PETITIONED PUBLIC HEALTH ASSESSMENT
NEWTOWN COMMUNITY
GAINESVILLE, HALL COUNTY, GEORGIA
The Agency for Toxic Substances and Disease Registry (ATSDR) was petitioned to evaluate health concerns for residents living in the Newtown Community in Gainesville, Georgia. The petition was filed by the Newtown Florist Club, a fifty-year-old organization in the Newtown community. Area residents expressed concern over high rates of cancer, lupus and respiratory diseases that community members believe may be caused by emissions from nearby industrial facilities and by the location of the community over a landfill.
ATSDR reviewed all available environmental and health outcome data and concludes that the data do not suggest a threat to human health. However, some data may not be representative of potential exposure conditions in this community. Available environmental data indicate that environmental media may contain chemical contamination, but below levels associated with adverse health effects.
Based on all available data, ATSDR has made the following observations:
ATSDR will conduct health education activities in Newtown. ATSDR has facilitated and will continue to facilitate the involvement of other agencies, as appropriate, to investigate remaining health and environmental concerns.
On April 10, 1995, a member of the Newtown Florist Club petitioned the Agency for Toxic Substances and Disease Registry (ATSDR) to investigate the potential public health impact of combined industrial emissions on the Newtown Community [1]. ATSDR reviewed and evaluated available data from the Georgia Department of Natural Resources (GaDNR), the Georgia State University Geology Department (GSU), the Georgia Department of Human Resources (GaDHR), the Newtown Florist Club, the Morehouse School of Medicine, Emory University, and an exposure investigation conducted by ATSDR's Exposure Investigation and Consultation Branch (EICB). ATSDR evaluated community concerns and available soil, methane gas, groundwater, tap water, stormwater runoff, air, and biological data to determine the potential and extent of the exposure of residents to environmental contamination. The purpose of this document is to identify potential human exposures and to recommend appropriate public health follow-up activities.
Newtown is a residential area located in the southeastern section of Gainesville, Hall County, Georgia. Before 1936, the area currently known as Newtown has been reported to be the site of the Gainesville/Hall County landfill. In 1936, a tornado passed through the community and destroyed many nearby homes. Debris from the tornado were disposed of in the landfill, the fill materials were burned, and the landfill was covered with soil. No records of the landfill existing before the 1936 tornado can be found, and the landfill does not exist in city planning maps dated 1930. Approximately 75 homes were rebuilt on top of the debris landfill and the surrounding area with federal Reconstruction Finance Corporation loans within a few years following the tornado [2,3].
The Newtown Community is located in a highly industrialized area of Gainesville, Georgia. Within three miles of the community, there are 14 facilities required to report to the United States Environmental Protection Agency (EPA) Toxic Release Inventory, and 56 additional businesses that are regulated by EPA because they handle, store, or use hazardous materials. The area directly south of Newtown is zoned heavy industrial. To the east and west properties are zoned as a mixture of general business, light industrial, and residential; the properties include a number of businesses, restaurants, and industries. To the north of the community, properties are zoned as residential. A railroad track borders the community to the south and provides rail access to the many facilities in the area. The railroad track is within 20 feet of the community playground. There is a hospital and a school within 1/4 mile of the community. For maps of the community, refer to Appendix A.
Previous studies report that the specific area of interest in Newtown is a 10 street block, with 143 households and approximately 350 African-American residents [4,5,6,7]. Current population estimates for Newtown are available for 1998 at the census block group level only [8]. Block groups contain between 250 and 550 housing units and are often used to distinguish area neighborhoods. Newtown is primarily located in census tract 131398 (8), block group 2. Appendix B, Table 1 provides data for this block group as well as comparison data for Hall county.
The block group containing Newtown is predominantly African-American; approximately 76% of the 631 residents are African-American. Caucasians account for 22% of the total population and about 2% are of another race. Median age is about 5 years older than the median age for the county (40.2 and 35 years of age, respectively). Figure 1 and Table 1 in Appendix B illustrate the age distribution in this community. The median number of school years completed is 11. Median household income in Newtown is $22,939 compared to the county median household income of $39,849. The area appears to be relatively stable in that the median length of residence is over 18 years, in contrast to the county which has a median length of residence of 9.7 years.
There are 350 housing units in block group 2, and the vast majority are occupied (93.4%). Approximately as many houses are occupied by renters as by owners (50.5% and 49.5%, respectively). Almost half the homes in this area were built before 1949 (46.6%) and 80% were built before 1970. The median housing value in the Newtown area is lower than that of the county, with the median home value being 41% of the county value ($40,556 vs. $98,986). For additional demographic information, see Appendix B.
Specific health concerns expressed by Newtown residents were related to exposure to toxic emissions, discharges, and fallout from surrounding industries. Residents believe a number of health conditions in the community may be attributable to industrial emissions, including lupus, cancer, kidney failure, respiratory ailments such as chronic bronchitis and asthma, and heart conditions. The community was built over a landfill in 1936, and residents have concerns about exposure to contamination from landfill soils and gases [1]. In addition, a junkyard nearby is a source of concern for many residents who believe stormwater runoff from the site may be contaminating community soils with metals, oil, grease, and gasoline. Residents have also expressed concern about lead contamination of their homes and drinking water. Finally, for a number of years, the community noticed a fine dust that settled on houses and cars that could have been attributed to two different facilities located within a tenth of a mile of the community. They believe this dust has compromised their respiratory health. No particulate data were available for analysis at the time of this report to permit examination of exposure to ambient dusts in air.
Of particular concern to residents in the area are hexane emissions from a nearby facility. Residents believe an accidental hexane release was the cause of an emergency evacuation of a neighboring community on May 19, 1995. This incident resulted in approximately 25 people visiting the local hospital and two people being kept at the hospital overnight or longer. During the course of that evening, approximately 100 people were evacuated from their homes. An odor permeated the neighborhood and residents allege that they experienced respiratory discomfort, nausea, and burning itchy eyes from invading fumes. Although residents believe the source to be the nearby soybean processing plant, Cargill, Inc., the United States Environmental Protection Agency (EPA) also investigated other possible sources of release. EPA staff interviewed facility and hospital staff and investigated Cargill, Inc. The plant superintendent indicated that the Cargill plant was being prepared for "hot work" following all necessary procedural guidelines and that nothing unusual happened that night. The hot work process requires pumping of all hexane from the extraction system to underground storage tanks and purging the system to below the lower explosive limit, with washdown and steaming. The process began at 5 PM and lasted until 3 AM. Gas analysis in the facility and the adjacent neighborhood did not reveal the presence of an elevated level of gas vapors. The investigation of this incident did not identify the source of the release; however, it was an emergency event that raised concern in the area about exposure to nearby facility emissions to a greater level [9]. ATSDR was also unable to determine the source of the environmental release, given available information.
In addition to concerns over facility emissions, residents expressed concerns about low-lying power lines and potential exposure to electromagnetic field radiation. Also, residents stated that excessive noise from the industries and the nearby railroad and that a large rodent population are a nuisance [1]. Noise nuisance issues are best addressed by the local health department. Nuisance noise and rodents are outside ATSDR's purview of work, however limited followup was done on the rodent issue by ATSDR.
The discussion section of this document contains an evaluation of the environmental data available in the Newtown Community. In preparing this evaluation, ATSDR uses established methodologies for determining how people may be exposed to potential contamination related to surrounding industries and what harmful effects, if any, may result from that exposure. Exposure pathways (ways that humans come in contact with chemical exposure) that ATSDR evaluates include ingestion (eating), inhalation (breathing), and skin contact. ATSDR compares chemical concentrations in air, soil, and water to comparison values (CVs) for each of the chemicals. Comparison values are concentrations of chemicals that are considered safe levels of exposure, even for sensitive populations such as children and the elderly. Chemicals detected below CVs are not likely to represent a health concern, and those above CVs require a more detailed evaluation of site-specific exposure conditions. While concentrations at or below a particular CV might be considered safe, it does not necessarily follow that any concentration that exceeds a comparison value would be expected to result in negative health effects in the community. It is important to keep in mind that the comparison values are often calculated with safety factors that make them hundreds, or even thousands, of times below a level that ATSDR would expect to cause illness and disease in humans. If a chemical does not have a comparison value, ATSDR reviews available scientific literature to determine if the levels are of health concern. For a complete discussion of these criteria (quality assurance considerations, human exposure pathway analyses, ATSDR's health comparison values, and the methods of selecting contaminants above comparison values), refer to Appendix C.
Power lines, electrical wiring, and appliances all produce electric and magnetic fields (EMFs). EMFs are invisible lines of force that surround any electrical device. Electric and magnetic fields have different properties and possibly different ways of causing biological effects. Both electric and magnetic fields weaken with increasing distance from the source [10]. Most of the concern about the association between power lines and cancer stems from studies of people living near power lines and people working in electrical occupations. Some of these studies appear to show a weak association between exposure to power line EMF and the incidence of cancer. However, epidemiological studies done in recent years show little evidence that power lines are associated with an increase in cancer, and laboratory studies have shown little evidence of a link between power line electromagnetic fields and cancer. A connection between power line fields and cancer remains biologically unproven [11].
Residents in Newtown have expressed concern about EMF and its potential relationship to childhood leukemia. The largest studies ever conducted of childhood leukemias and their relationship to power line EMFs reported that the studies revealed no significant evidence for an association between childhood leukemias and power line fields [12,13,14] .
Georgia Environmental Protection Division Air Monitoring
Air emissions in Hall County have decreased dramatically in the past ten years. Improved air pollution controls have been installed in all area facilities since the 1980s. The Newtown Community was established in the late 1930s, before most environmentally protective legislation was passed in the United States. Unfortunately, sampling and air monitoring data do not exist in this area prior to the 1990s. Therefore, past emission concentrations and exposure levels are unknown.
In early 1997, the Georgia Division of Natural Resources initiated air monitoring in the Newtown community to monitor air quality. The monitoring station is located at a grade school approximately ¼ mile north of Newtown's northernmost boundary. A 24-hour sample is taken one or two days a month. State officials meet with residents from time to time to discuss sampling results. Meteorological data were taken for 9 months prior to installing the monitor and revealed that air direction was from the industrial areas (south, southwest, west) to the school monitoring station approximately 18% of the time [3]. Sampling may therefore not be representative of the true exposures of residents in the area to industrial air contaminants.
During 1997, there were a total of 22 sampling events at the Fair Street School monitoring station. During this period, several contaminants were detected above comparison values (CVs). These include: benzene, methylene chloride, hexachlorobutadiene, arsenic, and cadmium. Cadmium and methylene chloride were detected twice, and both exceeded comparison values in one sample. Hexachlorobutadiene was detected once above comparison values, but not at all for the rest of the year. Benzene was detected more frequently, approximately a quarter of the time. Arsenic was detected at low levels in almost half of the samples taken. Although many metals and volatile organic compounds (VOCs) were detected in these monitoring efforts, the data reveal that these contaminants were detected far below levels at which adverse health effects have been observed in humans. Furthermore, most were detected infrequently [15]. Refer to Appendix D, Table 1 for further information on contaminants exceeding comparison values. Particulate data were not provided to ATSDR. Because levels rarely exceeded comparison values and were not found with a high level of frequency, ATSDR concludes that ambient air contaminant levels detected by the Fair Street School monitor are not a threat to human health. However, the location of the Fair Street School monitor may not be representative of Newtown ambient air conditions, and an investigation of this sampling location is warranted. No data were available in this document for particulate matter analysis, so no conclusions can be made regarding potential respiratory aggravation from particulates in air.
Air canister analysis-ATSDR Exposure Investigation
In January, 2000 ATSDR conducted an exposure investigation of air and soil. ATSDR staff and residents collected ten air samples that were tested for VOCs. The purpose of an exposure investigation is to provide a timely screening of an environmental media of concern. Exposure investigations are not in depth collections of environmental data, and do not provide complete characterization of sampled media because of the small number of samples collected.
The community was instructed on taking samples with the air canisters. When the samples would be taken was at the discretion of the residents. ATSDR staff trained four residents to take the air samples and accurately record necessary sample information. ATSDR also took several of the samples near facilities of concern to the community, including Georgia Chair Company, ConAgra Broiler Company, and Cargill, Incorporated. The air results indicate contaminant levels exceeding CVs for benzene, methylene chloride, toluene, and n-butanone in several samples [16]. However, methylene chloride was found at higher levels in the sample blank than in the residential samples, so the validity of the methylene chloride level detected is questionable. In this case, a sample blank is an unexposed air canister not carried to the Newtown area; it was handled and analyzed in the lab in the same manner as air canisters that were actually used to take samples in the community. Sample blanks ensure that a sample taken is a true representation of the contamination present at a site, and that levels reported are the result of air contamination, not of instrument contamination or laboratory error.
Benzene was the only contaminant detected at levels exceeding CVs within the boundaries of the Newtown residential area. Methylene chloride, toluene, and n-butanone exceeded comparison values outside the residential area, on the perimeter of the previously mentioned facilities. Hexane and hexane constituents, a major concern in the community, were detected in one sample at levels below ATSDR comparison values [16].
In a single sample, benzene exceeded the ATSDR cancer risk evaluation guide (CREG), but the lowest reported level at which cancer has been associated with benzene is 300 ppb [16, 17]. This association was found in chemical workers who had daily occupational exposure to benzene between the period of 1940 to 1970. ATSDR assessed cancer risk of benzene exposure using ambient levels of benzene detected in available environmental data. The risk assessment indicated that there is no apparent increase in cancer risk from benzene exposure within or in the area surrounding the Newtown community. More information about this evaluation is provided in Appendix G. Most likely, the presence of benzene is the result of high vehicle traffic in the area, and is not uncommon in urban and industrialized settings. Generally, background levels of benzene in air range from 2.8 to 20 per billions parts of air (ppb). People living in cities or industrial areas are generally exposed to higher levels of benzene in air than those living in rural areas. Smokers are also exposed to benzene in cigarettes. The average smoker takes in about 1.8 milligrams of benzene per day. This is about 10 times the daily average intake of nonsmokers [18]. Toluene exceeded the comparison values in a single sample, but was reported at levels unlikely to result in health effects. The highest detected level of toluene in this investigation was forty times lower than the lowest reported level resulting in adverse health effects [19].
Freon 11 and Freon 113 were detected in low levels in many of the samples. Freon 11 is the most toxic of the fluorocarbons, and has been banned from most uses in the United States. It is the most persistent fluorocarbon, and may remain in the atmosphere for years. Levels detected in this community are well below levels at which health effects have been reported. While environmental exposure limits have not been established, occupational exposures to these contaminants of 1000 ppm for 8 hours are not expected to result in health effects [20]. In addition, Freon 113 was detected in levels higher than in the environmental samples in the sample blank, which indicates uncertainty in the accuracy of the residential samples. 4-ethyltoluene was detected in two samples at very low levels, but does not have a comparison value. Toxicity of 4-ethyltoluene requires a very large oral dose to cause health effects in study animals, but no animal or human inhalation studies could be located. There are no reports in the scientific literature of human toxicity to environmental exposures to 4-ethyltoluene. This contaminant was not detected in residential areas or in the Newtown Community, but was detected by air canister samples taken near two industries at low concentrations. To review specific levels of concentrations exceeding ATSDR comparison values, see Appendix D, Table 2. In conclusion, data analyzed for the ATSDR exposure investigation do not indicate a health hazard in residential ambient air. However, the isolated elevations of VOCs detected in air may warrant the relocation of the state air monitor closer to the community so that these contaminants may be more closely monitored.
Subsurface soils
A public meeting was held by the Georgia Department of Natural Resources (GaDNR) for Newtown residents in 1993 regarding resident concerns about the contents of the landfill and sinkholes in some residential lots. Following the public meeting, the Georgia Geologic Survey conducted a subsurface soil and methane gas analysis of the Newtown community. The purpose was to investigate the causes of sinkholes in some residential yards, determine the type of landfill which previously existed on the site, characterize waste material of the site, and determine if the landfill material, if present, posed any threat or danger to Newtown residents [6].
Later that year, the Georgia DNR drilled 21 borings ranging in depth from 3 to 23 feet in residential yards along four streets (see Figure 1 in Appendix E for sample locations). The study found that major components of the landfill include glass, china, charcoal, concrete, metal, and bricks. The landfill is shallow, with a maximum depth of 6 feet. Most of the landfill materials are located in the area between Mill and Cloverdale Streets on the north and south, and Elm and Harvey Streets on the west and east. Eight subsurface soil samples collected from two of the 23 borings were analyzed for VOCs (volatile organic compounds), SVOCs (semi-volatile organic compounds), pesticides, PCBs (polychlorinated biphenyls), and metals [6]. Aluminum, arsenic, and vanadium exceeded comparison values for children who exhibit pica behavior, but not for adults and children who do not exhibit this behavior (see Appendix E, Table 1). Pica behavior is exhibited in individuals who eat non-food items, such as soil and clay. However, since the most shallow samples were collected at the subsurface level, any contaminant exposure to children is unlikely.
The Georgia DNR report indicates that the landfill under a portion of the Newtown community was essentially one where materials were piled and burned. The sinkholes residents reported were due to jumbled construction debris underlying parts of some streets. Only two of the 21 borings were analyzed for metals, volatile and semivolatile organics, PCBs, and pesticides. The small sample size prevents a complete characterization of surface soils, especially because the two surface soil samples that were collected were a composite of 12 inches of soil.
Since the community was built on a landfill, Georgia DNR conducted a methane survey on 44 residences, none of which revealed significant levels of methane. No value exceeded 1 percent LEL (the lower explosive limit of methane is 4%) [6].
In 1994 an additional soil analysis was conducted. The University of Georgia drilled 9 borings and analyzed 27 soil samples for a limited number of metals (see Appendix D, Figure 2 for sampling locations). Again, only two of these samples were within the top foot of soil, and both were composite samples. Aluminum, iron, manganese, molybdenum, and nickel exceeded ATSDR comparison values for pica children, but not for adults or normal children. In addition, iron exceeded EPA's Risk Based Concentration Levels (RBCs) levels in several samples, and lead exceeded RBCs in a single sample. Lead was detected at this level at 9 feet below the soil surface (see Appendix D, Table 2) [7].
Several metals exceed comparison values for children who exhibit pica behavior. In order to determine whether or not children exhibiting pica behavior are at risk for exposure to any of these metals, more information is needed to determine if children in this community exhibit pica behavior, and if so how often and how long they exhibit pica behavior. The likelihood that this behavior is widespread is low, as this behavior is unusual and occurs in short duration in few toddlers and young children. It is highly unlikely that children exhibiting this behavior would be able to access subsurface soils. ATSDR concludes that elevated concentrations of some metals were identified in subsurface soil at the location of the Newtown dump site, but the metals detected in subsurface soil were not present at levels that threaten human health. However, no surface soil samples were analyzed, and the number of samples taken is inadequate to characterize the extent of soil contamination. Subsurface soils in the community pose no health hazard to residents.
Surface Soils- ATSDR Exposure Investigation
In January, 2000 ATSDR conducted an exposure investigation of air and soil. ATSDR staff and residents collected five composite soil samples that were tested for metals. The purpose of an exposure investigation is to provide a timely screening of an environmental media of concern. Exposure investigations are not in depth collections of environmental data, and do not provide complete characterization of sampled media because of the small number of samples collected.
Surface soils were collected at depths of 0-3 inches in the residential playground within the community. Residents had expressed concerns that stormwater runoff from the junkyard adjacent to the community may be a source of contamination for the playground. The junkyard had been found out of compliance with Georgia Rules for Solid Waste Management and the Georgia Rules for Air Quality Control twice in 1999. As of November 1999 the manager of the facility had not produced a pollution prevention plan and had no stormwater runoff controls on the property. The runoff water collects in the playground because the playground is the lowest lying area in the community.
In this investigation, iron, aluminum, selenium, and thallium exceeded comparison values for children exhibiting pica behavior [16]. These levels would not be expected to cause adverse health effects in adults and children with normal exposure scenarios (see Appendix E, Table 3). However, pica children may be at somewhat greater risk but it is doubtful that pica behavior would be of sufficient frequency and duration to result in health concerns. The metals detected are not ones that would normally be associated with a scrap metal yard, but are instead naturally occurring minerals frequently found in soils. Based on the results from the exposure investigation, additional surface soil sampling of the playground is not warranted, and playground soils do not represent a health threat to Newtown residents.
Groundwater
In July 1993 two groundwater monitoring wells (MWs) were installed by the Georgia Department of Natural Resources. Data indicate that the two wells were sampled one time on the residential properties. The levels reported did not exceed comparison values, with the exception of iron in one of the monitoring wells [6]. Iron is a metal commonly found in soil and water. It slightly exceeded the risk-based concentrations (RBCs) established by the US Environmental Protection Agency (EPA) for drinking water, however the water tested in this community is not used for drinking water. Newtown has been on a municipal water supply since it was established in the late 1930s. Please refer to Appendix F, Table 1 for the results of this sampling and Appendix F, Figure 1 for a map of groundwater monitoring wells.
Groundwater was also tested by the University of Georgia. Two additional groundwater monitoring wells were drilled to the depths of 10 to 20 feet for the analysis of groundwater samples. All samples taken fell within acceptable drinking water ranges for metals and major ions as determined by the Federal Primary Drinking Water Standards, with the exception of chlorine (Appendix F, Table 2 and Figure 2). Chlorine was found at levels exceeding ATSDR's comparison values in two of the wells. In monitoring well 1 and monitoring well 2, these levels were found to be 8800 ppb (parts per billion) and 22,800 ppb [7]. These levels exceed ATSDR comparison values for chronic oral RMEGs (non cancer risk) for children (1000 ppb) and adults (4000 ppb). The presence of the chlorine is not naturally occurring, and the source of the chlorine in these samples is not known. However, since groundwater is not used for drinking water in this community, ATSDR concludes that residents are not likely to be exposed to the water, and that groundwater contamination is not a threat to human health to this community.
Stormwater Runoff
In October 1993, samples of stormwater runoff water were analyzed for 129 priority pollutants and for water quality pollutants by the City of Gainesville Public Utilities Department. Four metals were found to be present above detection limits. These included: lead, chromium, copper, and zinc. No volatile organic compounds (VOCs), pesticides, or polychlorinated biphenyls (PCBs) were detected. For sampling results and maps see Appendix F, Table 3 and Figure 3.
Levels of these metals were very often below those that are found naturally in the environment, and all fell below ATSDR comparison values [21]. However, there was an unexplained high level of fecal coliform bacteria. The source of the bacteria was not identified, but it was concluded that contributors could be the Purina plant, a lot where dogs are walked, a faulty sewer service line, leaking septic tanks, and ill-fitting manhole covers. A letter of correspondence between two state officials dated as early as 1975 acknowledged elevations of fecal coliform bacteria, stating that septic tanks may have been faulty and were discharging into the storm drains. However, there is no evidence that the source of this contamination was identified [22]. City public utility officials have determined that background levels of fecal coliform in Hall County commonly exceeds a count of 100,000, particularly in summer months. Tributaries of a nearby lake and the heads of small streams and creeks are also reported to have elevated fecal coliform counts [23].
Stormwater is not used as a drinking water source by this community. However, children in the community who play or swim in the stormwater runoff may be at higher risk for exposure to organisms that could cause illness. This is due to contamination of the water from the feces of warm blooded animals, including humans. Fecal coliform bacteria are "indicator" organisms of fecal contamination which may harbor other organisms. These other organisms can cause a number of health disorders and illnesses including gastro-enteritis, giardiasis, typhoid, dysentery, cholera, and hepatitis [24]. A number of studies have associated outbreaks of coliform-related illnesses with exposure to contaminated water by ingestion and dermal contact [25,26,27].
ATSDR concludes that exposure to chemical contamination in stormwater runoff is not likely to result in health effects, however, exposure to stormwater contaminated with fecal organisms via dermal absorption, inhalation, or incidental ingestion of contaminated stormwater runoff could potentially result in adverse health effects.
Tap Water
On October 19, 1999 the City of Gainesville Public Utilities Department tested seven residential homes for lead in tap water. Residents were concerned that their homes may have lead pipes that may expose them to unhealthy concentrations of lead. All lead levels found in residential taps were below EPA's risk-based concentration levels (see Appendix F, Table 4). Also, municipal water for the City of Gainesville is regulated under the Safe Drinking Water Act, and is regularly tested for quality assurance [28]. Since no samples exceeded the comparison values, ATSDR concludes that the tap water of the homes sampled is not contaminated with lead at levels of health concern.
Children are at greater risk than adults for certain kinds of exposure to hazardous substances emitted from waste sites and emergency events. They are more likely to be exposed for several reasons:
Therefore, ATSDR evaluated the types and quantities of chemicals detected in the air, water, and soil in the community to determine how children might be exposed and whether levels detected in the community could be associated with any reproductive or developmental effects.
While there are children living in the Newtown community, they generally do not have access to surrounding sites. Residents have reported problems in the past with children having easy access to the neighboring facility properties. However, during their visits, ATSDR staff did not notice any current holes in the fences or other points of access for children to the junkyard or any other nearby sites. ATSDR closely reviewed possible exposure situations for children while evaluating this site (for example, air exposure, trespassing, and soil in the community playground). In its evaluation, ATSDR used the Environmental Media Evaluation Guidelines (EMEGs) for children, who are considered the most sensitive segment of the population. No special chemical hazards to children were identified on the basis of available data, except slight potential risk in the community playground for children exhibiting pica behavior. Because only limited data were available for facilities in the surrounding community before 1987 (when pollution controls were more elementary and emissions were greater), no conclusions could be drawn regarding past air exposures.
There were two other hazards to children identified. Children exposed to stormwater runoff contaminated with fecal materials are at a greater risk for incidental ingestion, inhalation, or dermal contact with bacterial organisms that may cause gastrointestinal illnesses. In addition, some residential yards have sinkholes from decaying landfill debris, exposing some of the debris to the surface of the soil. The debris may pose a physical threat to children who play in or around these sinkholes, to the extent that children could sustain cuts from glass or other discarded items.
Health outcome data and health statistics are collected by government agencies, hospitals, universities, and other businesses such as insurance companies. It is collected from people on a local, statewide, or national scale. Some diseases are required to be reported by hospitals to government agencies to track their occurrence, such as cancer, heart disease, and birth defects. This information is included into computer databases that allow researchers to study trends of disease (surveillance), how often diseases are diagnosed (incidence), how many people are living with a particular disease (prevalence), and how many individuals die of the disease in a given period of time (mortality). Examining disease this way can help plan health intervention activities, identify disease trends, and determine the magnitude of disease incidence and prevalence to prioritize research efforts. These databases make it possible to determine if the rate of disease is occurring at a normal rate, or at a rate higher than expected. ATSDR reviewed four studies conducted by the community itself, a state agency, and two universities. Each study used existing health data or collected new information to examine disease in Newtown. The studies included a report of illnesses by community members, an epidemiologic study of cancer incidence, a study of biological samples, and a lupus study.
Newtown Community Survey- Newtown Florist Club
In the spring of 1990, the Newtown Florist Club members conducted a door-to-door survey that queried people about disease incidence and prevalence in their households. The data collection was self-reported and often the result of family testimony. Results were compiled from 40 households where families were residents for at least 20 years. The report includes the names and addresses of those reported with illnesses. Desota Street residents reported a disproportionate number of cancer illnesses, lupus, respiratory ailments, and death [5]. Desota Street is in close proximity to the junkyard, the Purina plant, and the Leece-Neville company. The results of this survey prompted the community to request the assistance of Georgia Department of Human Resources to conduct a more intensive health study of the community.
Georgia Department of Human Resources-June/July1990
Newtown Neighborhood Cancer Investigation-A State Epidemiologic Study
A representative from the Newtown Florist Club wrote a letter to the State of Georgia's Directors Office of Epidemiology, Division of Public Health, concerning the high rate of disease observed in the survey the club conducted and the possible link to exposures to toxic substances. In response, the Georgia State Department of Human Resources (DHR) agreed to conduct an epidemiologic study in the Newtown community. Georgia DHR collected information through surveys administered by Hall County Health Department employees. The study was directed by a Georgia DHR official and a physician from Morehouse School of Medicine.
The study collected information on cancer incidence through telephone interviews. The telephone numbers and addresses of community members were obtained through the Gainesville City Directory. Each health department employee attempted to contact a resident by telephone for two consecutive evenings, after which time if the resident could not be contacted, a visit was made to the resident's house for a face-to-face interview. Of 143 households in the community, 114 (79.7%) were successfully surveyed. Residents were asked to provide information on each member of the household who lived in the household for 6 months or more between 1970-1989. The data from this investigation were compared to the number of expected cancer cases in a comparison population and tested for statistical significance. Observed cases were those which were verified through the Northeast Georgia Tumor Registry, private physician and hospital records, or death certificate [29].
The study concluded that there was a higher incidence of cancers of the buccal cavity and pharynx than would be expected in a similar population, and that the higher rate of incidence was associated to the behavior and lifestyle of residents. The study indicated that all four individuals who reported this type of cancer had a history of drinking and smoking [29]. However, no data were provided to substantiate the association between these cancers and behavior and lifestyle.
The largest limitation of this study is that the comparison population used was Metropolitan Atlanta, a population which may not be representative of the Newtown population, who live in a more rural area. An urban population is probably more likely than the Newtown population to have better access to care and a different set of exposure scenarios. Using an urban population for comparison of cancer rates may mask or exaggerate expected cancer rates, and result in inaccurate analysis of cancer incidence in this community.
ATSDR obtained additional cancer information from the Northeast Georgia Medical Center cancer registry for cancers diagnosed from 1980 to 1996 in the Newtown community. This hospital was chosen because it is a public hospital within a quarter mile of the community. The most frequently occurring cancers in this community were prostate cancers, colorectal cancers, breast cancer and cervical cancers. These cancers are among the most commonly reported cancers in the United States, and most are very common in aging populations. The median age in Newtown is about 5 years older than in the county (40.2 and 35 years of age, respectively). Incidence and death rates from cancer increase markedly with advancing age. Because Newtown has a large elderly population, elevations of certain types of cancer are expected in the community. With the exception of cancers of the buccal cavity and pharynx, the cancer rates noted are within acceptable ranges given the age and sex distribution of Newtown's population. No new cancers of the buccal cavity and pharynx have been diagnosed in the community since 1987.
The lack of cancer patterns makes it difficult to draw conclusions about industrial emissions and their relationship to cancer incidence in this community. There were eighteen different types of cancer observed in Newtown in the study period, and they follow the frequency patterns of the United States cancer rates. Cancers caused by contamination of the environment are usually markedly present in highly elevated numbers, with only a single cancer or several related cancers present at abnormally high levels. ATSDR cannot associate such a wide distribution of different types of cancers to environmental emissions when environmental exposures experienced by residents in the past are unknown.
Morehouse School of Medicine-Hair Sample Collection
In April of 1994, a physician instructor at the Morehouse School of Medicine collected biological samples of head hair from sixteen individuals in the Newtown Community. The study was intended to screen nutrient mineral and toxic mineral levels in the hair of the subjects. ATSDR analyzed the raw data because no report of screening results was written. Levels of the following nutrient minerals were found in the hair of subjects at least fifty percent of the time, and at two standard deviations above the mean of the EPA comparison population: calcium, magnesium, sodium, potassium, iron, and chromium. Chromium and calcium were the most commonly noted minerals, present approximately sixty-six percent of the time. Chromium was present mostly in young women, and could potentially be related to home or occupational exposure. Chromium levels reported were not speciated, i.e. differentiated as to the type of chromium, and it is assumed that the reported levels were for total chromium. Chromium absorption through occupational exposure is possible and has been documented in many studies. For example, absorption of inhaled chromium following occupational exposure has been demonstrated by the measurement of chromium in serum, urine, and hair of workers in the leather tanning industry [30,31]. Chromium occurs naturally in the environment and has several forms. Chromium III is found in vitamins, dietary supplements, food, water, and air and is an essential nutrient for human survival. Chromium VI and chromium 0 are generally produced in industry. Chronic exposure to high levels of any form of chromium can be harmful [32].
Aluminum and nickel were present in approximately half of the subjects at levels two standard deviations above the mean of the comparison population or more. However, because these metals were not found to be highly elevated in other environmental media, ATSDR does not believe the elevations to be environmentally related. These minerals are also found in many popular multi-vitamins. One ten year old child was tested and had a significantly high elevation of lead in his hair, but further investigation would be necessary to determine the exposure route and if the exposure is environmentally related. The level of followup on this child is unknown.
Emory University-Systemic Lupus Erythematosus in Relation to Environmental Pollution: An Investigation in an African-American Community in North Georgia
A study of prevalence and incidence of lupus was conducted in Newtown by a medical resident and faculty member at the Rollins School of Public Health in 1994 and 1995. Eighty-one households were surveyed, lending information on 246 residents. Attempts were made to interview every household by telephone. Lupus cases were verified with medical records.
The study found a six-fold increase in the prevalence of lupus in this community and a nine-fold increase in incidence compared to rates in U.S. population studies. The comparison rates used in this study were derived from three population studies and may not be representative of the true prevalence and incidence of the disease in the United States. The researchers found three cases of lupus in the community and one case from a resident that had recently moved from the community. The study also gathered information on 12 past unconfirmed cases in residents who lived in the community in the 1960s and 1970s. The researchers suggested that the prevalence and incidence could be under-reported in this particular study, because only 81 of 143 households (56%) were surveyed [4].
The exact cause of lupus is unknown. However, certain drugs have been shown to be linked to lupus, and it is possible that environmental toxins could induce lupus. The Arthritis Foundation reports that more than 70 drug agents can induce lupus; 90 percent of drug-induced lupus patients develop the disease from one of six agents: procainamide, quinidine, hydralazine, phenytoin, D-penicillamine, or isoniazid. Other possible causes of lupus include family history of lupus, excessive ultra violet light exposure, chemical exposure (such as aromatic amines in drugs, food dyes, and cigarette smoke), infections (such as Epstein-Barr virus, parvovirus), estrogen containing hormones, exposure to hair dyes, and perhaps even certain forms of stress [33].
Lupus is more common in black females than in any other ethnic group, and minority women constitute the majority of lupus cases [34,35]. Actual rates are unknown, as prevalence studies are difficult to conduct and current rates are based on studies with very small sample size and considerable variability. This study verified the presence of lupus in three residents and one previous resident. However, the small sample size and lack of sufficient environmental data to substantiate environmental relationships with lupus make it difficult to draw associations between disease in the Newtown community and environmental exposure.
Access to surrounding facilities is restricted by fences, however, at various times, fences in need of repair have allowed children to gain entry to the junkyard. The railroad track that passes directly behind the playground and is along the southern most border of the community has a footpath next to it that passes through and around some local facilities. The easy access to the train tracks could be dangerous to area children. Also, some residents report that glass fragments and pieces of broken china from the landfill are surfacing because of the shallow depth of the landfill. Some residents have also reported sinkholes where debris has settled from the landfill, creating potentially dangerous uneven ground and exposing landfill materials that were previously not exposed.
Overall, ATSDR categorizes this site as an Indeterminate Health Hazard to residents living in the community. Although current data do not support evidence of widespread contamination, data are incomplete for some media and require further investigation.
Completed Activities:
Future Activities:
Prepared by:
Michelle A. Colledge, M.P.H.
Environmental Health Scientist
Petitions Response Section
Exposure Investigation and Consultation Branch
Division of Health Assessment and Consultation
David A. Fowler, Ph.D.
Environmental Health Scientist/Toxicologist
Petitions Response Section
Exposure Investigation and Consultation Branch
Division of Health Assessment and Consultation
Additional Team Members:
Gregory M. Zarus, MS
Atmospheric Scientist
Exposure Investigation Section
Exposure Investigation and Consultation Branch
Division of Health Assessment and Consultation
Jerome Cater, Ph.D.
Environmental Health Scientist/Immunologist
Health Consultation Section
Exposure Investigation and Consultation Branch
Division of Health Assessment and Consultation
Reviewed by:
Donald Joe, PE
Section Chief
Petitions Response Section
Exposure Investigation and Consultation Branch
Division of Health Assessment and Consultation
Captain John Abraham, PhD
Branch Chief
Exposure Investigation and Consultation Branch
Division of Health Assessment and Consultation
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