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Division of Health Education and Promotion
and
Agency for Toxic Substances and Disease Registry Agency for Toxic Substances and Disease Registry (ATSDR)(ATSDR)
Dean S. Seneca, MPH, MCURP, Health Scientist Policy, Tribal Portfolio, Portfolio Management Program, Office of the Chief of Public Health Practice, Centers for Disease Control
and Prevention
Tribal Environmental Health Education ProgramTribal Environmental Health Education Program
ATSDR’s MissionATSDR’s Mission
““To serve the public by using the To serve the public by using the best science, taking responsive public best science, taking responsive public health actions, and providing trusted health actions, and providing trusted health information to prevent harmful health information to prevent harmful exposures and disease related to exposures and disease related to toxic substances.”toxic substances.”
ATSDR Regional OfficesATSDR Regional Offices
Mandated FunctionsMandated Functions ATSDR is directed by ATSDR is directed by congressional mandatecongressional mandate to to
perform specific functions about the public health perform specific functions about the public health effects of hazardous substances in the effects of hazardous substances in the environment. These functions include:environment. These functions include: public health assessments and consultationspublic health assessments and consultations health surveillance and registrieshealth surveillance and registries response to emergency releases response to emergency releases applied research applied research education and trainingeducation and training
What Does ATSDR Do?What Does ATSDR Do?Determines the extent of danger to public Determines the extent of danger to public
health from hazardous substanceshealth from hazardous substancesProvides and explains results of evaluations, Provides and explains results of evaluations,
medical consultations, and investigations to medical consultations, and investigations to communities and tribescommunities and tribes
Provides environmental health education to Provides environmental health education to health care providers, communities, and health care providers, communities, and tribestribes
Conducts periodic surveys and screeningConducts periodic surveys and screening
ATSDR Does NotATSDR Does NotConduct large-scale site-related Conduct large-scale site-related
environmental sampling environmental sampling Enforce regulationsEnforce regulationsProvide medical treatment and health care Provide medical treatment and health care
servicesservices
Office of Tribal Affairs (OTA)Office of Tribal Affairs (OTA)Provides a point of contact for tribes to Provides a point of contact for tribes to
access ATSDR and its environmental public access ATSDR and its environmental public health programs health programs
Ensures availability of staff to help others Ensures availability of staff to help others within the agency coordinate effectively with within the agency coordinate effectively with tribestribes
Office of Tribal Affairs (OTA)Office of Tribal Affairs (OTA)
Four Key Services:Four Key Services:
1. Serves as a central conduit for tribes to 1. Serves as a central conduit for tribes to access agency programs and servicesaccess agency programs and services
2.2. Assists ATSDR in responding to Assists ATSDR in responding to presidential executive orders and federal presidential executive orders and federal mandates concerning tribesmandates concerning tribes
Office of Tribal Affairs (OTA)Office of Tribal Affairs (OTA)
Four Key ServicesFour Key Services (continued)(continued)::
3.3. Develops, in collaboration with tribes, Develops, in collaboration with tribes, ATSDR American Indian/Alaska Native ATSDR American Indian/Alaska Native policiespolicies
4.4. Coordinates programs and projects to Coordinates programs and projects to support tribal-specific public health needssupport tribal-specific public health needs
ATSDR Tribal Consultation PolicyATSDR Tribal Consultation PolicyRespects and honors the sovereignty of Respects and honors the sovereignty of
tribes, the responsibilities and rights to self-tribes, the responsibilities and rights to self-governance, and the differences between governance, and the differences between tribal nations and individualstribal nations and individuals
Consults with tribal governments to ensure Consults with tribal governments to ensure community concerns and impacts are community concerns and impacts are carefully considered before the agency carefully considered before the agency takes action or makes decisions affecting takes action or makes decisions affecting tribal communitiestribal communities
ATSDR Tribal Consultation Policy ATSDR Tribal Consultation Policy Maintains government-to-government Maintains government-to-government
relationships with tribesrelationships with tribesEnsures ongoing communication with tribal Ensures ongoing communication with tribal
governments, communities, and individual governments, communities, and individual tribal members to define concerns about tribal members to define concerns about possible adverse health impacts from possible adverse health impacts from exposures to hazardous substancesexposures to hazardous substances
Environmental Issues: “Land Is Life” Environmental Issues: “Land Is Life” Threat to subsistence lifestyles: fish Threat to subsistence lifestyles: fish
consumption, plants (medical purposes), consumption, plants (medical purposes), and animalsand animals
Threat to cultural practices: sweat lodges, Threat to cultural practices: sweat lodges, basket weaving, and pottery makingbasket weaving, and pottery making
Polluted land and waterways: environmental Polluted land and waterways: environmental compensationcompensation
Environmental IssuesEnvironmental IssuesEmotional traumaEmotional traumaPhysiologic traumaPhysiologic traumaPhysical traumaPhysical traumaSpiritual traumaSpiritual trauma
Exposure PathwaysExposure Pathways
Exposure Pathways: DefinitionExposure Pathways: DefinitionAn exposure pathway describes how An exposure pathway describes how
people come into contact with a chemical people come into contact with a chemical
Exposure Pathways: ElementsExposure Pathways: Elements
An exposure pathway is made up ofAn exposure pathway is made up of
five elements:five elements:1.1. Source of contamination (e.g., landfill)Source of contamination (e.g., landfill)
2.2. Environmental medium through which Environmental medium through which contaminants travel (e.g., water)contaminants travel (e.g., water)
3.3. Point of exposure (e.g., water tap)Point of exposure (e.g., water tap)
4.4. Route of exposure (keep in mind cultural Route of exposure (keep in mind cultural practices that might result in exposure)practices that might result in exposure)
5.5. Exposed populationExposed population
Environmental MediumEnvironmental MediumWaterWaterAirAirSoilSoilSedimentSedimentAnimals Animals Livestock, fish, birdsLivestock, fish, birdsPlants (medicinal and agricultural)Plants (medicinal and agricultural)
Routes of ExposureRoutes of ExposureIngestion (eating and drinking)Ingestion (eating and drinking)Inhalation (breathing)Inhalation (breathing)Dermal (skin contact)Dermal (skin contact)Injection (medicinal or accidental)Injection (medicinal or accidental)Human (placenta, breast milk)Human (placenta, breast milk)
Groundwaterrelease
Air release
Source
Little environmental contact.
Few exposure pathways.
© Harris and Harper (1997)
Typical Exposure Assessment Model, Typical Exposure Assessment Model, Suburban LifestyleSuburban Lifestyle
Decomposition and release of long-lived contaminants
Uptake from water and sediment
Human food,other uses
Habitat, feed
Caveat: dietary surveys cannot identify all of the links and pathways for even a single species (cattail)
Reeds:food storage
baskets
Pollen: cakes
Roots:
baked
Soil contact while collecting and preparing
© Harris and Harper (2000)
TraditionalPractices
Food
People are inextricably intertwined with the environment through unique and multiple uses of resources for food, cultural, ceremonial, and religious practices.
Contamination
Reeds Cooking PotWater
© Harris and Harper (1997)
Sleeping mats,Basket
Clothing,Shelter
Tribal Repatriation of Sacred Objects:Tribal Repatriation of Sacred Objects:
Public Health IssuesPublic Health Issues
Contaminated Collections: Contaminated Collections: Preservation, Access, and UsePreservation, Access, and UsePreservation of Native American and Preservation of Native American and
Historical Natural History Collections Historical Natural History Collections Contaminated with Pesticide ResiduesContaminated with Pesticide Residues Shepherdstown, WVShepherdstown, WV April 6-9, 2001April 6-9, 2001
Native American Graves Protection Native American Graves Protection and Repatriation Act (NAGPRA)and Repatriation Act (NAGPRA)Passed in 1990Passed in 1990In the year prior, 1989, National Museum of In the year prior, 1989, National Museum of
the American Indian Act passed, facilitating the American Indian Act passed, facilitating repatriation of objects held within the repatriation of objects held within the collection of the Smithsonian Museumcollection of the Smithsonian Museum
NAGPRANAGPRA……conduct an inventory and return any conduct an inventory and return any
human remains, funerary objects, sacred human remains, funerary objects, sacred objects and objects of cultural patrimony objects and objects of cultural patrimony belonging to Native Americansbelonging to Native Americans
In 1996, added requirement for notification In 1996, added requirement for notification of known pesticide or other chemical of known pesticide or other chemical contamination associated with the objectscontamination associated with the objects
As, Hg, pesticides, DDT, Naphthalene, As, Hg, pesticides, DDT, Naphthalene, dichlorvos, dichlorobenzene, strychnine, dichlorvos, dichlorobenzene, strychnine, sulfur, camphor, tobacco, sulfur, camphor, tobacco, ethylene dibromide, and ethylene dibromide, and other chemicals were other chemicals were used to prevent damage used to prevent damage from insects and rodentsfrom insects and rodents
Smithsonian Museum of Natural History Collection: Smithsonian Museum of Natural History Collection: Treatments Used to Prevent Damage from Treatments Used to Prevent Damage from Insects and RodentsInsects and Rodents
Early 1800’sEarly 1800’s As, HgAs, Hg
Mid-1800’sMid-1800’s As, Hg, tobacco, sulfur, camphor, heatAs, Hg, tobacco, sulfur, camphor, heat
Late 1800’s/Early 1900’sLate 1800’s/Early 1900’s As, Hg, strychnine, carbolic acid, naphthalene, As, Hg, strychnine, carbolic acid, naphthalene,
wax/solvents, carbon disulfidewax/solvents, carbon disulfide
Mid 1900’sMid 1900’s Dichlorobenzene, hydrocyanide gas, aluminum silicate, Dichlorobenzene, hydrocyanide gas, aluminum silicate,
DDT, ethylene dichloride, carbon tetrachloride, ethylene DDT, ethylene dichloride, carbon tetrachloride, ethylene dibromide, dichlorvos, sulfuryl fluoride, freezer dibromide, dichlorvos, sulfuryl fluoride, freezer
Evaluation of Carcinogenicity to Evaluation of Carcinogenicity to Humans (IARC)Humans (IARC)
CategoryCategory AgentAgent
1-human carcinogen1-human carcinogen Arsenic, SilicaArsenic, Silica
2A-probable human 2A-probable human Ethylene dibromide Ethylene dibromide carcinogencarcinogen
2B-possible human2B-possible human Carbon Tetrachloride, Carbon Tetrachloride, carcinogencarcinogen DDT, DDT, Dichlorobenzene, Dichlorobenzene,
Dichlorvos, HgDichlorvos, Hg
Potential for Exposure to Potential for Exposure to Chemical PreservativesChemical PreservativesDermal exposureDermal exposure
masks may be worn for ceremonymasks may be worn for ceremonyInhalationInhalation
off-gassing may occur from preserved off-gassing may occur from preserved artifact and in enclosed spaces may be a artifact and in enclosed spaces may be a source of exposuresource of exposure
IngestionIngestion hand to mouth activity from small childrenhand to mouth activity from small children
Characterize Risk to the Affected People and their Eco-cultural Systems
EcologicalExposure
CulturalExposure
Ecological Toxicityand Sensitivity
Cultural Toxicityand Sensitivity
Identify What Is “At Risk”- Resources at Risk
- Human Systems and Uses at Risk- Existing Stressors
New first step in CERCLA risk assessments
• Risk = exposure x sensitivity• There is such as thing as Cultural
Exposure and Toxicity.
Characterization of Cumulative Risks requires that all risks and impacts be included within the risk assessment
framework.
Characterize Ecological Risk
Hazard Identification- Probability
- Severity
Fate and Transport- Contamination of Media, - Contamination of Resources- Point and Aerial Extent Over Time
Human Exposure
Human Toxicity and Sensitivity
Characterize Human Health Risk
Characterize Cultural Risk
Also known asQuality of Life
Expanded Expanded RiskRiskFrameworkFramework
© Harris & Harper, 1999
General Health Effects of Agents General Health Effects of Agents Found on Museum ArtifactsFound on Museum ArtifactsArsenicArsenic
GI disturbances, skin lesions, peripheral GI disturbances, skin lesions, peripheral neuropathy, anemia, cardiovascular effects, skin neuropathy, anemia, cardiovascular effects, skin and lung cancerand lung cancer
Lab –Urine levels for recent exposure (r/o dietary Lab –Urine levels for recent exposure (r/o dietary sources)sources)
MercuryMercury Gingivitis, tremor, renal damage, neuropsychiatric Gingivitis, tremor, renal damage, neuropsychiatric
manifestationsmanifestations Lab –Urine levels of low-molecular weight proteins. Lab –Urine levels of low-molecular weight proteins.
Urine and blood mercury levels (r/o dietary sources)Urine and blood mercury levels (r/o dietary sources)
General Health Effects of Agents General Health Effects of Agents Found on Museum Artifacts Found on Museum Artifacts (cont.)(cont.)
NaphthaleneNaphthalene DermatitisDermatitis Lab–Urine biomarker and blood hydrocarbon Lab–Urine biomarker and blood hydrocarbon
DNA-adduct (r/o dietary and tobacco smoking DNA-adduct (r/o dietary and tobacco smoking sources)sources)
DDT DDT Irritant, GI disturbances, central nervous system Irritant, GI disturbances, central nervous system
effects, suspect fetotoxicity, possible liver/kidney effects, suspect fetotoxicity, possible liver/kidney damage, suspect carcinogendamage, suspect carcinogen
Lab–Serum DDT levels and urine metaboliteLab–Serum DDT levels and urine metabolite
Repatriation IssuesRepatriation IssuesShould each object be tested prior to return Should each object be tested prior to return
to Tribes?to Tribes?Are there safe decontamination procedures?Are there safe decontamination procedures?Tribal recipient health risks?Tribal recipient health risks?Museum worker health risks?Museum worker health risks?Handling protocols?Handling protocols?Research on extent of health effects among Research on extent of health effects among
exposed groups?exposed groups?
Contaminants of ConcernContaminants of Concern
Effects of ExposureEffects of ExposureHealth effects of exposure to any Health effects of exposure to any
hazardous substance depend on the:hazardous substance depend on the: Dose (how much)Dose (how much) Duration (how long)Duration (how long) Event (how the exposure happens)Event (how the exposure happens) Health, traits, and habits of the person Health, traits, and habits of the person
exposedexposed Presence of other chemicals Presence of other chemicals
LeadLeadWhat:What: A bluish-gray metal with many uses A bluish-gray metal with many usesHow:How: Exposure is usually by ingestion or Exposure is usually by ingestion or
inhalationinhalationWhere:Where: Exposure can occur from Exposure can occur from
Old houses with lead paintOld houses with lead paint Working in a job where lead is usedWorking in a job where lead is used HobbiesHobbies Folk remediesFolk remedies
Lead: Health EffectsLead: Health EffectsLead affects almost every organ and system Lead affects almost every organ and system
of the bodyof the bodyThe central nervous system is the most The central nervous system is the most
sensitive, especially in young childrensensitive, especially in young childrenIn children, lead can cause developmental In children, lead can cause developmental
delays, anemia, severe stomachache, and delays, anemia, severe stomachache, and muscle weaknessmuscle weakness
Lead can also damage the kidneys and Lead can also damage the kidneys and reproductive systemreproductive system
CadmiumCadmium What: What: Usually occurs as a mineral combined with Usually occurs as a mineral combined with
other elements other elements How: How: Exposure is usually by inhalation or ingestion Exposure is usually by inhalation or ingestion Where:Where: Exposure can occur from Exposure can occur from
Eating foods with cadmium (highest in shellfish and Eating foods with cadmium (highest in shellfish and liver and kidney meats)liver and kidney meats)
Smoking cigarettesSmoking cigarettes Working in a job where cadmium is used (battery Working in a job where cadmium is used (battery
manufacturing, welding)manufacturing, welding)
Cadmium: Health EffectsCadmium: Health EffectsSeverely damages lungsSeverely damages lungsCauses stomach irritation, vomiting, and Causes stomach irritation, vomiting, and
diarrheadiarrheaCauses kidney disease Causes kidney disease Makes bones fragileMakes bones fragile
Polychlorinated Biphenyls (PCBs)Polychlorinated Biphenyls (PCBs) What: What: Colorless to light yellow oily liquids or solids. Colorless to light yellow oily liquids or solids.
No known natural sources. No known natural sources. How: How: Exposure is usually by skin contact, Exposure is usually by skin contact,
inhalation or ingestioninhalation or ingestion Where:Where: Exposure can occur from Exposure can occur from
Eating foods with PCBs (mainly fish)Eating foods with PCBs (mainly fish) Working in a job involving transformers, fluorescent Working in a job involving transformers, fluorescent
lights, or other electrical deviceslights, or other electrical devices Breathing air near hazardous waste sitesBreathing air near hazardous waste sites
PCBs: Health EffectsPCBs: Health EffectsSkin conditions (acne, rashes)Skin conditions (acne, rashes)Liver damageLiver damageMay cause cancerMay cause cancer
PesticidesPesticides What: What: A mixture of many chemicals used to control A mixture of many chemicals used to control
unwanted insects indoors or outdoorsunwanted insects indoors or outdoors How: How: Exposure is usually by inhalation or ingestionExposure is usually by inhalation or ingestion Where:Where: Exposure can occur from Exposure can occur from
Residues in foodResidues in food Living or working on or near a farm where Living or working on or near a farm where
pesticides are sprayed on cropspesticides are sprayed on crops Breathing air near hazardous waste sitesBreathing air near hazardous waste sites
Pesticides: Health EffectsPesticides: Health EffectsAcute exposure (high levels, short term) Acute exposure (high levels, short term)
may cause flu-like symptomsmay cause flu-like symptomsChronic exposure (longer term) may cause Chronic exposure (longer term) may cause
skin damage, cancers, and reproductive skin damage, cancers, and reproductive problemsproblems
MercuryMercury What:What: Naturally occurring metal; a silver liquid that Naturally occurring metal; a silver liquid that
turns to a gas when heated. Methylmercury is an turns to a gas when heated. Methylmercury is an organic compound. organic compound.
How: How: Exposure is usually by inhalation, ingestion, Exposure is usually by inhalation, ingestion, or skin contact or skin contact
Where: Where: Exposure can occur from Exposure can occur from Eating contaminated fish or shellfish Eating contaminated fish or shellfish
(methylmercury)(methylmercury) Breathing vapors from spills, contaminated airBreathing vapors from spills, contaminated air Religious or ethnic practices (e.g., Hispanic, Haitian)Religious or ethnic practices (e.g., Hispanic, Haitian)
Mercury: Health EffectsMercury: Health EffectsHarmful to the central nervous system, Harmful to the central nervous system,
especially in unborn babies and childrenespecially in unborn babies and childrenCan damage brain, kidneys, and digestive Can damage brain, kidneys, and digestive
systemsystemAcute exposure may cause nausea, Acute exposure may cause nausea,
vomiting, diarrhea, increased blood pressure vomiting, diarrhea, increased blood pressure or heart rate, and skin rashes or heart rate, and skin rashes
MoldMoldWhat: What: Type of fungus that lives on plants, Type of fungus that lives on plants,
foods, and other organic materialsfoods, and other organic materialsHow: How: Exposure is usually by inhalation Exposure is usually by inhalation Where:Where: Exposure can occur from Exposure can occur from
Indoor moisture caused by flooding, leaky Indoor moisture caused by flooding, leaky roofs or plumbing, and humidifiersroofs or plumbing, and humidifiers
Areas with high levels of humidityAreas with high levels of humidity
Mold: Health EffectsMold: Health EffectsA higher risk of health effects may be seen A higher risk of health effects may be seen
in children, the elderly, and persons with in children, the elderly, and persons with existing respiratory conditions or existing respiratory conditions or compromised immune systemscompromised immune systems
Causes respiratory irritation (wheezing, Causes respiratory irritation (wheezing, nasal and sinus congestion, cough, and nasal and sinus congestion, cough, and shortness of breath)shortness of breath)
Other ContaminantsOther ContaminantsSilverSilverUraniumUraniumCyanideCyanideBenzeneBenzeneSilicaSilicaIodine 131Iodine 131Methyl Methyl terttert-butyl ether (MTBE)-butyl ether (MTBE)
ATSDR uses EPA’s Cancer Slope Factors (CSFs) ATSDR uses EPA’s Cancer Slope Factors (CSFs) to calculate riskto calculate risk
Risk = Exposure Dose x CSFRisk = Exposure Dose x CSF Results in a maximum additional cases Results in a maximum additional cases of cancer in a population (theoretical risk)of cancer in a population (theoretical risk)
““Health Guideline” for cancer risk is usually 1 in Health Guideline” for cancer risk is usually 1 in 10,000 or 1010,000 or 10-4-4
One additional case of cancer in a One additional case of cancer in a lifetime of exposure per ten thousand lifetime of exposure per ten thousand individuals.individuals.
Calculating Cancer Risk
Cancer Risk ConceptsCancer Risk Concepts
Actual Risk of Cancer may be zero
95% Upper Bound
Risk of Cancer at Specific Dose by Direct Extrapolation
DOSE
RE
SPO
NSE
Actual Data Points
Cancer Slope Factorunits: (mg/kg/day)-1
- estimated from studies
CVs – e.g. CREG(units: mg/kg or mg/L or ug/m3)
2) Convert dose (mg/kg/day) to env. concentrations, using conservative assumptions.
1) Calculate dose at “1 in a million” risk level, where excess Cancer Risk = Dose x Cancer Slope Factor.
For cancer evaluation: Select a For cancer evaluation: Select a Contaminant as a “Contaminant of Concern” if:Contaminant as a “Contaminant of Concern” if:
Its concentration exceeds a CV, orIts concentration exceeds a CV, or It was detected and is a carcinogen, orIt was detected and is a carcinogen, or Its detection limit exceeds the CV and it Its detection limit exceeds the CV and it
may occur at the site (remember non-may occur at the site (remember non-detect = 0), ordetect = 0), or
There is no CV.There is no CV.
Examples of Cancer Clusters Leading to Examples of Cancer Clusters Leading to Identification of Human CarcinogensIdentification of Human Carcinogens
Occupational
1775: Scrotal cancer in chimney sweeps exposed to soot from coal (8)
1929: Osteosarcoma in watch dial painters exposed to radium (9)
1965: Mesothelioma and lung cancer in asbestos workers (10)
1974: Angiosarcoma of liver in chemical workers exposed to vinyl chloride monomer (11)
Medical
1971: Vaginal clear cell carcinoma in daughters exposed to in utero diethylstilbesterol (12)
Other
1981: Kaposi sarcoma in homosexual men with AIDS exposed to human herpes-virus-8 (13)
Want More Information?Want More Information?
ATSDR Web PageATSDR Web Page http://www.atsdr.cdc.govhttp://www.atsdr.cdc.gov
ATSDR’s toll-free numberATSDR’s toll-free number 1-888-42-ATSDR (1-888-422-8737)1-888-42-ATSDR (1-888-422-8737)
OTA Web PageOTA Web Page http://www.atsdr.cdc.gov/tribalhttp://www.atsdr.cdc.gov/tribal