How a local health department in Colorado got involved in regulatory oversight of a $2.4 billion dollar Superfund Cleanup Program the Rocky Mountain Arsenal (RMA) that is now transitioned into Wildlife Refuge and has led to other related projects.

The RMA was established by the Army in 1942 as an industrial complex to manufacture chemical weapons for use during World War II. The 27 square mile site is located 10 miles northeast of downtown Denver. The Army used the site to manufacture mustard gas, napalm and sarin nerve gas. During the1950’s through 1970’s Shell Chemical Company leased the site to manufacture pesticides.

Over the 40-year use of the site as a production facility a variety of waste disposal means were utilized including unlined solid waste disposal trenches, lined and unlined evaporation lagoons, piping leaks, accidental spills and un-permitted landfills that led to contamination of structures, soils and groundwater on a large scale. In 1982, all manufacturing activities ceased and in 1987, the EPA listed the Arsenal as a Superfund cleanup site. Tri-County Health Department (TCHD), which serves Adams, Arapahoe and Douglas Counties, along with the EPA and State of Colorado provide regulatory oversight of the cleanup program.

Today, over 30 years later, all of the major cleanup is completed (except for groundwater) with the waste contained in on-site landfills and consolidation areas. As the soil/surface cleanup was nearing completion, the Regulatory Agencies collaborated with the PRP’s to develop long-term monitoring strategies to verify continued protectiveness of the remedy. The Regulatory Agencies continue to monitor the two hazardous waste landfills, over 773-acres of integrated covers, and on-post and off-post groundwater systems. Tri-County has also played an integral role as liaison with the surrounding communities in the development of the Arsenal’s remediation program, cleanup designs and transition into a National Wildlife Refuge.

TCHD has continuing responsibility for remedy and groundwater cleanup verification activities. To this day, the RMA and Regulatory Agencies continue to have an active community involvement and outreach programs.

As a result of TCHD’s involvement at RMA, other opportunities have arisen that has allowed TCHD to be involved in performing oversight on various landfills throughout the TCHD jurisdiction and also serve to protect the community interests on these projects. In addition, TCHD has become involved with the Army and the local water agency on the investigation of an emerging groundwater contaminant 1,4-Dioxane. These are examples of other activities that have availed themselves through TCHD’s involvement/experience with the RMA project.

Not Your Average Waste: Local Health Department’s Initiative on Household Medical and Hazardous Waste [POSTER]

In July of 2012, new legislation in Massachusetts was instilled (regulation 105 CMR 480.000) to regulate disposal of medical waste in household garbage and increase communication on the hazards of handling all waste types.

State laws guide local health departments on how to regulate hazardous and medical waste within each town. Medical waste consists of materials like old prescription medication, sharps (e.g. needles and lancets), and medical devices (e.g. IV bags). Health departments have previously enacted drop off sites for sharps, supplied public health nurses to aid in waste collection, or instilled mechanical kiosks to aid in the collection of medical waste. In many of these instances, untrained and unknowledgeable public health employees are handling medical waste. Other forms of hazardous waste, such as mercury containing devices (barometers, thermometers, bulbs and other instruments), are collected at satellite locations, and also handled by untrained personnel. The focus of this project was to create a manual that would educate and provide models of programs in which medical and other hazardous wastes are safely collected and disposed of for the town of Lexington, MA. For mercury waste, a fact sheet was created to outline a “no brainer” approach for handling and disposing of mercury contaminated waste.

The documents were intended to help inform individuals on how to handle and dispose of waste, and learn about what constitutes as hazardous and medical waste. For other household hazardous waste, such as oil-based paints, house cleaners, batteries, pesticides and oil, previously instilled collection days were continued; on these collection days, a contracted vendor comes to town and properly collects and disposes of these waste streams. The newly generated manuals and fact sheets were shown to residents on these collection days, and feedback was used to make the documents more user-friendly. The medical waste disposal manual, fact sheet for disposing of items containing mercury, and the poster presenting this work were all supported by the Massachusetts Environmental Health Association.

Take Back - Take Where? API Disposal Dilemma

Health care providers practice with the commitment to First Do No Harm. The reality is that this requires an additional commitment to the precautionary principle, for harm turns out to be much more complex an issue than maltreatment of an individual patient. The presentation will focus on what is known and unknown about Active Pharmaceutical Ingredients (APIs) found in the water and the efficacy of different drug disposal methods, including discussion of a life-cycle analysis of three different methods of household drug disposal recommended by the federal government. Currently the national effort has been focused on take-back programs that have the dual purpose of reducing the epidemic of abuse of prescription drugs and the “safe” disposal through collection and incineration. Unfortunately there is no conclusive evidence that this approach will lessen the human health, environmental health risks and impacts and it may increase societal costs. Since 2008, when the AP published a series of articles about APIs found in drinking water, public concern over this issue has escalated. There is a role for health care systems and health care professionals to begin to look at more sustainable ways to manage human health and environmental risks posed by the improper disposal of unused medications.

A recent life cycle analysis of three disposal methods for unused pharmaceuticals concluded that trash disposal of pharmaceuticals in the home would have the least environmental footprint when compared with tack-back programs with an end-point of incineration and/or disposal to the sewer. Further discussion is needed.

Superfund Human Health Risk Assessment: Unpacking the "Black Box"

This seminar will provide participants with a basic introduction to the fundamental concepts and terminology associated with risk assessments, specifically as they relate to human health and the Superfund Remedial Program. A simplified basic risk assessment case study will be presented to offer participants a better understanding of processes that occur within the "black box" of risk assessment. This seminar will also discuss the relationship between the basic risk-assessment process, and risk management, and conclude with a discussion on where risk assessment fits in the Superfund pipeline.

Disaster Debris Management - Lessons learned from the March 2011 Great East Japan Earthquake and Tsunami

On March 11, 2011 at approximately 2:45 PM, a 9.0 earthquake occurred in the Pacific Ocean off the coast of Japan’s Tohoku region. Thirty minutes later, a Tsunami wave of unprecedented force broke over 650 kilometers of coastline, toppling sea walls and other defenses, flooding more than 500 km² of land, and washing away entire villages and towns. The devastation left some 20,000 people dead or missing with most of the deaths caused by drowning. The tsunami leveled 130,000 houses and severely damaged 260,000 more. About 270 railway lines ceased operation immediately following the disaster, and 15 expressways, 69 national highways, and 638 prefecture and municipal roads were closed. Some 240 hectares of agricultural land were flooded. The worst areas hit were the northern provinces of Fukushima, Iwate and Miyagi prefectures.

The Great East Japan Earthquake was the first disaster ever recorded that included an earthquake, a tsunami, a nuclear power plant accident, a power supply failure, and a large-scale disruption of supply chains. The estimated economic damaged is expected to be over $210 billion, with more than 31.2 million tons of debris being processed by July 2012, and expected to continue through 2014. The Japanese government quickly mobilized its resources, fast tracked the bidding process (3-4 months) and issued contracts to begin processing debris within 6 months! As of September 2012, 23 primary yards in the northern prefectures were established to collect debris and then transport that debris to the 170-acre secondary yard in Ishinomaki to make the debris ready to send for final disposal. The debris is sorted and processed for recyclables (wood, plastics, paper, etc.), checked for hazardous materials/wastes, metals (cars, refrigerators, etc.), and eventually combustible materials are sent to the incineration units while non-combustibles are cleaned and re-used, or sent to landfill.

The scope and magnitude of the operation is something to be seen (the largest outdoor Municipal Recycling Facility in the world), and with pictures and my first-hand view of the operations, I hope to be able to bring my experiences to others and prepare them in future disaster risk management planning.

The Dairy-Air: Exposure Investigation of Environmental Monitoring for Formaldehyde at Vermont Farm Manure Sites

The Agency for Toxic Substances and Disease Registry (ATSDR), in cooperation with the Vermont Department of Health (VDH) and the Vermont Agency for Agriculture, Food and Markets (VAAFM) conducted an Exposure Investigation for formaldehyde exposure at Vermont farm manure sites in the Spring of 2012. The Exposure Investigation was initiated by a petition to ATSDR from local residents who expressed concern that exposure to fugitive formaldehyde emissions from the manure pits was contributing to their adverse health effects.

Some dairy farms in Vermont use solutions of formaldehyde as a footbath to treat hairy heel wart disease in cows. The waste footbath solution is then discharged into manure pits on the farms and the manure from the pit is used to spray on fields where corn and hay are grown. To investigate if people’s health could be affected by exposure to formaldehyde from these operations, ATSDR along with VDH and VAAFM collected indoor and outdoor air concentrations of formaldehyde at two locations in Franklin County Vermont for one month.

This presentation will first describe how the agencies became involved with this topic and give an overview of the practice and extent of formaldehyde use in dairy farms is across the United States. Next, the Exposure Investigation process will be described and results will be explained. Finally, lessons learned during the project will be discussed and the positive impact of multi-agency collaboration will be highlighted.

Cancer Risk Disparities from Air Toxics: A South Carolina Assessment [POSTER]

Background: Populations of color and low-income communities are often disproportionately burdened by exposures to various environmental contaminants, including air pollution. Some air pollutants have carcinogenic properties which are particularly problematic in South Carolina (SC), a state that consistently has high rates of cancer mortality for all sites. The purpose of this study was to assess the impact of sociodemographic factors on estimated cancer risk associated with air toxics in SC with a particular focus on comparing differences in cancer risk in urban and rural areas.

Methods: The U.S. Environmental Protection Agency’s National Air Toxics Assessment (NATA) risk data for varying risk categories were linked by tract ID and analyzed with demographic variables from the 2000 census using R. The average change in cancer risk from all sources by demographic variable was quantified using simple linear regression. Spatial methods were employed using ArcGIS 10 to assess the distribution of all source risk at the census tract level. The relative risk estimates of high cancer risk from all sources and their 95% confidence intervals (CIs) were calculated between the first quartile and later three quartiles while the variance in the percentage of high cancer risk between quartile groups was tested using Pearson’s chi-square.

Results: The average total cancer risk was 26.8 ppl/million. The risk from on-road sources was significantly higher than the risk from other sources (excluding background risk). The percentage of African-Americans with less than a high school diploma and percentage of urban area explained 49% of the variation in cancer risk. Within urban areas (100% urban), a one percent increase in African-Americans increased cancer risk by 0.12 ppl/million which became 6 times higher after accounting for all areas (0.021 ppl/million, rural and urban areas combined).

Conclusion: Based on our findings, there are substantial disparities in cancer risk within SC that are mostly attributable to on-road and area sources. Areas that had predominately urban landscapes or were mostly composed of African American populations had disparities in cancer risk which implies that cancer prevention efforts should focus on how to reduce mobile and area emissions in non-White and urban communities.

Smog in the Classroom: Power Plant Emissions, Pediatric Asthma, and School Attendance – A New Strategy

Adverse educational outcomes have been repeatedly linked to recurring school absenteeism, which are exacerbated by chronic illness. Asthma is the most prevalent pediatric chronic illness and is the leading cause of health-related school absenteeism. This study seeks to understand the impacts of coal power plant emissions on asthma aggravation and resulting school absenteeism. Data from a unique, nationally administered pediatric asthma survey are combined with power plant emissions information to estimate the emissions’ impacts on school absenteeism by asthmatic children. These particular data (confidential Behavioral Risk Factor Surveillance System asthma module) have never been exploited in this way, and present a novel large scale investigation into environmental impacts on educational outcomes through air quality. Exogenous wind pattern information and structural corrections for selection bias are used to identify households affected by emissions. Empirical results show a robustly positive relationship between power plant emissions and asthma induced school absences. Moreover, we show that without appropriate identification and controls for self-selection, effects of coal power plant emissions on school absenteeism are underestimated.

This methodology controls for important exogenous factors in a way that is especially useful to researchers who lack easy access to certain detailed information, such as monitor data and power plant characteristics on a national scale, and this presentation explores the ways researchers with limited resources can test hypotheses in an efficient, yet empirically robust, way. Participants will be encouraged to share their views on the burden of data accessibility in their line of work and the feasibility of implementing the methodology presented here. The NEHA community can provide insight on the validity of this approach in various public health and experimental settings as well as suggesting extensions to fields the presenters are unfamiliar with.

Successful Means of Managing Indoor Air Quality Concerns: The Start to Finish Approach

Do you spend your days responding to indoor air quality concerns, wondering whether or not they are in fact legitimate? Do you rack your brain trying to think of the best way to approach the concerns and what strategy to use? It can be very tricky to manage indoor air quality concerns, especially when there are so many moving parts to buildings, when there are so many types of personalities that can be involved, and the sensitivity that some of the concerns present. It is critical to be knowledgeable about the various types of concerns that may occur, what symptoms can be associated with the various IAQ issues, what the proper steps are to mitigate each type of issue, and most importantly, how to relate to and manage the individuals that are concerned. It is critical to maintain the people aspect during these investigations, and at the same time, to be able to decipher legitimate concerns vs. those that are being expressed because of ulterior motives. During our presentation, we will aim to help those in attendance to be able to use the proper investigative techniques, effectively analyze any available information, and to be able to decipher information obtained through interviewing those involved with the concern.

Environmental Health Problems of Urbanization in Nigeria, a case study of Jos the capital city of Plateau state, Nigeria

Urbanization is the transformation of rural areas into towns or cities. This process involves a lot of changes which in turn can affect the lives of the inhabitants of that settlement. This write up is centered on the environmental health problem of urbanization in Nigeria with a case study of Jos the capital city of Plateau state. Plateau state is one of the 36 states in Nigeria. It is situated in the North-central Geo-political Zone and is located in the middle-belt zone and lies within latitude 80022 and 100024 North and longitude 80032 and 100038 east. The state has a total landmass of 26,899sqkm with an approximated population of about 3 million people, while Jos the capital city has an approximate population of 490,471 (2006 Nigerian census) with a total land mass of about1, 695sqm the environmental health problems of urbanization in Nigeria with a case study of Jos can be classified into three main problems as follows- physical, biological, and social problems. These problems include poor and ill ventilated housing, poor waste management and poor road network, poor sources of drinking water, industrialization and improper sewage management. All these problems are accompanied with the following diseases: typhoid fever, malaria, dysentery, diarrhea, meningitis, hepatitis, sexually transmitted diseases, malnutrition, conflict and crises to mention a few. These problems can be managed properly by the government, civil society organizations, and communities. Solid waste and sewage can be managed well by Government and the relevant agencies that deal with related health and social issues.

TakeawayTM is no way to do a take back. [POSTER]

The presence of pharmaceuticals and active pharmaceutical ingredients (APIs) in water is an escalating concern among environmental and public health officials. In the past this issue has conflicted with public health policy makers’ concerns about how unused, unwanted, or expired medication collections can impede efforts to combat drug diversion. Consumers can potentially help divert medications and their APIs from entering water sources by buying and utilizing TakeAwayTM Environmental Return System envelopes made by Sharps Compliance, Inc. The researchers considered how these envelopes are a possible option for medication disposal by identifying the availability of the TakeAway envelopes in different pharmacies, exploring what happens to non-controlled and controlled medications when they are mailed back, and assessing pharmacists’ knowledge and attitudes regarding mail-back envelopes and medication disposal. Using qualitative and quantitative methods, the researchers conducted a pilot study in the Philadelphia region. The researchers found the envelopes are not widely available among community pharmacies where consumers can fill prescriptions; within a one-month period, 85% of surveyed pharmacists reported that five or less people inquired about medication disposal; and of those that sold the envelopes, most did not sell any TakeAwayTM envelopes. When tracking what happens to the unwanted medications within Sharps Compliance, non-controlled medications are processed using a patented Waste Conversion Process, but this process is not clearly detailed. Although controlled substance are not to be mailed, representatives from the company could not detail what happens to the controlled substances in the case that they are included in the envelopes. With limited availability, cost to consumers, and lack of acceptance of controlled substances, the researchers conclude that the TakeAwayTM envelopes are no panacea for medication disposal or diversion.