Jacksonville Ash Sites: Tracking Health Impacts & Training Community Stakeholders

1. Jacksonville Racial and Ethnic Approaches to Environmental Health (REEACH)Presented toCDC/ATSDRSociety of Toxicology Annual Meeting by Alan Becker PhD, MPHCynthia M. Harris, Ph.D., DABTDirector and ProfessorFAMU Institute of Public HealthMarch 10, 2012

2. Outline -Florida Environmental Health Tracking -Toxicology Curriculum - Duval County Health Update and physician training -EPA Data Modeling

3. Environmental Public Health Tracking Project

4. Jacksonville REEACH • Four Ash Sites Brown’s Dump – (1949- 1955) – 50 acres – Bethune Elementary School now sits on – public health hazard due to high concentrations of metals Fifth and Cleveland Street Incinerator - (1943-1969) – municipal waste buried on site (9 acres) – developed as city park, daycare center and housing east of site – (high levels of metals)

5. Jacksonville REEACH • Four Ash Sites (cont’d) Forest Street Incinerator – 10.5 acres (1941) high soil lead, arsenic and PAH levels Lonnie C. Miller Sr. Park – (100 acre) – high levels of arsenic, lead, manganese, PAHs, dioxins and furans *ash sites within low-income, African American communities in Jacksonville

6. Jacksonville REEACH • Specific Aim To initiate a pilot translational research program involving modeling and environmental health tracking of exposures to arsenic and polyaromatic hydrocarbons associated with the Jacksonville Ash sites.

9. Ash Sites & Contaminants

10. Lung Cancer Skin Cancer Stomach Cancer Kidney Cancer Nasopharynx Cancer Liver Cancer Kidney Disease Oral Cancer Breast Cancer Asthma COPD Anemia Kidney Disease Heart Disease Cardiovascular Disease Health Outcomes

11. GIS Mapping Created ½ mile buffer around each site to gather census tracts and zip codes for waste sites

12. Analysis Plan • Compare Expected vs Observed for hazardous waste sites with rest of Duval County • Using GIS: • Analyze health outcomes and geographic location • Using SAS: • Analyze health outcomes from AHCA data • Analyze demographic data from US Census

13. Accomplishments: • IRB and data identified for analysis • Student assigned to work on the analysis with the Florida Department of Health, Environmental Tracking Program • GIS will be conducted as part of the analysis • EPA sampling data will be used to focus on risk and exposure to residents • The Florida Department of Health and FAMU to collaborate on a publication

14. Jacksonville Ash Site Community Toxicology Curriculum

15. Jacksonville REEACH • Specific Aim To develop a sustained community-based and culturally sensitive environmental health and toxicology program through proactive outreach and training of lay community stakeholders (train-the-trainer approach)

17. Jacksonville Ash Site Community Toxicology Curriculum

18. FAMU Faculty delivering Training

19. FAMU Faculty Training Community Leader

20. Community Leader Training Residents

21. Accomplishments: • Presented toxicology curriculum to community leaders, residents in summer 2011 • Incorporating comments and suggestions from Community and Stakeholders • Include video designed from Toxicology Curriculum to simplify terminology presentation • Provide an electronic copy to the community leaders for future training • Publication in preparation for this work

23. Environmental Medicine/Toxicology Training Program forMedical Professionals Duval County Health Department Environmental Health & Safety Division 23 23

24. Jacksonville REEACH • Specific Aims To plan, develop, and implement a environmental health and toxicology educational research program with a focus on the training of health professions students regarding environmental contaminants and health concerns associated with the Jacksonville Ash sites.

25. Accomplishments: • Finalized the training program (presentation, activities, “Packet Guide”) • Compiled and updated the list of Health Care Providers to be approached for training workshops • Finalized survey mail outs to health care providers • Requested authorization for draw down of unused REEACH DCHD-allocated funds for mass production of Pocket Guide and purchasing flash drives for training materials • In process of compiling the health care providers’ feedback on logistics for training workshops

26. Training Presentation Outline • Module 1 • Background (Ash sites) • Module 2 • Basics of Toxicology • Module 3 • Risk Assessment • Module 4 • Environmental Contaminants of Concern 26 26 26

27. Training Presentation GOALS To enhance knowledge of hazardous substances found in the environment To learn how to evaluate potentially exposed patients (exposure history form) To learn to recognize exposure-related diseases 27 27 27

28. Samples of Presentation Pages:

29. Module 1 - Background Until 1960’s, City of Jacksonville burned solid waste Produced Ash Dumped at four major locations Jacksonville Ash sites Affected Zip codes: 32202, 32204, 32206, 32208, 32209 and 32254 (Health Zone 1) 29 29 29

30. Module 2 • Basics of Toxicology • Terminology • Dose-Response • Exposure Routes 30 30 30

31. Module 3 – The 4 Steps RISK MANAGEMENT • Hazard Identification • Collect data to determine whether a substance is toxic • Dose-Response Assessment • Calculate the dose at which harmful effect will occur • Exposure Assessment • Examines amount, frequency, length of time, and route • Risk Characterization • Calculate the dose at which harmful effect will occur 31 31 31

32. Module 3 – Exposure History Form Just say “ACHHOO”… • Activities • Community • Household • Hobbies • Occupation • Oral 32

33. Module 4 ROLE-PLAYING ACTIVITY • Environmental Contaminants of Concern - Case Studies for: • Lead • Arsenic • Dioxins • Polycyclic Aromatic Hydrocarbons (PAHs) 33 33 33

34. “Pocket Guide” Developed for the Medical Provider Training Program

35. Additional DCHD Activities Under REEACH Project • Developed the article about REEACH Project and submitted it for publication to the Environmental Justice Journal (as of 3/1/12 the article is still under review by the publisher) • Drafted and submitted to FAMU a proposal for extension of the REEACH Project under “the Human Health Studies Applied Research and Development Cooperative Agreement” next funding cycle. • Requested permission to utilize unused DCHD-allocated funds for promotional items such as usable grocery bags, pencils, pens with REEACH logo to promote the project at the community events. • Discussed potential soil testing under REEACH Project with FAMU, DOH & City of Jax’s “Project New Ground” • Participated in community events promoting REEACH Project

36. Major Highlights of Drafted Proposal for Extension of the REEACH Project • First year: Complete community and health care providers’ training sessions & develop assessment tools • Second Year: Conduct this assessment applying developed assessment tools to identify project’s successes and challenges and ways to overcome identified barriers. • Third Year: Complete our training of (and outreach to) residents & health care providers in other communities impacted by contamination issues. • Develop a REEACH interactive website with all REEACH’s products and possibly including the training modules and links to important partners.

37. DCHD Community Outreach and Education about REEACH Project • The REEACH outreach materials and information about contaminants of concern as well as education programs established for impacted residents and health care providers were discussed and shared during the following meetings and events: • Jan 11, 2012: Meeting with Wolfson’s Hospital and American Lung Association Asthma Coalition Partners • Jan 17, 2012: One-on-One Health Fair Event held in the DCHD main office building • Feb 27, 2012: Fairfax Community Meeting held next to the Brown’s Ash site to discuss environmental contamination impacting local residents

38. Jacksonville REEACH THANK YOU, CDC/ATSDR!! CDR Jessilynn B. Taylor Dr. Paul Mehta