ATSDR in Partnership With Georgia
The Agency for Toxic Substances and Disease Registry (ATSDR) is the lead
public health agency responsible for implementing the health-related provisions
of the Comprehensive Environmental Response, Compensation, and Liability Act of
1980 (CERCLA). ATSDR is an Atlanta-based federal agency with more than 400
employees and a budget for 2004 of approximately $73 million. ATSDR assesses the
presence and nature of health hazards at specific Superfund sites, helps to
prevent or reduce further exposure and illnesses resulting from those hazards,
and expands the knowledge base about the health effects of exposure to hazardous
substances.
ATSDR works closely with state agencies to carry out its mission to serve the
public by using the best science, taking responsive public health actions, and
providing trusted health information to prevent harmful exposures and disease
related to toxic substances. ATSDR provides funding and technical assistance to
states and other partners through cooperative agreements and grants to identify
and evaluate environmental health threats to communities. These resources enable
state and local health departments and other grantees to further investigate
environmental health concerns and to educate communities. From
fiscal
years 1990 through 2003, ATSDR awarded more than
$11.2 million—more
than
$1.1 million in the last 2 years-in direct funds and
services to
Georgia for comprehensive support of its
environmental health unit. In addition to direct funds and services, ATSDR staff
provides technical and administrative guidance for state-conducted site
activities.
ATSDR Site-Specific Activities
Public Health Assessment-Related Activities
One of the agency's important mandates is to conduct
public health
assessments of all National Priorities List (NPL) sites and of other
sites where a significant threat to public health might exist.
Nineteen
sites have been designated to the NPL in
Georgia.
A public health assessment is a written, comprehensive
evaluation of available data and information about the release of hazardous
substances into the environment in a specific geographic area. Such releases are
assessed for current or future impact on public health. ATSDR, in collaboration
with public health and environmental officials from Georgia,
has conducted 37 public health assessments in the state,
including the following recent example.
Terry Creek—In a public health assessment
released in August 2002, ATSDR evaluated the public health importance of the
Terry Creek Dredge Spoil Areas/Hercules Outfall in Brunswick.
The Hercules manufacturing plant produced toxaphene, a polychlorinated
camphene (PCC) insecticide. In 1972, discharges of this kind of insecticide
were restricted in Hercules wastewater. Since then, PCC concentrations in
environmental samples (e.g., sediment and fish) have decreased
significantly. Both Terry Creek and nearby Dupree Creek are used for fishing
and crabbing.
Seafood consumption is the main source of toxaphene exposure for people at
and near the site. Components of technical-grade toxaphene, its breakdown
products, or both have been detected in edible fish from Dupree and Terry
creeks. Information about quantitative determinations of PCC residues in
seafood from the Terry Creek area is needed. Because these data are lacking,
ATSDR classified this site as an indeterminate public health hazard.
ATSDR will reevaluate the health hazard at this site when new data become
available. New data on fish will be assessed in a health consultation
scheduled for release after this public health assessment.
ATSDR recommends further evaluation of air quality in the general area of
Brunswick, particularly with respect to potential carcinogens and
respiratory irritants.
A health consultation is a written or oral response from
ATSDR to a specific request for information about health risks related to a
specific site, chemical release, or hazardous material. A health consultation is
a more limited response than a public health assessment is. To date, 131
documented health consultations have been conducted at 70 sites
in Georgia, including the following recent example.
Northside Drive Area Lead Investigation—The
U.S. Environmental Protection Agency (EPA) asked the Georgia
Division of Public Health (GDPH), an ATSDR
cooperative agreement recipient, to review soil-sampling data to determine
whether lead concentrations measured in soil posed a health hazard to
residents living in specific neighborhoods near Northside Drive in
Atlanta. GDPH also was asked to provide health education to
residents about potential health effects of exposure to lead in soil,
including testing blood lead levels of children and ways to reduce and
eliminate exposure to lead in soil and other sources.
In 2001, EPA began to investigate the levels of lead in residential yards
within an approximate 1-mile radius of two facilities that have been a
source of lead contamination for residents in the surrounding neighborhoods
since 1901. Lead levels found in soil in some yards were elevated. However,
additional sampling needs to be conducted to characterize the full extent of
contamination. Most homes in the area have substantial ground cover that
would minimize the potential for direct exposure to contaminated soil;
however, repeated exposure to lead-contaminated soil and from other sources
could result in higher exposures than what is considered safe.
As a result, EPA began excavating contaminated soil from the area in
November 2003. GDPH coordinated a blood lead testing program for children in
the area, and no elevated blood lead levels have been reported. Blood
testing will continue to be offered during the remediation phase of the EPA
investigation. In addition, GDPH continues to provide health education to
residents about lead exposure, including ways to reduce and eliminate
exposure to lead in soil and other sources.
GDPH concluded that this site poses a past and current public health hazard
to children because evidence exists that exposures to lead-contaminated soil
have occurred, are occurring, and are likely to occur until remediation is
complete. The full extent of lead contamination in soil has not been
determined; additional sampling is needed to determine the number of
residences affected. Removal of lead-contaminated soil is a prudent public
health action and will eliminate a future exposure pathway. In fall 2003,
EPA began ongoing removal that will eliminate the potential for future
exposure to lead-contaminated soil in the area.
An exposure investigation collects information about
specific human exposures through biologic sampling, personal monitoring, related
environmental assessment, and exposure-dose reconstruction. Following is an
example of an exposure investigation conducted in Georgia.
Newtown Community—The purpose of this
exposure investigation released in October 2000 was to determine whether
residents of the Newtown community in Gainesville are being
exposed to airborne volatile organic compounds (VOCs) at levels of public
health concern and whether the soils of the Newtown public park contain
heavy metals at levels of public health concern.
Newtown is a residential area in a highly industrialized section in
southeastern Gainesville. Within 3 miles of the community are 14 facilities
required to report to the EPA Toxic Release Inventory (TRI), and 56
businesses that are regulated by EPA because they handle, store, or use
hazardous materials. TRI data reveal that several tons of VOCs are released
into the air near the Newtown community.
ATSDR accepted a petition for a public health assessment at this site. To
assist with the public health assessment, ATSDR conducted an exposure
investigation in the community for VOCs in the air and metals in the soil of
the park.
The public health assessment concluded that the concentrations of VOCs
detected in ambient air do not pose a public health hazard. In addition, the
concentrations of heavy metals detected in the soil of the playground do not
pose a public health hazard.
Health Education and Community Activities
Georgia has participated in ATSDR's cooperative agreement
program since 1995. Under this program, GDPH has received
funding and technical assistance to develop community education and activities
associated with human exposure to hazardous substances in the environment.
During fiscal year 2003, the GDPH Chemical Hazards Program (CHP)
published region-specific brochures to increase knowledge
about fish and seafood consumption advisories. This was part of a
comprehensive campaign to promote good health practices, such as avoiding
excess amounts of contaminated species while encouraging fish consumption
through nutrition education. Also, CHP worked with the Georgia
Department of Natural Resources and the University of
Georgia Cooperative Extension Service to develop, evaluate,
publish, and distribute brochures for women of childbearing age. These
brochures contain site-specific consumption guidelines for both sport fish
and commercial fish. Before publishing the brochures, an extensive
evaluation process was instituted to receive and measure impact of the
brochures.
published the Chemical Hazards Reference Guide for district and
county environmental health staff and the public. The 55-page guide contains
both general information about CHP as well as specifics about hazardous
materials exposures, contact information, and other multiagency resources
for sites, fish consumption advisories, chemical facts, and more.
published and distributed site-specific health education materials in
support of the Northside Drive Area Lead Investigation, CSX Signal Shop, VC
Chemicals, and Locust Grove Mercury Spill sites. These materials contained
information about conducting a health consultation and
media/chemical-specific fact sheets that were established as templates.
These materials can be customized for health education activities associated
with future health consultations and public health assessments.
Health Studies
Health studies are investigations to determine the relations between
exposures to hazardous substances and adverse health effects. Health studies
also define health problems that require further investigation through, for
example, health surveillance or an epidemiologic study. Following is an example
of a health study or investigation that ATSDR conducted or supported in
Georgia.
Case Series Study, Basket Creek—The Basket
Creek Surface Impoundment and Drum Disposal sites are in a rural residential
area in Douglasville. The impoundment contains an unknown amount of waste
oils, solvents, unsaturated amines, glycols, and aromatic compounds that
were reportedly dumped into the impoundment between 1975 and 1976. People
living adjacent to these two sites had expressed concern that health
complaints were related to exposure to these sites. Thirty-seven persons
were examined and biological specimens collected. Although some participants
had health problems, the examining physicians did not link any of these
problems to environmental exposures. However, testing to determine exposures
to hazardous chemicals detected higher than expected blood levels of
methylene chloride in 20 of the 34 persons who had lived near the site.
Also, some other chemicals not usually found in nonoccupationally exposed
persons were found among 14 of the 23 persons who still lived near the site.
Results were provided to each participant. Residents with any questionable
or abnormal test results were counseled or referred to personal doctors for
appropriate medical followup. ATSDR also prepared a summary report of this
case series.
Association of Occupational and Environmental Clinics
Through a national cooperative agreement with the Association of Occupational
and Environmental Clinics (AOEC), ATSDR supports an occupational and
environmental health program in
Georgia. This support is
provided to improve education and communication related to surveillance,
diagnosis, treatment, and prevention of illness or injury related to exposure to
hazardous substances. The member institution in Georgia is the
Center
for Rehabilitation Medicine in
Atlanta. Eight staff
physicians with specialties in five areas provide a broad range of services to
patients and to other physicians throughout the southeastern United States.
Since 1998, ATSDR has funded AOEC to support a project establishing Pediatric
Environmental Health Specialty Units (PEHSUs) as a national resource for
pediatricians, other health care providers, federal staff, and the public. The
PEHSUs develop materials and train health professionals and public health
officials on environmental health issues and their impact on children's health.
The PEHSU for Alabama, Florida,
Georgia, Kentucky, Mississippi,
North Carolina, South Carolina, and Tennessee is the
Southeast Pediatric
Environmental Health Specialty Unit at
Emory University
in
Atlanta. The PEHSU provides medical education and training,
telephone consultation, and clinical specialty referral for children who may
have been exposed to environmental hazards. Established in 1999 as a regional
center for pediatric environmental health, the unit links the
Department
of Environmental and Occupational Health in the
Rollins School
of Public Health, the
Department of Pediatrics in the School of
Medicine, the
Georgia Poison Control Center, the
Marcus Institute, and a variety of other Emory-affiliated clinical
facilities, including
Children's Health Care of Atlanta and the
Hughes Spalding Children's Hospital.
Minority Health Professions Foundation Research Program
The Minority Health Professions Foundation (MHPF) Program supplements the
substance-specific information needs of the public and the scientific community
and supplies necessary information for conducting comprehensive public health
assessments of hazardous waste sites. The program addresses ATSDR's goals to
ascertain the relations between exposure to toxic substances and disease and to
build and enhance effective partnerships. The purpose of the MHPF Program is to
initiate research to fill ATSDR-identified data needs for priority hazardous
substances and to enhance existing disciplinary capacities to conduct research
in environmental health at MHPF member institutions, one of which is the
Morehouse School of Medicine in
Atlanta.
Morehouse participates in ATSDR's Environmental Medicine and Toxicology
Rotation Program. This program is a health education project to implement and
evaluate a didactic research and practice program for physicians in training to
promote the initial recognition, control, and prevention of toxic exposures and
environmental hazards to humans. The program also will provide Morehouse
physician consulting for ATSDR activities related to health disparities.
Poisoning From Maternal-Infant
Relationship Through Early Childhood—A prevalence study was conducted to
determine the distribution of blood lead levels in minority children in
Atlanta. The relation between the blood lead levels in the children
tested and lead levels in the soil, water, paint, and dust in and around
their households was examined. A second study, which is hospital based, was
designed to determine whether harmful effects result from the long-term
exposures to lead at the low levels now present in the environment.
Results from these studies indicated that approximately two thirds of homes
tested have at least one environmental medium that exceeds the acceptable
limits for lead. Children living in these homes tended to have higher blood
lead levels than did children in homes without elevated levels of
environmental lead. Blood lead levels in children from this subset of homes
generally ranged between 4 and 10 micrograms of lead per deciliter of blood
(µg/dL). These levels are below levels believed to indicate lead poisoning;
however, infant behavioral studies have shown that infants born to mothers
with prenatal blood lead levels 2.5-10 µg/dL demonstrated differences in
neonatal behavior in the areas of motor maturity, general tonus, and
hand-to-mouth activities. These infants also demonstrated more tremors and
defensive movements than did infants born to mothers with prenatal blood
lead levels below 2.5 µg/dL.
February 2004