are: B & E Landfill (Wayne Township, Pickaway County); and Tremont City Landfill (Tremont City, Clark County).

This page last updated on May 1, 2003

Contact Name: Joanne Cox/ ATSDR-OpeaMail@cdc.gov

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