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PUBLIC HEALTH ASSESSMENT

BRICK TOWNSHIP INVESTIGATION
(a/k/a BRICK TOWNSHIP AUTISM INVESTIGATION)
BRICK TOWNSHIP, OCEAN COUNTY, NEW JERSEY

APPENDICES

Appendix A: Contaminants of Concern

This list of Contaminants of Concern was compiled in part through ATSDR's literature review: Chemical Specific Consultation: Hazardous Substance Exposures and Autism. These chemicals were selected from studies and articles in the literature review, because they were suspected of causing or contributing to adverse health effects (i.e. autism or PDD) in children or during prenatal development. No one chemical or class of chemicals could be identified directly as a contributor to autism spectrum disorders, because very little is known about how biological and environmental factors contribute to autism and related disorders. This list was developed as a screening tool for looking at possible environmental exposures.

Contaminant	Concentration	Unit	Source
Acetone	1,000	ppb	CV
Anthracene	3,000	ppb	CV
Arsenic	3	ppb	CV
Benzene	1	ppb	CV
Benzo(b)flouranthene (PAH)	0.2	ppb	MCL
Benzo(a)pyrene (PAH)	0.005	ppb	CV
Benz(a)anthracene (PAH)	2,800	ppb	MCL
Bis(2-ethyl-hexyl)phthalate	6,000,000	ppb	MCL
Bromoform	4	ppb	CV
*Butyl benzyl phthalate	2,000	ppb	CV
Cadmium	5	ppb	CV
Carbon tetrachloride	0.3	ppb	CV
Chlordane	0.6	ppb	CV
Chlorobenzenes	100	ppb	CV
Chloroform	6	ppb	CV
Chromium	100	ppb	CV
Copper	100	ppb	CV
DDT	5	ppb	CV
Di-n-butyl phthalate	1,000	ppb	CV
Dibenzo(a,h)anthracene (PAH)	0.3	ppb	MCL
*1,2-Dichlorobenzene	600	ppb	CV
1,4-Dichlorobenzene	75	ppb	CV
Dichloroethanes	0	ppb	MCLG
1,1-Dichloroethene	0.06	ppb	CV
*Diethylstilbestrol
Dioxin (2,3,7,8 TCDD)	.00001	ppb	CV
Endosulfan	20	ppb	CV
Ethyl benzene	700	ppb	CV
Flouranthene (PAH)	400	ppb	CV
Heptachlor	0.008	ppb	CV
Heptachlor epoxide	0.004	ppb	CV
Hexachlorocyclohexane	0.02	ppb	CV
" alpha	0.006	ppb	CV
" beta	0.02	ppb	CV
" gamma	0.4	ppb	CV
Lead	0	ppb	MCLG
Mercury	2	ppb	MCL
Methylene chloride	5	ppb	CV
Naphthalene	20	ppb	CV
Nickel	100	ppb	CV
PCB's	0.02	ppb	CV
Pyrene (PAH)	300	ppb	CV
Silver	50	ppb	CV
Tetrachloroethylene (PCE)	0.7	ppb	CV
Toluene	200	ppb	CV
1,1,1-Trichloroethane	200	ppb	CV
1,1,2-Trichloroethane	0.6	ppb	CV
Trichloroethylene	20	ppb	CV
Vinyl Chloride	0.2	ppb	CV
Xylene	2,000	ppb	CV
Zinc	3,000	ppb	CV

* No Toxicological Profile
CV-Comparison Value
MCL-Maximum Contaminant Level
MCLG-Maximum Contaminant Level Goal
ppb-parts per billion

APPENDIX B: Comparison Values

To determine which chemicals might have some relationship to fetal birth effects, autism, and PDD ATSDR performed a literature search and developed a list of Contaminants of Concern (Appendix A). ATSDR evaluated all available environmental data from 1987 through 1995 to look for the Contaminants of Concern. To select chemicals for further evaluation, comparison values were used. Comparison values are chemical concentrations that are found in specific media (air, soil, and water). They are designed to be conservative and non-site specific. Therefore, they are protective for all probable exposures. Comparison values are intended to be used only to screen out chemicals that do not need further evaluation. They are not intended to be used as clean-up levels or to be indicators of public health effects. Comparison Values are derived from toxicological information, using assumptions regarding body weights, ingestion rates, and exposure frequency and duration. Generally, the assumptions used are very conservative (i.e., worst case).

There are two different types of comparison values, those based on carcinogenic (cancer-causing) effects, and those based on noncarcinogenic effects. Cancer-based comparison values are calculated from the EPA's oral cancer slope factor or inhalation unit risk. They are calculated for a lifetime exposure a (70 years) with an unacceptable excess lifetime cancer risk of one case per million exposed people. Noncancer comparison values are calculated from ATSDR's minimal risk levels, or EPA's reference doses or reference concentrations. These values are calculated for adults, children, and small children who may eat large amounts of soil or drink large amounts of water (2 liters per day).

Appendix A contains the list of chemicals evaluated and the comparison values used to select the appropriate chemicals for more in-depth analysis (bolded items). A chemical is selected for further evaluation (bolded items in Appendix A) if the chemical was found in a valid environmental sample and exceeds comparison values. The presence of a chemical in the Appendix A table does not mean that either exposure to the chemical or adverse health effects has occurred or will occur. A chemical that has been bolded in the tables indicates that the chemical has potential for human exposures and potential for adverse human health effects. The selected chemical will be discussed in more detail in the health consultation, because of its potential for human exposure and adverse health effects.

The comparison values used in this health consultation are listed and described below:

Cancer Risk Evaluation Guides (CREGs) are estimated concentrations that would be expected to cause no more than one excess cancer in a million persons exposed over a lifetime. CREGs are calculated from EPA's cancer slope factors.

Environmental Media Evaluation Guides (EMEGs) are based on ATSDR's minimal Risk Levels (MRLs) and factor in body weight and ingestion or inhalation rates.

Minimal Risk Levels (MRLs) are an estimate of daily human exposure to a chemical (in milligrams of the chemical per kilogram of body weight per day [mg/kg/day]) that is likely to be without an appreciable risk of deleterious effects (noncarcinogenic) over a specified duration of exposure. MRLs are based on human and animal studies. They are reported in the ATSDR Toxicological Profiles for acute (<14 days), intermediate (15-365 days), and chronic (>365 days) exposures. Proposed MRLs are peer reviewed and available for public comment when the ATSDR Toxicological Profile for that chemical is out for public comment.

Reference Dose Media Evaluation Guides (RMEGs) are similar to EMEGs, except that they are based on EPA's reference doses (RfDs).

Reference Doses (RfDs) are developed by EPA. They are an estimate of the daily exposure to a chemical that is unlikely to cause adverse health effects even if the exposure occurs over a lifetime (70 years). RfDs do not consider carcinogenic effects. EPA has any proposed RfD peer reviewed before publishing them.

APPENDIX C: Table 1

Contaminants Detected in Brick Township Municipal Drinking Water, Above Environmental Screening Values
Source: BTMUA and NJDEP Data

Chemical	Observed Concentration Range (ppb)	Frequency of Detection	Comparison Value (ppb)	EPA Cancer Slope Factor in (mg/kg/day) -1
Bromoform	0.6 - 5.0	14	4 (CREG) 2000 (EMEG)	0.0079
Chloroform	0.6 - 240	356	6 (CREG) 100 (EMEG)	0.0061
Tetrachloroethylene (PCE)	0.13 - 6.0	12	0.7 (CREG) 100 (RMEG)	0.052
Total Trihalomethanes	1.0 - 251	356	100 (MCL)	NA

APPENDIX C: Table 2

Contaminants Detected in Groundwater, Above Environmental Screening Values
Samples taken from Off-Site Monitoring Wells, Brick Township Landfill
Source: Remedial Investigation Data, January 1999

Chemical	Observed Concentration Range (ppb)	Comparison Value (ppb)	EPA Cancer Slope Factor in (mg/kg/day) -1
Arsenic	8.5 - 269	.02 (CREG) 3 (EMEG)	1.5
Benzene	1.9 - 57	1 (CREG)	.029
Cadmium	5.4 - 228	2 (EMEG)	NA
Chlorobenzene	68 - 130	100 (MCL)	NA
Chromium	102 - 6,100	100 (MCL)	NA
Copper	1,250 - 2,020	100 (MCLG)	.04
Lead	10.9 - 2,230	0 (MCLG)	NA
Mercury	2.0 - 26.8	2 (MCL)	NA
Nickel	107 - 1,020	100 (MCL)	NA
Vinyl Chloride	12 - 71	.02 (CREG) .2 (EMEG)	1.9
Zinc	5,890 - 12,800	3000 (EMEG)	NA

APPENDIX D

Theoretical Cancer Risk Associated with Exposure to Chemical Contaminants in the Brick Township Municipal Drinking Water Supply, Completed Exposure Pathway

Adults
Chemical	Maximum Concentration Detected (ppb)	Dose	EPA Cancer Slope Factor (ug/kg/day)-1	Length of Exposure (70 years)	Theoretical Cancer Risk
Bromoform	5	3.0x10-5	0.0079	10/70	2.4x10-7
Chloroform	240	1.4x10-3	0.0061	10/70	8.8x10-6
Tetrachloroehtylene (PCE)	6	3.6x10-5	0.052	10/70	1.9x10-6
Maximum Theoretical Cancer Risk for Adults from Exposure to Chemicals in Drinking Water					1.1x10-5

Appendix D

Bromoform

Persons who ingested water between 1987 and 1995 may have been exposed to bromoform at a maximum concentration of 5ppb or 0.005 milligrams per liter (mg/l). The EPA has set a Maximum Contaminant Level of 80 ppb or 0.080 mg/l for the combination of bromoform and other trihalomethanes in drinking water. The estimated exposure dose was below EPA's reference dose (RfD) of 0.020 milligrams per kilogram per day (mg/kg/day) and below the no-observed-adverse-effect-level (NOAEL) of approximately 10 mg/kg/day. ATSDR does not believe that adverse non-cancer health effects would occur due to these exposures. The Department of Health and Human Services and EPA have determined that bromoform is reasonably anticipated to be a carcinogen. The EPA has calculated a cancer risk factor, which can be used to estimate the probability of excess cancer risk for a lifetime of exposure to bromoform. Cancer risk for exposure was estimated based on the maximum concentration of bromoform in the contaminated medium. There appears to be no significant increased risk of cancer based upon these conservative estimations.

Chloroform

Persons who ingested water between 1987 and 1995 could have been exposed to chloroform at a maximum concentration of 240 ppb or 0.240 milligrams per liter (mg/l). The EPA has set a Maximum Contaminant Level of 80 ppb or 0.080 mg/l for the combination of chloroform and other trihalomethanes in drinking water. The estimated exposure dose was below EPA's reference dose (RfD) of 0.010 milligrams per kilogram per day (mg/kg/day) and below the no-observed-adverse-effect-level (NOAEL) of approximately 6 mg/kg/day. ATSDR does not believe that adverse non-cancer health effects would occur due to these exposures. The Department of Health and Human Services and EPA have determined that chloroform is reasonably anticipated to be a carcinogen. The EPA has calculated a cancer risk factor, which can be used to estimate the probability of excess cancer risk for a lifetime of exposure to chloroform. Cancer risk for exposure was estimated based on the maximum concentration of chloroform in the contaminated medium. There appears to be no significant increased risk of cancer based upon these conservative estimations.

Tetrachloroethylene (PCE)

The MCL for PCE is currently at 5 ppb. This MCL is based on a cancer risk estimate. Persons who ingested water between 1987 and1994 could have been exposed to PCE at a maximum concentration 6 ppb or 0.006 milligrams per liter (mg/l). The actual level of exposure is most likely much less than 6 ppb since the water from the wells contaminated with PCE was diluted with water from the rest of the Brick system before it reached Brick residents. The estimated exposure dose was below EPA's reference dose (RfD) of 0.010 milligrams per kilogram per day (mg/kg/day) and below the no-observed-adverse-effect-level (NOAEL) of approximately 20 mg/kg/day. ATSDR does not believe that adverse non-cancer health effects would occur due to these exposures. The Department of Health and Human Services and EPA have determined that PCE is reasonably anticipated to be a carcinogen. The EPA has calculated a cancer risk factor, which can be used to estimate the probability of excess cancer risk for a lifetime of exposure to PCE. Cancer risk for exposure was estimated based on the maximum concentration of PCE in the contaminated medium. There appears to be no significant increased risk of cancer based upon these conservative estimations.

Exposure Scenario for Bromoform, Chloroform and Tetrachloroethylene

Exact information regarding possible exposures to bromoform, chloroform, and PCE were not available. To evaluate possible exposures certain assumptions were made by ATSDR. The following assumptions were made:

• persons exposed were adults;
• exposures occurred at the maximum concentration detected;
• the maximum period of time people would have been exposed was 9 months (270 days) per year for 10 years;
• the main routes of exposure were most likely ingestion, dermal contact, and inhalation from showering and other hot water uses.

Discussion of Theoretical Cancer Risk

ATSDR evaluated the theoretical cancer risk for exposure to bromoform, chloroform, and PCE in municipal drinking water in the tables above. The calculations presented in this Appendix over estimate the risk of cancer by several orders of magnitude (the real risk is 100s to 1,000s times lower). In addition cancer risk calculations generally assume a lifetime of exposure (70 years), where the maximum exposure period for Brick Township residents would be 10 years or less.

Even if the theoretical cancer risk calculations are correct, the predicted cancer occurrence for exposure to bromoform, chloroform, and PCE combined would be 1 per 100,000 in adults. In Brick Township the theoretical cancer risk calculations would predict less than 0.74 extra cancers in the adult population.

Calculation of rates:

These calculations were based on population figures from 1990 U.S. Census data indicating a total population for Brick Township of 66,414 and a child population (3-10 years old) of 7,117.

The number of children aged 3 to 10 years in Brick Township in 1998 was estimated by CDC using a 25% inflation factor. The 25% inflation factor was equivalent to the increase observed in the Brick Township student population for grades K through 5 in the school years, 1989-90 and 1998-99, which were provided by the Brick Township Public Schools. Using this inflation factor, the estimated number of children aged 3 to 10 years in Brick Township in 1998 was 8,896.

For consistency, the same inflation factor (25%) was then used by ATSDR to estimate the adult population in 1998. Using this inflation factor the estimated adult population in Brick Township in 1998 was 74,121.

APPENDIX E: Figures

Figure 1. Place of Birth for children who participated in the clinical exams and were diagnosed with ASD

Figure 2. Vicinity Map

Figure 3. Municipal Water System Map

Figure 4. Study Participants

Figure 5. Location of Total Trihalomethane Levels with at Least One Sample Above 80 Parts Per Billion

Figure 6. Location of Total Trihalomethane Levels with at Least One Sample Above 80 Parts Per Billion with Residence at Birth/Conception for Study Participants

Figure 7. Landfill and Residence at Birth/Conception

APPENDIX F
ATSDR Plain Language Glossary of Environmental Health Terms
Revised - 15 Dec 99

Absorption:

How a chemical enters a person's blood after the chemical has been swallowed, has come into contact with the skin, or has been breathed in.

Acute Exposure:

Contact with a chemical that happens once or only for a limited period of time. ATSDR defines acute exposures as those that might last up to 14 days.

Additive Effect:

A response to a chemical mixture, or combination of substances, that might be expected if the known effects of individual chemicals, seen at specific doses, were added together.

Adverse Health Effect:

A change in body function or the structures of cells that can lead to disease or health problems.

Antagonistic Effect:

A response to a mixture of chemicals or combination of substances that is less than might be expected if the known effects of individual chemicals, seen at specific doses, were added together.

ATSDR:

The Agency for Toxic Substances and Disease Registry. ATSDR is a federal health agency in Atlanta, Georgia that deals with hazardous substance and waste site issues. ATSDR gives people information about harmful chemicals in their environment and tells people how to protect themselves from coming into contact with chemicals.

Background Level:

An average or expected amount of a chemical in a specific environment. Or, amounts of chemicals that occur naturally in a specific environment.

Biota:

Used in public health, things that humans would eat - including animals, fish and plants.

CAP:

See Community Assistance Panel.

Cancer:

A group of diseases which occur when cells in the body become abnormal and grow, or multiply, out of control

Carcinogen:

Any substance shown to cause tumors or cancer in experimental studies.

CERCLA:

See Comprehensive Environmental Response, Compensation, and Liability Act.

Chronic Exposure:

A contact with a substance or chemical that happens over a long period of time. ATSDR considers exposures of more than one year to be chronic.

Completed Exposure Pathway:

See Exposure Pathway.

Community Assistance Panel (CAP):

A group of people from the community and health and environmental agencies who work together on issues and problems at hazardous waste sites.

Comparison Value (CVs):

Concentrations or the amount of substances in air, water, food, and soil that are unlikely, upon exposure, to cause adverse health effects. Comparison values are used by health assessors to select which substances and environmental media (air, water, food and soil) need additional evaluation while health concerns or effects are investigated.

Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA):

CERCLA was put into place in 1980. It is also known as Superfund. This act concerns releases of hazardous substances into the environment, and the cleanup of these substances and hazardous waste sites. ATSDR was created by this act and is responsible for looking into the health issues related to hazardous waste sites.

Concern:

A belief or worry that chemicals in the environment might cause harm to people.

Concentration:

How much or the amount of a substance present in a certain amount of soil, water, air, or food.

Contaminant:

See Environmental Contaminant.

Delayed Health Effect:

A disease or injury that happens as a result of exposures that may have occurred far in the past.

Dermal Contact:

A chemical getting onto your skin. (see Route of Exposure).

Dose:

The amount of a substance to which a person may be exposed, usually on a daily basis. Dose is often explained as "amount of substance(s) per body weight per day".

Dose / Response:

The relationship between the amount of exposure (dose) and the change in body function or health that result.

Duration:

The amount of time (days, months, years) that a person is exposed to a chemical.

Environmental Contaminant:

A substance (chemical) that gets into a system (person, animal, or the environment) in amounts higher than that found in Background Level, or what would be expected.

Environmental Media:

Usually refers to the air, water, and soil in which chemical of interest are found. Sometimes refers to the plants and animals that are eaten by humans. Environmental Media is the second part of an Exposure Pathway.

U.S. Environmental Protection Agency (EPA):

The federal agency that develops and enforces environmental laws to protect the environment and the public's health.

Epidemiology:

The study of the different factors that determine how often, in how many people, and in which people will disease occur.

Exposure:

Coming into contact with a chemical substance.(For the three ways people can come in contact with substances, see Route of Exposure.)

Exposure Assessment:

The process of finding the ways people come in contact with chemicals, how often and how long they come in contact with chemicals, and the amounts of chemicals with which they come in contact.

Exposure Pathway:

A description of the way that a chemical moves from its source (where it began) to where and how people can come into contact with (or get exposed to) the chemical.

ATSDR defines an exposure pathway as having 5 parts:

1. Source of Contamination,


2. Environmental Media and Transport Mechanism,


3. Point of Exposure,


4. Route of Exposure; and,


5. Receptor Population.
   
   

When all 5 parts of an exposure pathway are present, it is called a Completed Exposure Pathway. Each of these 5 terms is defined in this Glossary.

Frequency:

How often a person is exposed to a chemical over time; for example, every day, once a week, twice a month.

Hazardous Waste:

Substances that have been released or thrown away into the environment and, under certain conditions, could be harmful to people who come into contact with them.

Health Effect:

ATSDR deals only with Adverse Health Effects (see definition in this Glossary).

Indeterminate Public Health Hazard:

The category is used in Public Health Assessment documents for sites where important information is lacking (missing or has not yet been gathered) about site-related chemical exposures.

Ingestion:

Swallowing something, as in eating or drinking. It is a way a chemical can enter your body (See Route of Exposure).

Inhalation:

Breathing. It is a way a chemical can enter your body (See Route of Exposure).

LOAEL:

Lowest Observed Adverse Effect Level. The lowest dose of a chemical in a study, or group of studies, that has caused harmful health effects in people or animals.

Malignancy:

See Cancer.

MRL:

Minimal Risk Level. An estimate of daily human exposure - by a specified route and length of time -- to a dose of chemical that is likely to be without a measurable risk of adverse, noncancerous effects. An MRL should not be used as a predictor of adverse health effects.

NPL:

The National Priorities List. (Which is part of Superfund.) A list kept by the U.S. Environmental Protection Agency (EPA) of the most serious, uncontrolled or abandoned hazardous waste sites in the country. An NPL site needs to be cleaned up or is being looked at to see if people can be exposed to chemicals from the site.

NOAEL:

No Observed Adverse Effect Level. The highest dose of a chemical in a study, or group of studies, that did not cause harmful health effects in people or animals.

No Apparent Public Health Hazard:

The category is used in ATSDR's Public Health Assessment documents for sites where exposure to site-related chemicals may have occurred in the past or is still occurring but the exposures are not at levels expected to cause adverse health effects.

No Public Health Hazard:

The category is used in ATSDR's Public Health Assessment documents for sites where there is evidence of an absence of exposure to site-related chemicals.

PHA:

Public Health Assessment. A report or document that looks at chemicals at a hazardous waste site and tells if people could be harmed from coming into contact with those chemicals. The PHA also tells if possible further public health actions are needed.

Plume:

A line or column of air or water containing chemicals moving from the source to areas further away. A plume can be a column or clouds of smoke from a chimney or contaminated underground water sources or contaminated surface water (such as lakes, ponds and streams).

Point of Exposure:

The place where someone can come into contact with a contaminated environmental medium (air, water, food or soil). For examples:
the area of a playground that has contaminated dirt, a contaminated spring used for drinking water, the location where fruits or vegetables are grown in contaminated soil, or the backyard area where someone might breathe contaminated air.

Population:

A group of people living in a certain area; or the number of people in a certain area.

PRP:

Potentially Responsible Party. A company, government or person that is responsible for causing the pollution at a hazardous waste site. PRP's are expected to help pay for the clean up of a site.

Public Health Assessment(s):

See PHA.

Public Health Hazard:

The category is used in PHAs for sites that have certain physical features or evidence of chronic, site-related chemical exposure that could result in adverse health effects.

Public Health Hazard Criteria:

PHA categories given to a site which tell whether people could be harmed by conditions present at the site. Each are defined in the Glossary. The categories are:

- Urgent Public Health Hazard
- Public Health Hazard
- Indeterminate Public Health Hazard
- No Apparent Public Health Hazard
- No Public Health Hazard

Receptor Population:

People who live or work in the path of one or more chemicals, and who could come into contact with them (See Exposure Pathway).

Reference Dose (RfD):

An estimate, with safety factors (see safety factor) built in, of the daily, life-time exposure of human populations to a possible hazard that is not likely to cause harm to the person.

Route of Exposure:

The way a chemical can get into a person's body. There are three exposure routes:
- breathing (also called inhalation),
- eating or drinking (also called ingestion), and
- or getting something on the skin (also called dermal contact).

Safety Factor:

Also called Uncertainty Factor. When scientists don't have enough information to decide if an exposure will cause harm to people, they use "safety factors" and formulas in place of the information that is not known. These factors and formulas can help determine the amount of a chemical that is not likely to cause harm to people.

SARA:

The Superfund Amendments and Reauthorization Act in 1986 amended CERCLA and expanded the health-related responsibilities of ATSDR. CERCLA and SARA direct ATSDR to look into the health effects from chemical exposures at hazardous waste sites.

Sample Size:

The number of people that are needed for a health study.

Sample:

A small number of people chosen from a larger population (See Population).

Source (of Contamination):

The place where a chemical comes from, such as a landfill, pond, creek, incinerator, tank, or drum. Contaminant source is the first part of an Exposure Pathway.

Special Populations:

People who may be more sensitive to chemical exposures because of certain factors such as age, a disease they already have, occupation, sex, or certain behaviors (like cigarette smoking). Children, pregnant women, and older people are often considered special populations.

Statistics:

A branch of the math process of collecting, looking at, and summarizing data or information.

Superfund Site:

See NPL.

Survey:

A way to collect information or data from a group of people (population). Surveys can be done by phone, mail, or in person. ATSDR cannot do surveys of more than nine people without approval from the U.S. Department of Health and Human Services.

Synergistic effect:

A health effect from an exposure to more than one chemical, where one of the chemicals worsens the effect of another chemical. The combined effect of the chemicals acting together are greater than the effects of the chemicals acting by themselves.

Toxic:

Harmful. Any substance or chemical can be toxic at a certain dose (amount). The dose is what determines the potential harm of a chemical and whether it would cause someone to get sick.

Toxicology:

The study of the harmful effects of chemicals on humans or animals.

Tumor:

Abnormal growth of tissue or cells that have formed a lump or mass.

Uncertainty Factor:

See Safety Factor.

Urgent Public Health Hazard:

This category is used in ATSDR's Public Health Assessment documents for sites that have certain physical features or evidence of short-term (less than 1 year), site-related chemical exposure that could result in adverse health effects and require quick intervention to stop people from being exposed.

APPENDIX G: Public Comments and ATSDR's Responses

Comment:	Throughout the report, the maximum contaminant level (MCL) for THMs is referred to as 80 ppb, reduced from 100 ppb in February 1999. This is wrong. The MCL for THMs was set at 100 ppb in 1979, was 100 ppb for the entire period of the autism investigation, and continues to be 100 ppb. THMs take a new MCL of 80 ppb in December 2001. We request that all text be adjusted to reflect this correction and that the milestone of 100 ppb be used in Figure 6 instead of 80 ppb.
Response:	One page 9, first full paragraph ATSDR modified the text to read as follows: The EPA Maximum Contaminant Level (MCL) was 100 ppb based on an annual rolling average during the study period. It should be noted however that the EPA revised the MCL for THMs in the Federal Register on December 16, 1998. The MCL was lowered from 100 ppb to 80 ppb, but community water systems serving 10,000 or more persons have been given until December 2001 to comply with this change. ATSDR used the MCL goal of 80 ppb for some of its analysis in this report to be conservative from a public health perspective.
Comment:	We think that including the single THM data point of 251 ppb (240 ppb chloroform) in the report is unfair and unnecessary, as well as misleading. We indicated in email dated January 27, 2000, sent with supporting documentation, that it was probably an error. This is obvious also from the fact that the next highest value was 142 ppb THM (116 ppb chloroform). Apparently 251 ppb compared to 100 ppb looks more favorable in an inconclusive investigation that 142 ppb compared to 100 ppb.
Response:	ATSDR reviewed the information submitted on January 27, 2000 in regard to the 251 ppb THM data point. Based on our review of the data ATSDR believes that it was possible for this high THM level to exist at the Crab Shack sampling location. The information submitted to us indicating that the 251 ppb THM level was ''probably" an error was not convincing enough to disregard the data point, so therefore it was included in our PHA with a qualifying footnote on page 9. ATSDR again chose to be conservative from a public health perspective. The data comes from documents that are public record and we do not believe inclusion of this data point is unfair or misleading. Removing the 251 ppb THM data point from the PHA would not change our recommendations or conclusions.
Comment:	On page 8, in the first full paragraph, after "Groundwater has very little organic matter so the chlorination of groundwater produces very low or undetectable amounts of THMs.", why not state here that the groundwater was the primary source of water that was treated for the period of the investigation instead of separating the two ideas on page 7 and 8?
Response:	The first couple of paragraphs under Trihalomethanes were general introductory material in the PHA to help the public understand some of the issues around disinfection by-products. ATSDR included this statement to try and distinguish for the lay person that there is (1) a difference in the organic content of groundwater and surface water and (2) that because of the lower organic content in groundwater there would be less of a chemical reaction with the chlorine and therefore lower THM levels in the treated water.
Comment:	Also on page 8, why is the obscure DBP, MX, mentioned with THMs and HAA's? There are more than 300 drinking water byproducts of chlorination and the report chooses to mention the one that sounds like nerve gas (VX). What purpose does it serve?
Response:	ATSDR chose to mention DBP and MX, because of the known disinfection byproducts of chlorination they are two of the most potent in terms of mutagenicity. The full chemical name for MX is provided in parenthesis in the text on page 8 of the PHA, making it difficult to confuse one short chemical name with another (i.e. MX and VX).
Comment:	Again on page 8, the last sentence of the third full paragraph states, "It is not known whether these cancers are caused by [1] one or more of the THMs, by [2] some other disinfection byproducts in drinking water, or [3] some combination of THMs and other disinfection byproducts." This statement implies that cancer is certainly caused by either 1, 2, or 3. Why is cancer even discussed in a report on autism prevalence anyway ?
Response:	For clarification this sentence was changed to read as follows: It is not known whether the cancers in these studies were caused by one or more of the THMs, by some other disinfection byproduct in the drinking water, or some combination of THMs and other disinfection byproducts. In addition, the cancer studies cited in the PHA help to provide the public with a complete picture of the toxicity of these compounds. ATSDR addressed cancer issues in the PHA, because cancer concerns were expressed to the agency, by members of the community, during one or more public availability sessions.
Comment:	Regarding the landfill, the report indicates that "the groundwater beneath the landfill is contaminated with a variety of VOC's and metals." The next sentence leaps to, "Contaminated groundwater would be unlikely to adversely effect pregnant mothers or children near the site, because residents in the area are supplied water by the municipal drinking water system, preventing exposure to the contaminated groundwater." We have seen results of analyses performed on wells around the landfill and wells from a significantly large residential area south and east of the landfill. This is some of the most thorough groundwater contamination we have seen, both from a variety of contaminant and level of concentration standpoint. Additionally, you make the sweeping conclusion that exposure was prevented because municipal water was supplied. This assumes 1) the contamination was known to exist and , 2) that residents used municipal water when their wells remained useable. Well use restrictions were not imposed until 1999. For a variety of reasons such as chlorine taste/odor, the fact that well water is 'free', and a false sense that well water is safe, people generally prefer their well to city water when given the choice. Yet the landfill is quickly brushed aside as a possible cause of alleged increased autism rate because "residents in the area are supplied water by the municipal drinking water system". Additionally, the "municipal drinking water system" that precluded "adverse affects to pregnant mothers and children" in this area is the Brick Township Municipal Utilities Authority and we request that be made clear on pages 2, 14, and 18. This is the same water that "contains bromoform, chloroform, and PCE above ATSDR comparison values" and is only "unlikely to be associated with ASD in Brick Township.
Response:	The landfill summary paragraph beginning at the bottom of page one summarizes the Brick Township Landfill section beginning on page 14 of the PHA. ATSDR explains beginning on page 14 that a 1989 PHA and a 1995 Site Review and Update were completed and these documents concluded that there was no apparent public health hazard, because residents were supplied water by the municipal drinking water system (a.k.a. Brick Township Municipal Utilities Authority). Based on information obtained from the Ocean County Health Department and ATSDR's public availability sessions there was no indication that residents have been using private well water for drinking purposes in lieu of municipal drinking water. Based on current information ATSDR believes that there is no completed exposure pathway to the contaminated groundwater beneath the Brick Township Landfill. If ATSDR receives new information indicating residents are or have in the past used private well water for drinking water, for an extended period of time, we would consider that information in future PHA's or in other documents. Even though ATSDR does not believe that exposures to the groundwater occurred during the study period (except for sporadic use through irrigation, car washing, etc.) we did look at addresses during pregnancy for children with autism spectrum disorder and did not find a relationship with the groundwater plume. Comments were added on pages 2, 14, and 18 indicating that the municipal drinking water system is supplied by the Brick Township Municipal Utilities Authority.
Comment:	On page 14, fifth paragraph, why does the ATSDR conclude that there is "no apparent public health hazard as a result of ingestion of contaminated groundwater [around the landfill] because maximum exposure doses of chloroform and TCE detected in residential wells were below levels where adverse health effects were likely". What about the dementing concentrations of mercury, arsenic, chromium, benzene, and chlorobenzene?
Response:	The following sentences were added to paragraph 5, page 14 for clarification: This conclusion was based upon calculated exposure doses. It is unlikely that those residents exposed to chloroform or trichloroethylene in the past by drinking contaminated private well water will experience significant additional carcinogenic risk. Even though ATSDR does not believe the levels of chloroform and TCE from contaminated private well water increased the risk for adult cancers, we do not know whether these levels could increase one's risk of childhood cancers, birth defects or developmental disorders such as autism. ATSDR did evaluate address during pregnancy for children with autism in the study and found no relationship with the groundwater plume. Based on information reviewed by ATSDR chloroform and TCE were the only contaminants found in past residential well sampling. Mercury, arsenic, chromium, benzene, and chlorobenzene have been found in on and off-site monitoring wells, but were not detected in residential wells.
Comment:	On pages 4 and 5, the report states that in Brick there were 6.7 ASD cases per 1000, and 4 of autism per 1000, quickly followed by stating 1 to 2 per 1000 could be expected. This immediately invites the conclusion that there are elevated levels in Brick. But then and only then is it indicated that the technique of "intense case finding" was employed and these prevalence rates are "similar" to other studies that employ "intense case finding" methods. But this is only mentioned after "we found 6.7 and 4, and 1 to 2 is the norm (paraphrased).
Response:	The text beginning on page 4 was modified to read as follows: The intense case finding of this study may have contributed, to some extent, to the high rate of autism found in Brick Township. For example, recent studies that have employed intense case finding methods, to study populations of comparable size or larger than the Brick Township population, have found prevalences for autistic disorder as high as 3.1 cases per 1,000 children. However, these prevalences are still lower than the prevalence for autistic disorder found in Brick Township (i.e. 4 cases per 1,000 children). In addition, most of the children with autism in Brick Township were born in town, so migration cannot explain the high prevalence found. The prevalence report prepared by CDC followed the standard outline for presenting scientific findings. As such, other factors that may impact results, such as methodological issues, are presented in the Discussion section along with other information that may assist with interpretation of investigation findings.
Comment:	We request that the term U.S. and New Jersey" be replaced with "United States" on page 7, first sentence under a. Trihalomethanes. New Jersey is in the United States.
Response:	This change was made on page 7.
Comment:	In conclusion, the report used Brick's drinking water as a convenient subject to make statements like "probably does not cause cancer", in an effort to fill pages in a document that was probably not going to be well received. In the body of the report, there are 7.5 pages on the drinking water system, 1.5 on the landfill, 0.5 on Fluid Packaging, and 0.3 on swimming in the river. Also, the report suddenly and curiously changes focus away from autism and toward cancer, possibly because of the plethora of statements heard at the April 18 meeting, regarding the vagueness of the report. These statements included: "We would not have that information at this time." "Every study has its limitations." "There is unknown in this." "Muddier waters" "We don't have all the data in hand to determine if Brick is high." "There is no perfect study." This change of focus also allowed for reference to a much larger pool of data pertaining to emotional, catastrophic illness, fitting of this report.
Response:	ATSDR's PHA devotes more space to drinking water, because that was the only completed exposure pathway found in Brick Township and the contaminant levels in the municipal drinking water supply made it a plausible cause of the high autism prevalence, given the referenced studies on neural tube defects. The main focus of the PHA was to address whether community members may have been exposed to hazardous chemicals in the environment. The community's main concern was the relationship between chemicals in the environment and autism, but cancer was a secondary concern expressed to our agency. The majority of the PHA is devoted to exposures relevant to autism, but cancer issues are discussed. ATSDR tried to keep cancer information separate from the main document by placing this information in Appendix D.
Comment:	Both the contents and release of the Autism study in Brick Township, new Jersey was politics at its brilliant best and public service at its tragic worse. Twenty years of dumping mutagenic and carcinogenic chemicals being referred to as a "mineral oil spill" indicates the political nature of this entire report. It is more than a shame you think so little of our intelligence and so much of your own.
Response:	ATSDR removed the term "mineral oil spill" on page 15, paragraph three and replaced it with "Volatile Organic Compounds (VOC's) and metals". A list of the VOC's and metals and the levels at which they were found can be reviewed in the 1998 Brick Township Municipal Utilities Authority report titled Results of Fluid Packaging Data Review.
Comment:	More information on autism spectrum disorder should be included. The current knowledge base of mechanism and prevalence should be discussed.
Response:	For additional information regarding autism spectrum disorder and prevalence please see the Centers for Disease Control and Prevention report: Prevalence of Autism in Brick Township, New Jersey, 1998: Community Report, April 2000 and the ATSDR DRAFT Chemical Specific Consultation: Hazardous Substance Exposure and Autism, 1998.
Comment:	Either a section on autism spectrum disorders and their etiology should be added to this report or the public should be directed to literature that will help them understand what is currently known about autism and the disease characteristics.
Response:	General information on autism spectrum disorders, including information concerning etiologies, is contained in the ATSDR DRAFT Chemical Specific Consultation: Hazardous Substance Exposure and Autism prepared by the ATSDR Division of Toxicology. A reference to this review and information on obtaining a copy, have been added to the report. Other sources of information on autism spectrum disorders and their etiology can be obtained by contacting the following organizations: Centers for Disease Control and Prevention, Division of Birth Defects, Child Development, and Disability and Health http://www.cdc.gov/nceh/cddh National Alliance for Autism Research http://www.naar.org National Institute of Health http://www.niehs.nih.gov

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