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PUBLIC HEALTH ASSESSMENT

HIPPS ROAD LANDFILL
JACKSONVILLE, DUVAL COUNTY, FLORIDA


B. Health Outcome Data Evaluation

FHRS epidemiologists attempted to evaluate the cancer rates in the 32222 zip code encompassing the site. This evaluation considered all cancer data contained in the Florida Cancer Data System (FCDS), an FHRS program operated by the University of Miami School of Medicine that covers all cancers reported in Florida between 1981 and 1987. Nevertheless, problems with the population data made it impossible to calculate valid cancer rates for this zip code. In addition, in response to the residents' request, FHRS epidemiologists reviewed the 1991 epidemiology report prepared for the Hipps Road residents' lawsuit against the U.S. Navy (Paigen 1991). State epidemiologists found the report inconclusive because: it surveys medical records of exposed residents only without comparison to a control group, the participation rate was low, and there was no characterization of the differences between participants and non-participants. Consequently, we could not determine if cancer or other illness rates within this area are elevated.

C. Community Health Concerns Evaluation

In this subsection, we address the community health concerns in terms of our findings presented in the Toxicological Evaluation subsection above. Nearby residents are particularly concerned about the potential additive effects on the same body organ from the many chemicals found around the site. Little is known about the interactive effects among all the chemicals found at the site, but when we have this information, we consider it in our evaluation. Still, the existence of additive effects does not depend solely upon two or more chemicals affecting the same tissue. True additive effects on a particular organ depend upon two or more chemicals affecting the same cell type within a tissue, and affecting the same mechanism within the common cell type. Often, the cellular mechanisms by which contaminants exert their toxicity is unknown.

Although we interpret the health concerns in terms of our toxicological findings, it is important to remember that many of the individual symptoms, conditions, and illnesses reported by the community have more than one cause. Similarly, any one reported symptom may be indicative of many different illnesses. An in-depth health study is required to distinguish between illnesses caused by substances found at the site and those caused by other agents. Therefore, our findings in this subsection are best interpreted in terms of health problems that are possible, instead of health problems that are likely.

Conversely, it is also important to remember that our not finding an association between a contaminant and an illness in the toxicological literature does not necessarily mean the association does not exist. There are two possible explanations for this insufficiency in the literature. On one hand, there truly may be no association between a contaminant and a specific illness, or between a contaminant at the estimated concentration and a specific illness. Consequently, certain health effects will not be found no matter how many studies are conducted. On the other hand, there may not be enough reliable studies to identify an existing association between a contaminant and an illness. Therefore, the associations should be found if there were more studies. Without more research, we cannot tell which alternative correctly describes the literature insufficiency.

We address each community health concern as follows:

Circulatory System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused heart and circulatory problems in the community, including: blood clots, anemia, blood disorders, blood poisoning, phlebitis, heart murmurs (including mitral valve prolapse in males), arrhythmias, palpitations, cardiomyopathy, pericarditis, atherosclerosis, high blood pressure, angina, other chest pain, aortic aneurysms, heart attacks, and stroke.

    Lead ingestion doses similar to past doses we estimated for all age groups have been associated with blood formation problems in the human and animal studies we reviewed. Young children are more sensitive than adults to the effects of lead exposure. In addition, lead can cross the placenta, and unborn babies seem to be more sensitive than their mothers to the effects of lead ingestion (Amdur et al. 1991; ATSDR 1993l). The present-day lead ingestion doses we estimated for young children are somewhat smaller than the doses associated with the blood formation problems in these studies. The blood formation problems associated with lead exposure at these levels include decreased formation of heme, an important constituent of blood and other cells. In the blood, heme is the functional component of hemoglobin, the part of the blood that carries oxygen to body tissues. Decreased amounts of hemoglobin in the blood can cause anemia, a condition characterized by a reduced amount of oxygen reaching the body tissues. People with anemia may report the following circulatory or respiratory symptoms: fatigue, shortness of breath, or heart palpitations. Doctors may hear a rapid heartbeat or a heart murmur upon ejection of the blood into the body. These symptoms represent circulatory and respiratory adjustments the body tries to make to compensate for the decreased oxygen carried by the blood. The degree to which symptoms occur in an individual depend upon the presence of underlying heart or blood vessel disease as well as the severity and chronicity of the anemia. If the anemia has developed rapidly, there may not be time for the compensatory adjustments to take place, and a person may have more marked symptoms than if an anemia of equal severity had developed more slowly. Individuals with mild anemia often have no symptoms, whereas persons with severe anemia may show symptoms while at rest. The symptoms of severe anemia can extend to other body organ systems, and may include: dizziness, headache, fainting, ringing in the ears, difficulty in sleeping, difficulty in concentrating, hypersensitivity to cold, anorexia, indigestion, nausea, bowel irregularity, abnormal menstruation (either lack of menstrual periods or excessive bleeding during menstrual periods) in females, or impotence or loss of sex drive in males (Wilson et al. 1991).

    Heme is also a component of other chemical systems in the body. For example, heme is a part of the energy-producing system within cells. Decreased amounts of heme in the body may impair cellular energetics, particularly in cells of the nervous system. As a result, decreased amounts of heme may be related to nerve dysfunction in some individuals. In addition, reduced amounts of heme may affect the kidney's processing of vitamin D to its hormonal form, and eventually disturb the many uses of calcium throughout the body. Finally, heme is involved in the regulation of some chemical reactions in the liver. Decreased amounts of heme may impair the liver's detoxification of environmental toxins and drugs, as well as the liver's metabolism of amino acids, hormones, and other substances produced by the body (ATSDR 1993l).

    Lead ingestion doses similar to past doses we estimated for all age groups also have been associated with blood pressure problems in the animal studies we reviewed. Nevertheless, the potential relationship between lead ingestion and high blood pressure in humans is inconclusive and is an area of much scientific controversy (ATSDR 1993l). Until this relationship in humans is established, the meaning of other data correlations (such as males being more likely than females to experience lead-induced blood pressure increases) remains uncertain. Similarly, the potential association between barium or cadmium and blood pressure in humans is also uncertain.

    In human studies, arsenic ingestion doses similar to past doses we estimated for young children have been associated with a thickening of blood vessel walls that might lead to vessel damage. This health effect was reported in a study of five children who had been exposed to high levels of arsenic in their drinking water for 12 years (ATSDR 1993d); however, it is not known if these children were coexposed to other toxic substances.

    The toxicological literature is insufficient to associate any of the other reported circulatory system health complaints with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that some children in the community have never had normal blood counts (that is, red cell to white cell ratio) and many residents have chronically high white cell counts.

    The toxicological literature is insufficient to associate illnesses of the bone marrow or abnormal blood counts with our estimated doses for chemicals found at the site.

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused leukemia in the community.

    Both genetic and environmental factors are important in the development of the many types of leukemia (blood cancer). Acute myelogenous leukemia (AML; the ongoing, rapid production of a specific group of white blood cells) can develop after radiation exposure or cancer drug treatment; it may also appear after the development of some forms of anemia (Wilson et al. 1991). Case reports and epidemiological studies of workers have established a causal relationship between benzene exposure and AML. Although some case reports and epidemiological studies of workers have found associations between benzene exposure and other types of leukemia and even lymphomas, only the incidence of AML has been increased consistently in workers with excess benzene exposure (ATSDR 1993e). Using modeled inhalation data, we estimate the increased risk of developing AML from past benzene inhalation to be moderate if actual exposure conditions were close to those used in the model.

    Although vinyl chloride inhalation has been associated with angiosarcoma of the liver, a rare form of liver cancer in humans, a few studies indicate inhalation exposure also might be associated with cancer of the lymph/blood forming system, including leukemia or lymphomas in women (no other details were available). However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk for vinyl chloride-induced blood cancers (ATSDR 1993t).

  4. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused some residents to die from heart disease.

    We did not find contaminants at exposure levels associated with death from heart disease. In addition, we did not have the data necessary to determine if similar changes in body heme content or other potential circulatory system effects might eventually cause death from heart disease.

Digestive System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused digestive problems in the community, including: oral ulcers, submaxillary gland problems, stomach pain, stomach ulcers (in children 10+ years and older, and in adults), reflux problems, herniated bowels, appendicitis, gas pains, pancreas attacks, gallbladder attacks, gallstones, gallbladder removal, chronic disaccharidase deficiencies, gastroenteritis (including gastritis, enteritis, and gastrointestinitis), hepatitis (in both children and adults), other liver dysfunction (including jaundice and enlarged liver), colitis, diverticulitis, spastic colon, proctitis, constipation, acute and chronic diarrhea, and rectal bleeding.

    In human studies, arsenic ingestion doses similar to past doses we estimated for young children have been associated with symptoms of digestive system irritation, including: nausea, vomiting, diarrhea, and abdominal pain. In addition, arsenic ingestion doses similar to past doses we estimated for young children have been associated with liver tenderness or enlargement in humans (ATSDR 1993d). Tetrachloroethene inhalation doses similar to past doses we estimated for all age groups have been associated with liver enlargement in one study of mice. It is uncertain if this effect occurs in humans at similar doses, or if there might have been additive effects for young children exposed to both of these substances (ATSDR 1993r).

    As described under Circulatory System Complaints above, lead ingestion doses similar to past doses we estimated for all age groups have been associated with impairments in heme formation in the human and animal studies we reviewed. Decreased heme formation might impair the liver's detoxification of environmental toxins and drugs, as well as the liver's metabolism of amino acids, hormones, and other substances produced by the body (ATSDR 1993l).

    In addition, in one study of rats, vinyl chloride ingestion doses somewhat larger than the past doses we estimated for all age groups has been associated with microscopic changes in liver cells; the physiological significance of these mild changes was not reported (ATSDR 1993t). It is also not known if PCB inhalation is associated with noncancer effects on the human liver (ATSDR 1993q).

    The toxicological literature is insufficient to associate any of the other reported digestive system health complaints with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused a child to be born with decayed teeth (decayed in the sack) and another child to be born with a navel hernia.

    The toxicological literature is insufficient to associate either of these developmental effects with our estimated doses for chemicals found at the site.

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused esophageal, stomach, liver, and colon cancer in the community.

    Both ingestion and inhalation of vinyl chloride are associated with angiosarcoma of the liver, a rare type of liver cancer (ATSDR 1993t). Based on the exposure and dose estimates we have, we estimate the increased risk of this liver cancer from past vinyl chloride ingestion to be moderate. Using modeled inhalation data, we estimate the increased risk of developing this liver cancer from past vinyl chloride inhalation also to be moderate if actual exposure conditions are close to the estimated conditions used in the model. The cancer-causing effects of vinyl chloride from both exposure routes seem to be additive, and we estimate the overall increased liver cancer risk from past vinyl chloride exposure to be moderate. There is no apparent increased cancer risk from present-day ingestion and/or inhalation of vinyl chloride.

    Similarly, animal studies indicate ingestion or inhalation of high methylene chloride doses is associated with another type of liver cancer (ATSDR 1993m). Based on the exposure and dose estimates we have, we estimate the increased risk of developing liver cancer from past methylene chloride ingestion to be low, and from past inhalation to be moderate. It is not clear how methylene chloride exerts its cancer causing effects (Amdur et al. 1991; ATSDR 1993m). The cancer-causing effects of methylene chloride from both exposure routes may be additive, and, if so, we estimate the overall increased liver cancer risk from past methylene chloride exposure to be moderate. We estimate the increased liver cancer risk from present-day ingestion and/or inhalation to be negligible.

    Furthermore, animal studies indicate PCBs are also associated with liver cancer. The cancer-causing potential of PCB mixtures depends on the degree of chlorination, and ingestion of PCBs that are at least 60% chlorine by weight is associated with liver cancer in rats. In addition, studies with rats and mice indicate that PCBs with lower chlorine content can act as tumor promoters once these cells have been treated with chemicals acting as tumor initiators (ATSDR 1993q). Based on the exposure and dose information we have, we estimate the increased liver cancer risk from past PCB ingestion to be moderate.

    In addition, animal studies indicate there may be a link between di(2-ethylhexyl)phthalate and liver cancer (ATSDR 1993k). Based on the exposure and dose information we have, we estimate the increased liver cancer risk from past di(2-ethylhexyl)phthalate ingestion to be low.

    Animal studies indicate chronic ingestion of high benzene doses can cause cancer in various parts of the digestive system, particularly the mouth (ATSDR 1993e). Based on the exposure and dose estimates we have, we estimate the increased risk of developing digestive system cancer from past benzene ingestion to be low.

    Although arsenic ingestion has been associated with skin cancer in humans, there is mounting evidence arsenic ingestion may increase the risks of developing several internal cancers, including liver cancer. However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk for arsenic-induced internal tumors (ATSDR 1993d).

Endocrine System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused endocrine system problems in the community, including: hypoglycemia, diabetes, and thyroid trouble.

    As described under Circulatory System Complaints above, lead ingestion doses similar to past doses we estimated for all age groups have been associated with impairments in heme formation in the human and animal studies we reviewed. Decreased heme may hinder the kidney's processing of vitamin D to its hormonal form and eventually disturb the many uses of calcium throughout the body. In addition, decreased heme amounts may interfere with the livers's metabolism of some hormones, such as cortisol (ATSDR 1993l).

    The toxicological literature is insufficient to associate any of the reported endocrine system health complaints with our estimated doses for chemicals found at the site.

Excretory System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused excretory problems in the community, including: bladder infections, kidney infections, urinary tract infections, hematuria, cystitis, urethritis, ureteral reflux, incontinence, bladder suspension, kidney stones, and kidney disease (requiring kidney removal).

    Cadmium ingestion doses much smaller than the past doses we estimated for all age groups have been associated with excreting abnormal amounts of protein in the urine in some human. In addition, tetrachloroethene inhalation doses similar to past doses we estimated for all age groups also have been associated with excretion of excess protein in the urine in a few human studies. Protein excretion in the urine can be a symptom of mild kidney tubule dysfunction (ATSDR 1993g, 1993r). Under normal conditions, the body resorbs most proteins that enter the kidney tubules during blood filtration. However, if the kidney tubules are damaged, protein resorption can be less efficient, and abnormal levels of small proteins may be excreted in the urine (Wilson et al. 1991). The health significance of this mild kidney damage is difficult to assess. The decreased resorption of small proteins does not seem to be adverse in itself, but may be indicative of increased excretion of other small substances in the urine, including increased excretion of calcium. This secondary loss of calcium could be associated with a variety of bone disorders, including osteoporosis. In addition, a couple of studies indicate excess protein excretion in the urine does not decrease when cadmium exposure stops; rather, kidney dysfunction may continue to increase (ATSDR 1993g).

    As described under Circulatory System Complaints above, lead ingestion doses similar to past doses we estimated for all age groups have been associated with impairments in heme formation in the human and animal studies we reviewed. Decreased heme formation might disrupt the kidney's processing of vitamin D and subsequently disturb calcium balance throughout the body (ATSDR 1993l).

    The toxicological literature is insufficient to associate any of the other reported excretory system health complaints with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused a child to be born without any kidneys and another child to be born with severe kidney disease that required kidney removal shortly after birth.

    The toxicological literature is insufficient to associate either of these developmental effects with our estimated doses for chemicals found at the site.

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused bladder and kidney cancer in the community.

    Although arsenic ingestion has been associated with skin cancer in humans, there is mounting evidence arsenic ingestion may increase the risks of developing several internal cancers, including bladder and kidney cancer. However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk for arsenic-induced internal tumors (ATSDR 1993d).

  4. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused residents to die from kidney disease.

    We did not find contaminants at exposure levels associated with death from kidney disease. Although some epidemiological studies report an association between increased mortality rate and kidney disease in some populations exposed to cadmium (ATSDR 1993g), we do not have the data necessary to determine if similar associations exist in the Hipps Road vicinity.

Hypersensitivity Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused them to become hypersensitive to the presence of chemicals. Several residents report they can smell chemicals in the air even when nonresidents cannot smell them, and other residents report they cannot tolerate any chemical smell (for example, while using oven cleaners or going into hardware stores where chemicals are present). One resident reports experiencing a runny nose, a feeling of bulging eyes, and an almost emotional response to immediately get away from the chemicals when encountering a chemical smell.

    Many of the hypersensitivity symptoms nearby residents have reported are consistent with symptoms presented in medical case studies compiled by Rea (1992). The development of chemical sensitivities is very controversial and is not well understood by the scientific community.

Immune System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused immune system problems in the community, including: swelling of lymph nodes, mononucleosis, and lupus.

    There is some animal evidence that PCB ingestion or 1,2-dichloroethane inhalation might be linked with a suppressed immune response; however, the association between PCBs or 1,2-dichloroethane and immune response in humans is not clearly established (ATSDR 1992h, 1993q).

    The toxicological literature is insufficient to associate any of the immune system health complaints with our estimated doses for chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air caused residents to die from lymphoma.

    Although there is some evidence that inhalation of benzene or vinyl chloride may be associated with lymphoma, EPA has not yet derived the toxicity values needed to estimate an increased lymphoma risk from exposure to either of these compounds (ATSDR 1993e, 1993t).

Learning Disabilities:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused community children to have learning disabilities, low IQ scores, memory problems, and behavioral problems in school.

    In animal studies, lead ingestion doses similar to past doses we estimated for young children have been associated with learning problems in young animals. In humans, young children are particularly sensitive to the effects of lead on the nervous system, and learning problems resulting from a young child's lead exposure may persist for a lifetime. Although the toxicological literature contains studies both supporting and opposing the association between lead ingestion and learning impairments in humans (ATSDR 1993l), many toxicologists agree chronic ingestion of lead levels similar to those measured in the Hipps Road vicinity can cause learning impairment in young children. Some studies indicate low-level lead exposure may be associated with 4-5 point decreases in IQ scores (ATSDR 1993l). In a series of studies following a group of children throughout their scholastic education, first- and second-grade children without symptoms of lead toxicity, but with elevated lead levels in their teeth, had deficits in psychological and intelligence tests, speech and language processing, attention, and classroom performance. At the fifth-grade level, those children with elevated lead levels in teeth had lower I.Q. scores and a greater need for special academic services. In a ten-year follow-up, neurological and behavioral deficits continued to persist. Other human studies support the associations between low blood levels of lead and deficits in intelligence, behavior, and other neuropsychological parameters, as well as hyperactivity (Amdur et al. 1991).

Mental Health Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused depression, panic attacks, nervous breakdowns, psychosis (including schizophrenia), and attempted suicides in the community.

    The toxicological literature is insufficient to associate any of these mental health/nervous system problems with our estimated doses for other chemicals found at the site.

Nervous System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused nervous disorders in the community, including tremors or trembling; pain, numbness, tingling, or loss of feeling in hands, feet, arms, or around the lips; weakness in hands and dropping things; ringing in ears; neuralgia; ganglion cysts; Parkinson's disease; and meningitis.

    In human studies, arsenic ingestion doses similar to past doses we estimated for young children have been associated with mild symptoms of nerve dysfunction. These symptoms can initially appear as numbness in the hands and feet which may later develop into a painful "pins and needles" sensation (ATSDR 1993d).

    As described under Circulatory System Complaints, lead ingestion doses similar to past doses we estimated for all age groups may be associated with nerve cell dysfunction. One nervous system effect often associated with lead exposure is a decrease in the transmission speed of nerve impulses. This effect may have two causes. First, lead can interfere with the release or uptake of body chemicals used to transmit impulses between individual nerve cells (ATSDR 1993l; Klaassen et al. 1986). Sometimes this problem is secondary to decreased heme formation in the body (ATSDR 1993l). Second, decreased conduction velocities in nerves outside of the brain and spinal cord may be caused by a loss of myelin (a fatty covering that speeds up the conduction of nerve impulses) around these nerves, resulting in a condition called segmental degeneration (Klaassen et al. 1986).

    Segmental degeneration is characteristic of many disorders of the nervous system (Klaassen et al. 1986), and the first noticeable symptoms often include tingling, tickling, burning, or other unusual sensation in the tips of the toes, in the balls of the feet, or over the entire soles of the feet. In some cases, symptoms begin with weakness in moving the feet or toes, without the tingling or burning sensations. In either case, the symptoms can progress to a general loss of sensation in the feet and legs, often reported as a numb or wooden feeling in the feet or lower part of the legs. Individuals with these symptoms may experience difficulty in walking, and the feet may slap while walking. By the time the sensory impairment reaches the knees, a person may begin to have similar symptoms in the tips of the fingers. This can progress to an overall weakness in the hands, and difficulty in holding objects or unbending the fingers or wrist. This loss of sensation can progress up the legs and into the trunk of the body and, in extreme cases, impair breathing. During this process, the degree of spontaneous pain varies, but can be considerable (Wilson et al. 1991).

    As also described under Circulatory System Complaints, lead ingestion doses similar to past doses we estimated for all age groups may be associated with anemia, secondary to decreased heme formation in the body (ATSDR 1993l). Ringing in the ears can be a symptom related to severe anemia (Wilson et al. 1991).

    Furthermore, tetrachloroethene inhalation doses similar to past doses we estimated for all age groups have been associated with nervous system/behavioral changes in a few human studies. The symptoms of impairment in perception, attention, and intellectual function are likely to be related to tetrachloroethane's anesthetic properties, and might include dizziness, headache, sleepiness, or memory loss. In one study, workers exposed to low levels of air-borne tetrachloroethene also reported difficulty in falling asleep (ATSDR 1993r).

    In addition, a cadmium ingestion dose similar to the past dose we estimated for adults has been associated with effects on the nervous system in one study of unborn baby rats; however, the association between cadmium and nervous system development in babies is still uncertain in humans (ATSDR 1993g). Similarly, one study of newborn rats suggests low-level manganese ingestion might be associated with biochemical changes in the nervous system, but this association is uncertain in humans (ATSDR 1992f).

    The toxicological literature is insufficient to associate any of the other reported nervous system health complaints with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused a child to be born with 1/3 of the brain missing, and another child to be born with only half of the brain developed and cerebral palsy.

    The toxicological literature is insufficient to associate either of these developmental effects with our estimated doses for other chemicals found at the site.

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air caused a resident to die from a brain tumor.

    Although vinyl chloride inhalation has been associated with angiosarcoma of the liver, a rare form of liver cancer in humans, a few studies indicate inhalation exposure also might be associated with cancers of the brain and central nervous system. However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk for vinyl chloride-induced nervous system cancers (ATSDR 1989f, 1993t).

  4. Nearby residents are concerned the neurotoxin tri-ortho- cresyl phosphate has not been analyzed for but was present in the groundwater. Residents are concerned exposure to this substance may have adversely affected their health.

    Tri-ortho-cresyl phosphate (TOCP) is a chemical used as a plasticizer in making polyvinyl chloride and other substances, a flame retardant, a solvent, an additive to extreme pressure lubricants, and hydraulic fluid (Lewis 1993). It is often found at military bases, and was allegedly used at one of the naval facilities that disposed of wastes at the Hipps Road Landfill (CRAP 1989). TOCP is toxic to the nervous system, and can harm nerves both in the spinal cord and in the body outside of the spinal cord. The toxic effects on the nervous system are typically delayed for a few days or a few weeks. After this time period, muscle soreness can develop, leading to weakness in the arms and legs, muscle cramping, and abnormal reflexes. These problems may be accompanied by numbness in the fingers, calf muscles, and toes. After chronic exposure, there can be extreme weakness or paralysis of muscles in the foot, ankle, wrist and fingers, making it difficult to walk or hold objects in the hands (Amdur et al. 1991, Sittig 1985). Although TOCP was not analyzed for at the site, many of the nervous system problems reported by the residents are consistent with TOCP poisoning. Nevertheless, we do not have the data needed to determine if TOCP exposure occurred at the site.

Reproductive System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused female reproductive system problems in the community, including: abnormal female breast development, abnormal female reproductive organ development, ovarian adhesions and cysts, vaginal cysts, reproductive organ tumors, pelvic inflammatory disease, heavy menstrual bleeding (requiring a visit to a doctor), difficulty in conceiving, postpartum difficulty, persistent lactation, hysterectomy (in both young and older women), abnormal vaginal bleeding after a hysterectomy, abnormal or precancerous cervical cells (in teenagers and older women, requiring rechecks every 3-6 months), oophorectomy, and breast cysts.

    In animal studies, lead ingestion doses similar to past doses we estimated for all age groups have been associated with reproductive problems in adult females. In humans, these problems might appear as menstrual cycle irregularities (ATSDR 1993l), abnormal menstruation (either lack of menstrual periods or excessive bleeding during menstrual periods) (Wilson et al. 1991), ovarian cyst development, or delayed sexual maturation (ATSDR 1993l).

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused male reproductive system problems in the community, including: lumps or swelling in the groin (in children), epididymitis (in children), other swelling or pain in the testes (in children and adults), and difficulty in conceiving.

    In animal studies, lead ingestion doses similar to past doses we estimated for all age groups have been associated with reproductive problems in adult males. In humans, these problems might appear as decreased sperm counts, low sperm movement, increased prostate gland weight, or impotence (ATSDR 1993l).

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused a child to be born with a twisted testicle.

    The toxicological literature is insufficient to associate this developmental effect with our estimated doses for chemicals found at the site.

  4. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy has caused miscarriages (including loss due to blighted ovum and nonimmune fetal hydrops), premature birth, and delayed birth in the community.

    The toxicological literature is insufficient to associate any of these health complaints with our estimated doses for chemicals found at the site.

  5. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused breast, cervical, ovarian, and prostate cancer in the community.

    We did not find contaminants associated with these cancers at significant exposure levels.

Respiratory System Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused respiratory problems in the community, including: sinus problems, allergy problems, asthma, bronchitis, pleurisy, pneumonia, shortness of breath, dyspnea, and infant apnea.

    As described under Circulatory System Complaints, lead ingestion doses similar to past doses we estimated for all age groups may be associated with anemia, secondary to decreased heme formation in the body (ATSDR 1993l). Shortness of breath can be a symptom related to severe anemia as the body makes respiratory adjustments to compensate for the decreased oxygen carried by the blood (Wilson et al. 1991).

    The toxicological literature is insufficient to associate any of the other reported respiratory system health complaints with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused children to be born with rib cage/chest deformities and hyaline membrane disease.

    The toxicological literature is insufficient to associate either of these developmental effects with our estimated doses for chemicals found at the site.

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused lung cancer in the community.

    There is animal evidence inhaling methylene chloride is associated with lung cancer in animals. However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk for methylene chloride-induced lung tumors (ATSDR 1993m).

    In addition, although vinyl chloride inhalation has been associated with angiosarcoma of the liver, a rare form of liver cancer in humans, a few studies indicate inhalation exposure also might be associated with cancers of the lung and respiratory tract. However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk for vinyl chloride-induced respiratory system cancers (ATSDR 1989f, 1993t).

    Similarly, although arsenic ingestion has been associated with skin cancer in humans, there is mounting evidence arsenic ingestion may increase the risks of developing several internal cancers, including lung cancer. However, EPA has not yet derived the toxicity values needed to estimate an increased cancer risk of arsenic-induced internal tumors (ATSDR 1993d).

  4. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused some residents to die from lung disease, including lung cancer.

    We did not find any contaminants at exposure levels associated with death from noncancer lung diseases. In addition, we did not have toxicological information to estimate increased lung cancer risks from past inhalation of methylene chloride or vinyl chloride, or past ingestion of arsenic (ATSDR 1993d, 1993m, 1993t).

Skeletal/Muscular and Other Connective Tissue Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused skeletal problems and connective tissue disorders, including: rhabdomyolysis, weak joints and bones, arthritis, cold gout, bursitis, bone deterioration, disc problems (in adults, 20+ years and older), chondromalacia patella, hip infections, vertebral spurs, Schmoral's nodes on lumbar vertebrae, and back pain.

    As described under Excretory System Complaints, past cadmium ingestion and tetrachloroethene inhalation doses have been associated with excretion of excess protein in the urine in some human studies, a symptom of mild kidney tubule dysfunction that could cause calcium loss in the urine (ATSDR 1993g, 1993r). In addition, past cadmium and lead ingestion doses might be associated with disruptions in the kidney's processing of vitamin D (ATSDR 1993g, 1993l). Because the body needs processed vitamin D to absorb calcium from the intestines (Guyton 1981; Wilson et al. 1991), interference with vitamin D processing in the kidney may interfere with adequate uptake of calcium from food into the body. A relative decrease in blood calcium, whether from excessive calcium excretion in the urine or from inadequate calcium uptake in the intestines, can disturb the calcium balance throughout the body (ATSDR 1993g; Wilson et al. 1991). In order to obtain more calcium, certain hormones will cause the withdrawal of calcium from bones, the body's calcium reservoir. This withdrawal can decrease bone mass and result in a variety of bone disorders (Wilson et al. 1991). For example, prolonged calcium withdrawal from the bones can increase the risk of osteoporosis (bone loss), particularly in post-menopausal women. In addition, osteomalacia (softening of the bones that can lead to adult rickets) and spontaneous bone fracture have been observed in some humans chronically exposed to cadmium in their diets (at unspecified quantities) (ATSDR 1993g). Many of these bone disorders can be quite painful. Aching in the lower back or area behind the chest can accompany osteoporosis or osteomalacia (Wilson et al. 1991).

    The toxicological literature is insufficient to associate any of the other reported skeletal/muscular/connective tissue health complaints with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused children in the community to be born with turned feet, twisted legs, crooked spines, and a cleft palate.

    The toxicological literature is insufficient to associate any of these developmental effects health complaints with our estimated doses for chemicals found at the site.

Skin Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, , surface water, sediment, soil, and air has caused: abnormally dry skin, unexplained hand and foot rashes, itching skin, various benign skin tumors, actinic keratosis, lichen planus, warts, hives, and Herpes viral infections in children.

    In human studies, arsenic ingestion doses similar to past doses we estimated for young children have been associated with various skin changes, such as a thickening of the skin, wart or corn formation on the palms of the hands or soles of the feet, or alternating areas of dark and light pigmentation on the face, neck, and back (ATSDR 1993d).

    Furthermore, direct skin contact with some of the chemicals found around the site can cause an allergic reaction in sensitive individuals, often characterized by redness, swelling, itching, or small blisters on the skin. These chemicals are: chromium(III), chromium(VI), cobalt, 1,2-dichloropropane, mercury, nickel, and trichloroethene. Usually the threshold concentration for eliciting the allergic response is not known (ATSDR 1989c, 1992c, 1992d, 1992i, 1993o, 1993s). However, chromium ingestion doses similar to past doses we estimated for all age groups have been associated with a worsening of chromium-induced dermatitis in sensitized individuals in a couple of human studies (ATSDR 1992d).

    In addition, highly concentrated solutions of benzene, methylene chloride, tetrachloroethene, trichloroethene, or vinyl chloride are known to irritate human skin (ATSDR 1993a, 1993m, 1993r, 1993s, 1993t). The lowest level at which such irritations develops is not known. Nevertheless, skin contact with any of these substances through household uses of groundwater might be associated with skin irritation.

    The toxicological literature is insufficient to associate any of the other reported skin effects with our estimated doses for other chemicals found at the site.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air during pregnancy caused a child to be born with skin cancer and other children to be born with benign skin tumors.

    Although there is convincing evidence arsenic ingestion is associated with the development of benign skin tumors and with the development of cancer, we did not find any studies reporting children born with benign or malignant skin tumors. Results from animal studies have not found unborn babies to be more sensitive than their mothers to the effects of arsenic exposure (ATSDR 1993d).

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused melanoma, basal cell carcinoma, and other skin cancers in the community.

    There are many known causes of skin cancer. Exposure to sunlight, particularly ultraviolet light is a primary factor in developing nonmelanoma skin cancer. Other predisposing factors include exposure to cancer-causing agents, trauma or scarring, chronic radiation damage, viral infection, and immune suppression. Arsenic is the most common chemical agent associated with skin cancer; nonmelanoma skin cancers can occur decades after exposure (Wilson et al. 1991). The most common lesions appear to develop from arsenic-induced warts and corns, although other sources of arsenic-induced skin cancer occur (ATSDR 1993d). Based on the exposure and dose information we have, we estimate the increased risk of developing skin cancer from past arsenic ingestion to be moderate.

Visual Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused visual problems in the community, including: cataracts, blurred vision, eye irritation, burning eyes while showering, and other visual disturbances.

    In animal studies, lead ingestion doses similar to past doses we estimated for all age groups have been associated with changes in the eye structures important in night vision. A couple of studies in rats have found an association between low-level lead ingestion and rod degeneration of unknown severity. Rods are light-sensitive structures on the retina of the eye that distinguish between light and dark. In humans, vision at night is accomplished through use of the rods. In humans, such potential changes might lead to a decreased ability to see well at night. Visual effects associated with lead exposure have been noted in humans, but are not well documented (ATSDR 1993l).

    Exposure to high levels of air-borne 1,2-dichloroethane is associated with eye irritation and cloudiness in humans, but the effects of low-level vapors on eye are not known.

    The toxicological literature is insufficient to associate any of the other reported visual effects with our estimated doses for other chemicals found at the site.

Nonspecific Illness and Unexplained Death Complaints:

  1. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused the following nonspecific illnesses and complaints in the community: dental problems (including loose teeth), nose bleeds, muscle spasms, equilibrium loss (including dizziness, loss of balance, vertigo, Meniere's syndrome, lightheadedness, unsteadiness), clumsiness, falling, difficulty walking, swelling (including edema, angioedema, and swelling in limbs), nausea, vomiting, dehydration, acute and chronic headaches, migraines, fatigue, lethargy, fainting (including syncope and black outs), seizures, fevers, frequent flus and colds, chronic sore throats, chronic ear infections, premature hair loss, chronic insomnia and other sleep disturbances, anxiety, nervousness, irritability, memory problems, and difficulty in healing after surgery.

    As noted under the headings above, some of these symptoms might be secondary to illnesses associated with the residents' past inhalation of tetrachloroethene or past ingestion of lead or arsenic. These secondary symptoms may include: headache, fatigue, dizziness, fainting, sleep disturbances, memory problems, difficulty walking, diarrhea, nausea, vomiting. Dehydration can result from excessive vomiting or diarrhea. Still, assignment of a cause to these symptoms without further studies is inappropriate because each one of these symptoms is a characteristic of many illnesses.

    The toxicological literature is insufficient to associate any of the other reported nonspecific symptoms or illnesses with our estimated doses for other chemicals found at the site. In addition, some health complaints (such as anxiety, nervousness, etc.) cannot be easily determined in experimental animals and may not be reported in epidemiological studies.

  2. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused the following illnesses and complaints in the community: vocal cord nodules, fluid in ears (infant), and adenocarcinoma.

    The toxicological literature is insufficient to associate either of the noncancer conditions with our estimated doses for chemicals found at the site.

    Adenocarcinoma is a generic term for glandular or gland-like cancers. Without more information as to a specific cell or tissue type, we cannot specifically address this concern.

  3. Nearby residents are concerned that exposure to contaminated groundwater, surface water, sediment, soil, and air has caused several unexplained deaths in the community. A child died shortly after birth from unknown causes. In addition, residents report there are several other cases in which the causes of death could not be found, even after autopsies were performed on the deceased.

    We did not find any contaminants at exposure levels associated with death. In addition, we do not have the data necessary to determine if any potential illnesses described in this section could progress to death.

Health of Pets:

  1. Nearby residents report that pets in the community have had the following health problems: dogs have had cancer, kidney problems, and birth defects; one dog developed an abnormally swollen head; thoroughbred horses have gone crazy, necessitating their removal from racing; one horse died from kidney problems after drinking from surface waters close to the site; and several cats, monkeys, ferrets, chickens, and pet birds have died unexpectedly.

    Inquiring about the health of pets or farm animals can aid in identifying potential illnesses in the community because of their close proximity to the environment and their shortened life span. Because of these characteristics, illnesses sometimes appear in pets before they appear in humans. None of the conditions or illnesses reported for pets in the Hipps Road vicinity introduced new health concerns to address.

Other (Nonhealth) Concerns:

  1. Nearby residents are concerned about declining values of property near the site. Some residents report they cannot sell their homes because of their proximity to the site. These residents also believe even if they were able to sell their homes, they would not have enough money to move out of the neighborhood because of the money they've lost from declining property values. At least one resident has rental property in the area and reports a loss of income because of the difficulty in finding tenants to live near the site.

    Although this is a serious problem that is common around hazardous waste sites, it is not within the scope of a public health assessment.

  2. Nearby residents are concerned that government officials responsible for investigating or cleaning up the site have not considered or do not have all of the data generated about the site, particularly the data values showing the greatest contamination. Some residents believe officials have played down the examination of site-related health effects and will continue to do so in the future.

    In this public health assessment, we have attempted to assess all of the environmental data and to address all of the residents' health concerns in an objective manner. We have used the highest known contaminant concentrations to estimate the residents' exposures, as well as model data, when available, to fill in data gaps.

  3. Nearby residents are concerned that site-related contamination has not been fully identified or delineated. Some residents point out the lack of sampling data for some exposure points, such as volatilization of solvents from nearby surface waters, landfill and yard soils, and while showering. Others think the extent of groundwater contamination has not been properly delineated, and the contaminant plume is actually much larger in all directions than government officials currently believe or publicly state.

    We agree volatilization of solvents from nearby surface waters, landfill and yard soils, and household water uses (including showering) was not measured. To estimate exposure from unmeasured sources, we used a mathematical model to estimate solvent concentrations in air and in vegetables from known groundwater and soil concentrations. We also agree more sampling needs to take place to better delineate local groundwater movement and contamination, and to determine if exposure to contaminants is continuing. To address these concerns, we have recommended EPA conduct a groundwater movement and contamination assessment in the general directions east, south, and west of the site. In addition, we have recommended surface soil and sediment sampling in the area to fill in some data gaps and determine if exposure to hazardous substances is continuing at levels of concern.

    Residents are also concerned the groundwater contaminant plume northeast of the site is larger than believed, and extends beyond the groundwater capture zone delineated by Golder Associates (1993b). To support this idea, residents cite the analytical results for monitor well TMW-13I from Golder Associates' (1993a) baseline groundwater sampling performed during the air stripper's trial run. This well is at the north end of Paul Howard Drive, approximately 600 feet northeast of the outermost (away from the landfill) capture zone boundary. During the baseline sampling, chlorobenzene, cis-1,2-dichloroethene, ethylbenzene, vinyl chloride, and xylenes were detected in TMW-13I. Of these substances, only vinyl chloride was above its MCL, at 6.6 µg/l. To address plume migration and private well contamination concerns, we have recommended EPA continue monitoring the monitor wells and Duval CPHU continue monitoring private wells in the area so that these groundwater problems can be identified and appropriately addressed as quickly as possible.

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