ATSDR in Partnership With North Carolina
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 an annual budget for 2003 of approximately $82 million. ATSDR is
responsible for assessing the presence and nature of health hazards at specific
Superfund sites, helping to prevent or reduce further exposure and illnesses
resulting from those hazards, and expanding 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 1989 through 2003, ATSDR awarded more than
$4.5 million—more
than
$415,000 in the last 2 years—in direct funds and services
to
North Carolina 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.
Thirty-one sites have been designated to the NPL in
North
Carolina.
A public health assessment is a written, comprehensive
evaluation of available data and information on 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 North Carolina,
has conducted 32 public health assessments in the state,
including the following recent examples.
Barber Orchard—Barber Orchard, west of
Waynesville, is a former commercial apple orchard. The site is now
being developed as a residential community.
During the orchard operation, pesticide mixtures were used to control
insects and rodents. These mixtures were delivered to trees using a
pressurized underground piping system. Product application, leakage of the
piping system, and spills during product mixing are thought to have led to
contamination of the groundwater and soil. Pesticides, arsenic, and lead
have been detected in site soils and in private drinking wells on the site.
In a public health assessment released in July 2002, ATSDR concluded that
current exposures to site contaminants are not likely to result in adverse
health effects. Residents are filtering their water to remove contaminants,
and connections to the municipal water supply will be available within 2
years. In addition, frequently used areas of residential lots with high
arsenic and lead soil levels have been cleaned up to safe levels.
ATSDR also did an exposure investigation at this site to look at lead and
arsenic levels in children and adults. No levels of health concern were
found.
Davis Park Road Trichloroethene (TCE)—The
Davis Park Road TCE site is in the southwestern part of Gastonia.
Groundwater at the site was contaminated with volatile organic compounds
(VOCs), including TCE and tetrachloroethene (PCE). These compounds
reportedly originated from contaminated soil behind a local auto repair
shop. Groundwater contamination was detected in private wells in the area,
so residents have been provided with filters for their private wells or have
been connected to the municipal water system.
In a public health assessment released in April 2002, ATSDR concluded that
the Davis Park Road TCE site does not pose a public health hazard at this
time. Residents are no longer drinking contaminated water, and levels of
contaminants in soil are too low to cause health effects. ATSDR considers
the site a past public health hazard: in the past, the maximum levels of TCE
detected in well water exceeded regulatory standards and could have
increased the risk for adverse health effects if that water was used for
drinking for many years. ATSDR provided the public with information on the
potential health concerns associated with their past exposure. Arsenic and
lead detected in site soils were present at levels too low to result in
health effects.
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, 61
documented health consultations have been conducted at 41 sites
in North Carolina, including the following recent examples.
Sigmon's Septic Tank Service Facility/Sigmon
Environmental Services—In June 2001, ATSDR received a request from
the U.S. Environmental Protection Agency to determine the public health
impact of Sigmon's Septic Tank Service Facility in Statesville
on private wells near it. In 2002, ATSDR released two health consultations
on this site.
In the health consultation released in March 2002, ATSDR reviewed
groundwater data. ATSDR concluded that the chemicals identified in seven of
the private wells surrounding the facility pose no apparent public health
hazard to area residents using them.
In the health consultation released in July 2002, ATSDR reviewed the surface
water data for the site. The surface water pathway is of concern because
tributaries near the site flow into two major recreational fishing waters,
the Catawba River and Lake Norman.
Furthermore, analytical results of surface water and sediment samples
collected by the North Carolina Superfund Section indicate
chemical releases into the surface water bodies near the site. These
analytical results may imply a potential for contamination of the biota
within the recreational fished waters.
The July 2002 health consultation concluded that the chemicals identified in
the nearby surface water features surrounding the facility pose no apparent
public health hazard to area residents because levels of chemical exposures
in the soil/sediment and surface water near the facility are well below
exposure levels known to cause adverse health effects. In addition, chemical
levels estimated in the edible tissue of sport fish assumed to exist in
surface water features near the facility do not pose a potential impact to
public health.
Weyerhaeuser Company—The North Carolina Department of
Health and Human Services (NCDHHS) modeled air
emissions of hydrogen sulfide from the Weyerhaeuser Company's pulp and paper
mill in Plymouth. NCDHHS provided ATSDR with the summary
results of the modeled results and asked ATSDR whether the data indicated a
potential public health hazard to residents in the communities surrounding
the facility.
In a health consultation released in October 2003, ATSDR concluded that
residents living around the Weyerhaeuser paper pulp mill may be exposed to
ambient air concentrations of hydrogen sulfide that exceed health-protective
levels recommended by NCDHHS and the North Carolina Scientific
Advisory Board. Modeled 24-hour hydrogen sulfide concentrations
also exceed ATSDR's acute minimal risk level for hydrogen sulfide.
Because no actual ambient air monitoring data were available, the
Weyerhaeuser pulp and paper mill was classified as an indeterminate public
health hazard. ATSDR recommended air monitoring in residential areas near
the facility to better define the ambient air concentrations of hydrogen
sulfide to which people are being exposed. ATSDR also recommended a review
of available information on potential releases of other site-related
chemicals from nonprocess sources at the facility (e.g., the wastewater
treatment plant) to determine whether off-site ambient air monitoring for
other site-related chemicals is indicated.
Salisbury—ATSDR is involved with two petition sites in
Salisbury: APAC Carolina Inc. Hot Mix Asphalt and Associated
Asphalt, a liquid asphalt storage and distribution facility. These sites
have emissions of hydrogen sulfide; benzene, toluene, ethylbenzene, and
xylene; VOCs; and polycyclic aromatic hydrocarbons. In addition, local
residents have odor complaints about the sites, and groundwater at the sites
is contaminated.
ATSDR has agreed to write a health consultation on these sites and is
working with local residents and state and county health officials.
Health Education and Community Activities
As part of its ongoing outreach activities in affected communities, ATSDR
takes proactive steps to involve communities in identifying their health
concerns and developing actions to address them. An example of this type of
involvement in North Carolina follows.
Through a national cooperative agreement with the Migrant
Clinicians Network (MCN), ATSDR provides assistance to health care providers
working with migrant and seasonal farm workers. MCN, the second-largest
clinical network in the nation, brings together clinicians from various
professions to meet the needs of migrant and seasonal farm workers. MCN
members in North Carolina are Blue Ridge Community Health Services, Inc. (Hendersonville);
Goshen Medical Center, Inc. (Faison); Kinston Community
Health Center (Kinston); Piedmont Health Services, Inc. (Chapel
Hill); Tri-County Community Health Center (Newton Grove);
and North Carolina Primary Health Care Association (Cary).
Health Studies
Health studies are investigations conducted 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 are
examples of health studies or investigations that ATSDR conducted or supported
in North Carolina.
Hazardous Substances Emergency Events Surveillance
System (HSEES)—HSEES was established by ATSDR in
1990 to collect and analyze information about releases of hazardous
substances that need to be cleaned up or neutralized according to federal,
state, or local law, as well as threatened releases that result in a public
health action, such as an evacuation. The goal of HSEES is to reduce the
morbidity and mortality of first responders, employees, and the general
public resulting from hazardous substances emergencies. Fifteen state health
departments, including North Carolina, currently
participate in HSEES. HSEES captures data on more than 8,000 events
annually. Of these events, 80% occur at fixed facilities, and 20% are
transportation-related events. Most events occur between 8:00 AM and 5:00
PM, Monday through Friday. People most often injured are employees.
Exposure to VOCs in Drinking Water and Specific Birth Defects and
Childhood Cancers—The overall objective of this study is to examine
the associations between 1) maternal exposures within a 1-year period before
the child's birth to TCE and PCE in drinking water at Camp Lejeune
during 1968-1985 and 2) risk for specific birth defects and childhood
leukemia in offspring. These birth defects include neural tube defects
(e.g., anencephaly and spina bifida) and oral clefts (e.g., cleft lip with
and without cleft palate and cleft palate). The results of the planned study
will address the recommendation made in ATSDR's 1997 health assessment of
the U.S. Marine Corps Base Camp Lejeune that an epidemiologic study be
considered to determine whether mothers exposed to VOCs in drinking water
during their pregnancies were at higher risk for giving birth to a child
with health problems such as a birth defect or a childhood cancer. ATSDR
will publish a final report of the study, and it will be distributed to the
general public. Because of the geographic dispersion of participants,
results of the study will be distributed via the Web and may include a Web
broadcast.
In response to the public health assessment recommendation, ATSDR began the
multistep process of determining the appropriateness of conducting an
epidemiologic study of specific childhood cancers and birth defects at Camp
Lejeune. ATSDR surveyed by telephone the parents of 12,598 eligible children
born to women who were pregnant with them while living on the base during
1968-1985. The number of parents surveyed was about 80% of the estimated
total number who were pregnant while living on base during this time. The
year 1968 is the starting point, because that year North Carolina began
computerizing its birth records. The end point is 1985, because the tainted
wells were shut down that year. Parents were asked whether the child had a
birth defect or had developed a childhood cancer. ATSDR has finished the
survey and is now confirming the cases. All of the participants who took
part in the Camp Lejeune survey in 1999-2002 gave permission to be contacted
for future studies.
Environmental Exposure to Diisocyanate—The North
Carolina Division of Public Health's Occupational and Environmental
Epidemiology Branch, through a cooperative agreement with ATSDR, is
studying the possibility of diisocyanate exposures in communities residing
near facilities that use these compounds. The study involves a stepwise
approach of air monitoring and sampling, questionnaire administration, and
blood testing for diisocyanate antibodies in people living within a quarter
mile of a facility. If air monitoring does not indicate the presence of
diisocyanate in residential air, another community near another facility
will be selected. Four communities near facilities, along with four
comparison communities, will be tested. Comparison communities are selected
on the basis of socioeconomic, race, and percent homeownership factors.
North Carolina and ATSDR are working cooperatively with county health
departments, the facility, and the American Chemical Society's Diisocyanate
Panel. Air monitoring began around the first facility in early November
2003.
Research
In 1997, ATSDR awarded cooperative agreement funds to five universities to
conduct research to assess health risk after exposure to mixtures of
environmental chemicals. Results of this research will enable ATSDR to conduct
toxicity assessments of chemical mixtures that affect public health; study the
behavior of chemical mixtures; identify various end points that would be
affected; evaluate target organs that could be affected; study the mechanisms of
action, initiation, progression, and repair of injury; identify biomarkers to
determine the health of an organism; and develop qualitative and quantitative
methods to assess multiple health effects.
The purpose of the research of
North Carolina State University,
one of the awardees, was to develop an experimental, computational approach to
assess the absorption of toxic chemicals through the skin after topical
exposures to complex chemical mixtures. This study investigated the influence of
various components of a mixture that can alter their rate and extent of
penetration and absorption through the skin.
Association of Occupational and Environmental Clinics
Through a national cooperative agreement with the Association of Occupational
and Environmental Clinics (AOEC), ATSDR supports one occupational and
environmental health programs in
North Carolina. 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
North Carolina
is the
Duke University Medical Center Division of Occupational and
Environmental Medicine.
January 2004