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