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ATSDR > Public Health Assessments & Consultations

Petitioned Public Health Assessment

Soil Pathway Evaluation

Isla de Vieques Bombing Range
Vieques, Puerto Rico

V. COMMUNITY HEALTH CONCERNS

An integral part of the public health assessment process is addressing community concerns related to environmental health. ATSDR has been working with, and will continue to work with, the community to define specific health issues of concern. On multiple trips to the island, ATSDR has met with a variety of individuals and organizations, including local officials, physicians, nurses, pharmacists, leaders of women's groups, school educators, fishermen, and business people. ATSDR has also met with individual families. Meeting with a broad spectrum of community members is critical to determine health issues of concern and to assess the environmental health issues on Vieques.

General issues of health concern related to exposure to the soil on Vieques have been assessed in this PHA. In addition, ATSDR released a meeting summary report of an expert review panel who discussed the issue of whether an association existed between place of residence and morphological cardiovascular changes among fishermen (ATSDR and PSM 2001) and a PHA addressing Vieques groundwater and public water supply systems (ATSDR 2001b). Copies of these documents are available by contacting ATSDR (1-888-42-ATSDR) and from records repositories on Vieques. Public health issues related to exposure to chemicals in the air and in fish and shellfish were also evaluated by ATSDR. PHAs addressing these exposure pathways were released for public comment in October 2002.

This section of the PHA addresses additional community concerns relating to heavy metal uptake in plants and animals around Vieques and the state of the science of hair analysis.

Concern: Heavy Metal Contamination in Plants

Community members are concerned that heavy metals associated with the Navy's training activities are accumulating in agricultural plants and thereby, reaching the residents of Vieques through the food chain pathway.

In February and March 2000, researchers from Casa Pueblo and Recinto Universitario de Mayaguez (RUM), University of Puerto Rico, sampled the prevailing vegetation in the LIA (specifically Carrucho Beach, Monte David, and Gato and Icacos Lagoons) for heavy metals (Massol Deyá and Díaz 2000b). Reference populations of the same species were also collected in Bosque Seco de Guánica and RUM Alzamora Ranch. In addition, researchers from Casa Pueblo and University of Puerto Rico randomly collected agricultural and common vegetation from three sites within the residential section of Vieques: an agricultural area in Monte Carmelo, a section of Monte Carmelo that borders Camp Garcia, and an agricultural farm in Barrio Monte Santo, Gobeo sector (Massol Deyá and Díaz 2001). The authors reported that several species contained "excessive or toxic" levels of heavy metals and that these contaminants were moving through the food chain.

ATSDR determined through independent review with an agronomist with the US Department of Agriculture (USDA) that the studies provide insufficient evidence that heavy metals are accumulating in plants at a level that would cause harm to people.

First, many of the samples that were analyzed are not species that are eaten. In addition, when species that are eaten were sampled, the edible parts (e.g., pepper fruits, pumpkins, and seeds of pigeon peas) were not sampled, rather the stems and leaves were analyzed. Human exposures from locally grown foods can only be estimated from the edible portions of the food source (USDA 2002). In general, the edible portions of plants (e.g., fruits and berries) are less likely to accumulate metals from soil because of normal plant processes (e.g., physiological barriers that prevent contaminants from getting to the tops of plants) (ATSDR 2001a).

Second, without quality assurance samples, it is likely that errors occurred in the analysis process (USDA 2002). The reports lack the use of standard reference materials (e.g., orchard leaves available from the National Institute of Standards and Technology) to demonstrate that the results are accurate and background corrections for lead, cobalt, nickel, and cadmium to eliminate the effect of light scattering by non-element materials in the samples.

Third, research has shown that small soil particles can become embedded in the surface waxy layer of leaves and are difficult to remove (USDA 2002). Even with a thorough washing, soil particles will adhere to the plant materials. This adhered soil can actually carry more contaminants than what is taken up by the plant from the soil (ATSDR 2001a). When elements are present in plant samples as soil particles, they are often of low bioavailability and while the external contamination may also be ingested, the chemicals bound to soil are not usually in a form that can be absorbed by the body (USDA 2002). While there are methods to determine how much of a chemical concentration is adhered as soil and how much is in the plant tissue, these were not utilized by the researchers.

Because of these factors, ATSDR could not quantify exposures from these reports nor draw any health conclusions about whether consuming plants grown in Vieques would result in harmful health effects.

Concern: Heavy Metal Contamination in Livestock

Community members expressed concern over the possibility that livestock are accumulating heavy metals by grazing on contaminated plants. In support, a study by Casa Pueblo de Adjuntas reports that heavy metals were found in the hair of goats. To address this concern, the Puerto Rico Department of Agriculture in cooperation with the Farmers Association of Puerto Rico (AAPR) sampled grass, fruit-bearing trees, and bovine livestock from Monte Carmelo, Martineau, Monte Santo, Esperanza, Lujan, Gubeo, and western Vieques for cadmium, cobalt, copper, lead, manganese, and nickel. They concluded that the agricultural products from Vieques are suitable for consumption and do not contain toxic levels of these contaminants (El Nuevo Día 2001).

To date, ATSDR has not been able to obtain the original data or report that support these findings. Once the information becomes available, ATSDR will also evaluate whether eating agricultural products grown on Vieques could lead to any potential health effects.

Concern: Hair Analysis

Community members expressed concern that they were being exposed to unhealthy levels of metals, as shown by hair analysis. However, the medical literature recommends that physicians not rely solely on hair analysis to diagnose or treat heavy metal toxicity (Frisch and Schwartz 2002).

In June 2001, ATSDR convened an expert panel to discuss the state of the science relating to analyzing hair for environmental exposure (ATSDR 2001c). The panel consisted of individuals who represented state and federal government agencies, academia, and private practice and whose expertise, interests, and experience covered a wide range of related technical disciplines.

The panelists agreed that "for most substances, insufficient data currently exist that would allow the prediction of a health effect from the concentration of the substance in hair. The presence of a substance in hair may indicate exposure (both internal and external), but does not necessarily indicate the source of exposure." They noted that a relationship between contaminant concentrations in hair and any kind of measurable outcome have only been established for methylmercury and to a limited extent for arsenic, provided external contamination can be ruled out.

The expert panel recognized that laboratory methods exist to measure the levels of some environmental contaminants in hair, but commented that procedures need to be standardized to help ensure more accurate and reliable results. They also identified several factors that limit the interpretation of even the most accurate, reliable, and reproducible laboratory results: (1) the lack of reference (or background) ranges in which to frame the interpretation of results, (2) difficulties in distinguishing internal from external contamination in hair, (3) a lack of understanding of how and to what extent environmental contaminants are incorporated into the hair, (4) the lack of correlation between levels in hair and blood and other target tissues, as well as the lack of epidemiologic data linking substance-specific hair levels with adverse health effects, and (5) little information is available pertinent to the study of environmentally relevant organic compounds in hair.

Copies of the meeting summary report are available by contacting ATSDR (1-888-42-ATSDR) and on ATSDR's Web site (http://www.atsdr.cdc.gov/HAC/hair_analysis/).

Community members can direct additional health concerns to:

Program Evaluation and Records Information Services Branch
ATSDR, Division of Health Assessment and Consultation
Attn: Isla de Vieques, Puerto Rico
1600 Clifton Road, NE (E-56)
Atlanta, Georgia 30333

Community members can also telephone the ATSDR regional representatives in New York, New York at (212) 637-4307 or call the toll-free telephone number, 1-888-42-ATSDR.

VI. ATSDR CHILD HEALTH INITIATIVE

ATSDR recognizes that in communities faced with contamination of their water, soil, air, or food, infants and children can be more sensitive to environmental exposure than adults. This sensitivity is a result of the several factors, including (1) because they play outdoors, children are more likely to be exposed to certain media (e.g., soil); (2) children are shorter than adults, which means they can breathe dust, soil, and vapors close to the ground; and (3) children are smaller than adults, therefore childhood exposure results in higher doses of chemical exposure per body weight. To account for this greater susceptibility, ATSDR assumes a higher ingestion rate for children than adults. Because children can sustain permanent damage if these factors lead to toxic exposure during critical growth stages, ATSDR as part of its Child Health Initiative is committed to evaluating their special interests at sites such as Vieques.

Based on a thorough review of the available data, ATSDR concludes that children are not being exposed to harmful levels of chemicals in the soil on Vieques. As described in the Public Health Evaluation section (IV.C), most of the chemicals detected on Vieques are below conservative comparison values and; therefore, are not at levels of health concern. Childhood exposures were further evaluated for the seven metals (arsenic, cadmium, chromium, iron, lead, manganese, and vanadium) detected above comparison values, plus mercury. According to the toxicological and epidemiological literature, children can be more susceptible to arsenic, cadmium, iron, lead, and mercury exposures than adults. But whether children are more susceptible to chromium, manganese, and vanadium than are adults has not been established.

Children can experience health effects from lower arsenic doses (due to less inorganic arsenic being converted into organic arsenic) than those reported in the literature for adults. Nevertheless, the health effects levels are an order of magnitude higher than the exposure dose expected to result from children who incidentally ingest soil on Vieques. Furthermore, a 50% reduction in health effects levels to compensate for the greater susceptibility in children would still result in higher effects levels than the expected exposure for children contacting arsenic in the soil on Vieques.
Although children can experience health effects from a lower cadmium dose (due to the possibility that children can absorb more cadmium) than that reported for adults in the literature, the effects levels are still two orders of magnitude higher than the exposure dose expected to result from children incidentally ingesting soil on Vieques. Furthermore, a 50% reduction in effects levels to account for the greater susceptibility in children, would still result in health effects levels much higher than the exposure expected for children contacting cadmium in the soil on Vieques.
Children are more susceptible to accidentally poisoning themselves with iron-containing supplements than are adults. ATSDR specifically addressed childhood exposures in comparison to health effect levels of iron in the Public Health Evaluation section (IV.C) of this PHA, concluding that the dose expected to result from children incidentally ingesting soil on Vieques is well below documented health effects levels.
Children are more susceptible to health effects from exposure to lead than are adults. The health effects levels reported in the literature, however, are two orders of magnitude higher than the exposure dose expected for children incidentally ingesting soil on Vieques. In addition, the blood lead level expected to result from exposure to lead in the soil is below CDC's level of health concern for children.
During critical periods of development, children are more susceptible than adults to metallic mercury and methylmercury exposure. The health effects levels reported in the literature, however, are several orders of magnitude higher than the exposure dose expected to result from children incidentally ingesting soil on Vieques. Furthermore, a 50% reduction in effects levels to account for the greater susceptibility in children would still result in health effects levels several orders of magnitude higher than the exposure expected for children contacting mercury in the soil.

VII. CONCLUSIONS

Soil Characteristics

After evaluating the soil geologically to identify any chemical trends between geologic units (e.g., rock formations) on Vieques, ATSDR concluded that significant differences existed in the metal composition of soils developed on the different geologic units. The soil developed on a complex assemblage of marine sandstones, siltstones, conglomenates, lava, and tuff. The tuff (the Kv formation) is the most dissimilar geologic unit, with significantly different concentrations of 14 metals. The soil developed on the alluvial sands, silts, and gravels (the Qa formation) is similar to the soil developed on other geologic units, with no significantly different metals. This indicates that the soils of Vieques are strongly influenced by the constituent chemicals of their parent materials.
ATSDR compared the quality of the soil on Vieques with the sediment of the Puerto Rican mainland. After acknowledging the inherit differences between the two media, ATSDR noted that the soil of Vieques has higher concentrations of antimony, arsenic, cadmium, calcium, manganese, molybdenum, silver, strontium, and yttrium than the stream sediment samples collected throughout the mainland of Puerto Rico. However, when ATSDR compared the background sediment samples collected in the former NASD to the sediment data collected on the mainland of Puerto Rico, the levels of metals from the former NASD are lower or in the low end of the range.
ATSDR also compared the quality of the soil on Vieques with background soil concentrations within the United States. A statistical comparison was not conducted, but the average concentrations for several of the metals were noted to be higher on Vieques than the averages on the United States. The maximum concentrations of copper, iron, lead, tin, and zinc detected on Vieques were outside the ranges found throughout the United States. However, the levels detected on Vieques are not inconsistent with what one would expect from soils also underlain by igneous or volcanic rocks.
ATSDR evaluated whether Navy training activities have elevated the levels of metals in the soils of the LIA. To do this, ATSDR (1) compared concentrations of chemicals detected at the LIA to the remainder of Vieques and (2) compared concentrations of chemicals detected at the LIA to background soil samples in the former NASD. The results of the evaluations indicate that the soils of the LIA have been influenced by Navy training activities and contain elevated levels of heavy metals. However, the concentrations of the chemicals in the soil are not at levels that pose an adverse health threat (see the Public Health Evaluation section).
ATSDR evaluated general spatial trends for specific metals to identify whether a spatial pattern indicated chemicals are moving from the LIA to the residential area. The available data do not indicate a pattern of high to low concentrations from east to west. Thus, this data set does not provide evidence for airborne transport of metals from the LIA to the residential area.

Public Health Evaluation

ATSDR concludes that the levels of the metals found in the soil on Vieques would not result in harmful health effects for either adults or children who might incidentally ingest or come in contact with the soil while living on Vieques or while living on the LIA for a year. ATSDR has categorized this site as having no apparent public health hazard from exposure to soil on Vieques (definitions of public health categories are included in the glossary in Appendix B).

ATSDR compared the chemicals detected in the soil on Vieques to conservative comparison values. Only seven metals (arsenic, cadmium, chromium, iron, manganese, lead, and vanadium) were detected above comparison values. All other chemicals were detected at concentrations too low to be of health concern for anyone (adults and children) incidentally ingesting or contacting the soil. After evaluating in greater detail the seven metals detected above comparison values, as well as mercury, ATSDR reached the following conclusions:

Exposure to arsenic in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for adults and children are below the conservative health guideline for adults and below levels of health effects documented in the toxicological literature for children and (2) the small amount of arsenic that can be absorbed through the skin is not likely to result in any serious internal effects.
Exposure to cadmium in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for adults and children are below the conservative health guideline for adults and below levels of health effects documented in the toxicological literature for children and (2) virtually no cadmium can enter the body through the skin.
Exposure to chromium in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for adults and children are below the conservative health guideline for adults and below levels of health effects documented in the toxicological literature for children and (2) very little chromium will enter the body through contact with the skin.
Exposure to iron in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure dose from incidental ingestion for adults is below the conservative health guideline, (2) a child's estimated daily consumption is below levels known to result in childhood poisoning, and (3) only a minimal amount of iron is assumed to enter the body through the skin.
Exposure to lead in the soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for both adults and children are below levels of health effects documented in the toxicological literature, (2) the resulting child blood lead level is below CDC's health guideline, and (3) only small quantities of lead can be absorbed by the body through the skin, and what is absorbed represents a much smaller amount than that absorbed via ingestion.
Exposure to manganese in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for adults and children are below the conservative health guideline for adults and below levels of health effects documented in the toxicological literature for children and (2) the increased exposure expected to result from dermal contact is below the NOAELs documented in the literature.
Exposure to mercury in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for both adults and children are below levels of health concern documented in the toxicological literature and (2) the increased exposure expected to result from dermal contact is at least an order of magnitude lower than the reported NOAELs documented in the literature.
Exposure to vanadium in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for adults and children are below the conservative health guideline for adults and below levels of health effects documented in the toxicological literature for children and (2) due to its low solubility, vanadium is not considered to be readily absorbable through the skin.

ATSDR also conducted a public health evaluation specific to the protestors, who from April 1999 to May 2000 lived on the LIA. ATSDR compared the chemicals detected in the soil on Vieques to conservative comparison values. Only two metals (arsenic and iron) were detected above comparison values. All other chemicals were detected at concentrations too low to be of health concern for anyone (adults and children) incidentally ingesting or contacting the soil. After evaluating in greater detail the two metals detected above comparison values, as well as mercury, ATSDR reached the following conclusions:

Exposure to arsenic in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for adults and children are below the conservative health guideline for adults and children and (2) the small amount of arsenic that can be absorbed through the skin is not likely to result in any serious internal effects.
Exposure to iron in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure dose from incidental ingestion for adults is below the conservative health guideline, (2) a child's estimated daily consumption is below levels known to result in childhood poisoning, and (3) only a minimal amount of iron is assumed to enter the body through the skin.
Exposure to mercury in soil on Vieques is not expected to result in harmful health effects because (1) the estimated exposure doses from incidental ingestion for both adults and children are below levels of health concern documented in the toxicological literature and (2) the increased exposure expected to result from dermal contact is at least an order of magnitude lower than the reported NOAELs documented in the literature.

VIII. PUBLIC HEALTH ACTION PLAN

The Public Health Action Plan for Vieques contains a description of actions taken and those to be taken by ATSDR, the Navy, EPA, USGS, the Puerto Rico Environmental Quality Board (PREQB), and the Puerto Rico Department of Health (PRDOH). The purpose of the Public Health Action Plan is to ensure that this PHA not only identifies public health hazards, but also provides a plan of action to mitigate and prevent harmful human health effects that may be resulting from exposure to hazardous substances in the environment. The public health actions that are completed or ongoing are as follows:

Actions Completed:

Various organizations sampled soil, including USGS and PRDNR, the Naval Surface Weapons Center, contractors for the Navy, and Servicios Científicos y Téchnicos, Inc.
In August 1999, ATSDR conducted an initial site visit to Vieques to meet with the petitioner, tour the island and bombing range, and gather environmental data. As a result of this site visit, ATSDR accepted the resident's petition and initiated the public health assessment process.
In September 2000, ATSDR met with various agencies, including PRDOH, PREQB, EPA, USGS, and the Navy, to gather data and to discuss the scope and nature of ATSDR investigations. ATSDR also met with the petitioner to tour various sites on Vieques and to update the petitioner on our efforts.
In June and October 2000, ATSDR discussed with local health care providers their public health concerns and provided training regarding how to medically assess environmental exposures. During these visits ATSDR met with numerous residents of the island to discuss health concerns.
In February 2001, ATSDR released the public comment version of the Public Health Assessment for the Drinking Water Supplies and Groundwater Pathway Evaluation.
In March 2001, ATSDR held a public availability session to meet individually with community members regarding the findings of the evaluation of drinking water and groundwater on Vieques.
In April 2001, ATSDR toured Vieques both by land and by air with the principal purpose of identifying suitable areas to sample fish and shellfish off the coast of Vieques.
In June 2001, the Navy, ATSDR, and contractors for both collected air samples on Vieques to characterize levels of air contamination during air-to-ground bombing exercises. ATSDR's air exposure pathway PHA will document the sampling results.
In July 2001, ATSDR, the Ponce School of Medicine, and CDC sponsored an expert review panel to address whether an association existed between place of residence (Vieques or Ponce Playa) and morphological cardiovascular changes among fishermen.
In July 2001, EPA's Environmental Response Team--in cooperation with ATSDR--sampled fish and shellfish in the coastal waters off Vieques. A PHA will document the sampling results. ATSDR also met with the petitioner to provide an update on ATSDR efforts.
In September 2001, ATSDR conducted additional community involvement activities to inform participants of the scope of ATSDR investigations and seek additional community input. Continuing education and public health training was held for the nurses of Vieques and environmental health instruction was given to area parents and high school students.
In October 2001, ATSDR released the Public Health Assessment for the Drinking Water Supplies and Groundwater Pathway Evaluation.
In October 2001, ATSDR released a report summarizing the expert panel review addressing whether an association existed between place of residence (Vieques or Ponce Playa) and morphological cardiovascular changes among fishermen.
In October 2002, ATSDR released the public comment version of the Public Health Assessment for the Fish and Shellfish Evaluation.
In October 2002, ATSDR released the public comment version of the Public Health Assessment for the Air Pathway Evaluation.

Actions Ongoing:

ATSDR is continuing to meet with various community members and organizations to receive concerns and exchange information. This effort will continue throughout the public health assessment process.
ATSDR will continue to meet with local health care providers to discuss health concerns for the community and to provide educational materials for addressing the community's health needs.
PRDOH is working on Vieques and in Puerto Rico generally to gather information regarding the incidence of cancer in Puerto Rico and on Vieques. That information will be added to the current cancer registry information.
ATSDR will review cancer registry information and data gathered by PRDOH. The information will be evaluated as it relates to potential pathways of environmental exposure.

PREPARERS OF REPORT

Jeffrey Kellam, M.S.
Geologist
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation

W. Mark Weber, Ph.D.
Geologist
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation

Gary Campbell, Ph.D.
Environmental Health Scientist, Section Chief
Federal Facilities Assessment Branch
Division of Health Assessment and Consultation

Michelle Arbogast, M.S.
Environmental Scientist
Eastern Research Group

Dana Abouelnasr, Ph.D.
Senior Scientist
Office of Federal Programs

Paul Calame
Geographic Information Specialist
Electronic Data Systems

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Department of Health and Human Services

Petitioned Public Health Assessment Soil Pathway Evaluation Isla de Vieques Bombing Range Vieques, Puerto Rico

Petitioned Public Health Assessment

Soil Pathway Evaluation

Isla de Vieques Bombing Range
Vieques, Puerto Rico