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Exposure Pathways

The following table summarizes the potential exposure and public health conclusion category for each environmental exposure pathway. A detailed discussion can be found in the specific sections referenced by the appropriate page numbers.

Environmental Pathway Potential
Public Health Conclusion Pages
Past Air Emissions
(Before 1996)
Yes Indeterminate
(Further Investigation Required)
Non-occupational On-base Employees Yes Indeterminate
(Further Investigation Required)
Lead in Soil Yes Indeterminate
(Further Investigation Required)
Present Air Emissions
(After 1995)
Yes No Apparent Health Hazard 32-35
Leon Creek:
surface water
fish consumption
Yes No Apparent Health Hazard 37-40
Groundwater None Apparent No Apparent Health Hazard
(East Kelly to be evaluated)
Soil Gas Yes No Apparent Health Hazard
(East Kelly to be evaluated)
Noise Yes No Apparent Health Hazard
(Condition Corrected)
Fuel Jettisoning Yes No Apparent Health Hazard 58-59
Homegrown Produce Yes No Apparent Health Hazard 60
Thallium in Drinking Water Yes No Apparent Health Hazard 48-49
Radioactive Waste No No Health Hazard 61

Community Health Concerns

Community residents have expressed concern that there is there a higher than expected number of people with lupus, hearing problems, asthma, allergies, hepatitis and diabetes in the area. ATSDR is presently attempting to locate data to attempt to answer most of these concerns. However, data may not be available for all of the health outcomes of concern since public health agencies do not routinely collect this information. Once this information is complete, it will be made available to the public and included in Phase II of the public health assessment.

Health Outcome Data

  • Cancers that were elevated in at least one of the initial zip code areas evaluated (78237, 78211, and 78228) include leukemia, liver, kidney, and cervical cancer. It is unknown what contributions, if any, past air emissions may have made towards these elevations.
  • Liver cancer rates are elevated in many zip code areas around Kelly Air Force Base, as well as other areas in Texas. The reasons for these elevations are unknown.

  • Zip code area 78237 had elevations in the number of low birth weight babies and children born with a specific birth defect (bulbus cordis anomalies and anomalies of cardiac septal closure). These outcomes have not previously been associated with contaminants at the levels currently measured at Kelly.

  • Elevated blood lead levels (above the Centers for Disease Control and Prevention recommended guidelines) were reported among some children in 90% of the zip code areas in Bexar County. Limited environmental data was available for lead in soil but the reported values for neighborhood yards near Kelly were below levels of health concern.
  • More specific conclusions from the evaluation of health outcome data to date are provided in Appendix G, page G-15.


ATSDR recommends the following activities.

Activities related to environmental data evaluation

  • Perform a refined air dispersion model to evaluate non-occupational on-base employees exposures (Phase II).
  • Evaluate past air emissions to estimate past air concentrations. Kelly Air Force Base will conduct a review of practices that may have generated past air emissions and report the findings by the end of 1999. ATSDR will use this data to evaluate past air emissions and present the results in Phase II of the public health assessment.
  • Evaluate the environmental data for soil, water, and soil gas for the East Kelly area and report the results in Phase III
  • Evaluate the potential contamination of on-base drinking water supplies and report the results in Phase III of the public health assessment..
  • Identify and plug or seal Edwards aquifer wells located within the contaminated areas of the shallow aquifer (Phase II).
  • Continue periodic monitoring of appropriate areas for radioactivity and maintain institutional controls to prevent worker exposure to buried radioactive waste in the event of future construction.

Activities related to health education

  • Provide environmental health education workshops for community members and for medical personnel, primarily nurses and physicians (Phase I).

  • Conduct health education activities focused on risk factors for community-related health concerns (Phase II).

  • Provide chemical-specific health education to the community to increase their understanding of exposures as determined in the public health assessment (Phase II).

Activities related to health outcome data (Phase II)

  • Update health outcomes such as cancer, birth defects, and low birth weight babies including additional years of information.
  • Continue to monitor liver cancer incidence and mortality as more years of data become available.
  • Continue monitoring heart and circulatory system defects using vital statistic information and data from the Texas Birth Defects Monitoring Division as it becomes available.
  • Continue monitoring the number of low birth weight babies reported as additional data becomes available.
  • Determine if data is available to address community concerns regarding lupus, hearing problems, asthma, allergies, hepatitis and diabetes in the area.

Public Health Action Plan

Ongoing Activities

  1. ATSDR requested statistical reviews on health outcomes such as cancer, birth defects, and low birth weights in zip codes around Kelly AFB. These statistical reviews have been performed by the Texas Department of Health and evaluated by ATSDR. Additional analysis is ongoing.

  2. ATSDR performed a needs assessment and determined the need for health education and community involvement activities with residents living around Kelly AFB or personnel working at the base. Community involvement activities have been ongoing. Health education activities began in June 1999 with an environmental health workshop for nurses and continued in July for physicians and August for community members.

  3. ATSDR is developing information sheets summarizing information from this public health assessment. Information sheets in English and Spanish will be available to community residents.

Future Action Items

  1. The ATSDR Division of Health Assessment and Consultation will
    perform a more extensive air model in Phase II to refine potential exposures to non-occupational on-base employees;

    evaluate past air emissions in Phase II. Kelly AFB will collect data on past practices which may have resulted in past air emissions which is scheduled to be completed by the fall of 1999;

    evaluate environmental data from East Kelly and report results in Phase III to the public health assessment;

    perform a health consultation in Phase III on the past exposure of on-base personnel to potentially contaminated drinking water provided by the Kelly AFB water system..
  1. The United States Air Force will
    continue to monitor for radioactivity and maintain institutional controls to protect workers in the event of construction in the vicinity of buried radioactive waste.
  1. The appropriate regulatory authorities should coordinate with the appropriate organizations to determine the appropriate identification, and plugging or sealing of Edwards aquifer wells in the vicinity of the contaminated shallow aquifer.
  1. The ATSDR Division of Health Education and Promotion will
    Conduct health education activities focused on health outcomes that are reported in the communities or through official registries (such as the cancer registry, birth defects registry, and vital statistics.

    Provide environmental health education for community members and for medical personnel, primarily nurses and physicians, as appropriate.

    Provide chemical-specific health education to the community to increase their understanding of exposures as determined in the public health assessment.
  1. The ATSDR Division of Health Studies will continue to evaluate Health Outcome Data as it becomes available, will evaluate air modeling information for historic emission data when available, and will make recommendations for followup activities in Phase II, as appropriate.


  1. Management Action Plan. Kelly Air Force Base. December 1994.

  2. Basewide Remedial Assessment. Kelly Air Force Base. Annual Report. CH2M HILL, Inc. July 1996.

  3. Programmatic Environmental Impact Statement. Volume I. Draft. Kelly AFB, Texas. January 1997.

  4. Basewide Remedial Assessment. 1995 Annual Report. Final. CH2M HILL, Inc. July 1996.

  5. ensus of Population and Housing, 1990: Summary Tape File 1A (Texas) [machine-readable data files]. Prepared by the Bureau of the Census. Washington, DC: The Bureau [producer and distributor], 1991.

  6. 1990 Census of Population and Housing, Summary Tape File 3 (Texas).

  7. Bland, Yana. North Kelly Gardens Comprehensive Health Survey. 1997.

  8. Remedial Investigation Report. Site S-1. Final. NUS Corporation. June 1994.

  9. Human Health Risk Assessment. Building 1592 Area. Final. CH2M Hill, Inc. July 1997.

  10. Revised Interim Soil Lead Guidance for CERCLA Sites and RCRA Corrective Action Facilities, OSWER Directive #9355.4-12, July 14, 1994, Laws EP.

  11. ATSDR. Soil Comparison Values.

  12. Air Permits. Kelly Air Force Base Web Site. Environmental Management. 1996.

  13. 76th Medical Operations Squadron. Potential Health Hazard Assessment of Fugitive Vapor Emissions from 1500 Area Fuel Tanks. March 23, 1995.

  14. ATSDR Toxicological Profile for Jet Fuels (JP-4 and JP-7). June 1995.

  15. TNRCC. Interoffice memo. Laboratory Analysis, ACL Number 9678. March 19, 1996.

  16. North Kelly Gardens Air Survey. Southwest Research Institute. San Antonio, Texas. October 30, 31, 1997.

  17. Personal Communication. Mr. Noe Acevedo, personal interview with David Fowler and Diane Jackson. August 26, 1996.

  18. Leon Creek Monitoring Program. Final Report. Installation Restoration Program. United States Air Force. December 1994.

  19. Kelly Air Force Base and Leon Creek: Environmental Perspectives. CH2M HILL, Inc. July 1996.

  20. Environmental Protection Agency. National Pollution Discharge Elimination System (NPDES). Discharge Monitoring Report. Region 6. 01-01-90 through 06-30-96.

  21. Environmental Protection Agency. 1992.

  22. Shallow Aquifer Assessment. Technical Report. Final. Science Applications International Corporation. July 1994.

  23. Ozuna GB and Stein WG. Quality of the Shallow Ground Water in Southwest Bexar County, Texas. Water-Resources Investigation Report. U. S. Geological Survey. 1990.

  24. Bexar Metropolitan Water District Distribution System Maps. Provided by John Tapia, Engineering/Planning Supervisor, Bexar Metropolitan Water System. 1996.

  25. Focused Feasibility Study Report. IRP Zone 5. CH2M HILL, Inc. January 1996.

  26. Personal communication from Bexar Metropolitan Water District (telephone) to David Fowler concerning thallium. August 1997.

  27. Abandonment and Plugging of Production Wells 2, 3, and 12. Haliburton NUS Corporation. September 1991.

  28. Soil Vapor Survey. Zone 5. North Kelly/North Kelly Gardens Area. Remedial Investigation. CH2M HILL, Inc. 1995.

  29. Health and Safety Risk Assessment. Quintana Road Neighborhood. NUS Corporation. June 1990.

  30. Environmental Protection Agency. Estimating Potential for Occurrence of DNAPL at Superfund Sites. Office of Solid Waste and Emergency Response. Publication: 9355.4-0/FS. January 1992.

  31. Noise Study. USAF 76th Medical Group Bioenvironmental Engineering Services. 1997.

  32. Quiet Hours Memo. From SA-ALC to LABCC. February 17, 1993 requesting confirmation of policy established March 19, 1986. Requires approval to perform engine test runs between 11:00 PM and 6:00 AM. Reaffirmed January 31, 1997.

  33. Personal Communication. Authur Silva, personal interview with David Fowler of ATSDR. February 10, 1998.

  34. Threshold Limit Values for Chemical Substances and Physical Agents. Biological Exposure Indices. Second Printing. American Conference of Governmental Industrial Hygienists. 1996.

  35. United States Department of Transportation. 1980. Federal Aviation Regulations Part 150. Airport Noise Compatibility Planning (Federal Aeronautics Administration) 1989.

  36. Environmental Protection Agency. Information on Levels of Environmental Noise Requisite to Protect Public Health and Welfare with an Adequate Margin of Safety. Publication No. 550/9-74-004. Washington, DC, March 1974.

  37. Clewell HJ III. Fuel Jettisoning by US Air Force Aircraft, Volume I: Summary and Analysis. Final Report. March 1980.

  38. Tactical Air Command/United States Air Forces in Europe Regulation 55-115, February 1979.

  39. Strategic Air Command Regulation 55-12, April 1978.

  40. Clewell HJ III. Fuel Jettisoning by Air Force Aircraft, Volume II: Fuel Dump Listings. March 1980.

  41. Air Force Recovers Jettisoned Objects. San Antonio Express-News. Aug 15, 1996.

  42. Clewell, HJ. Evaporation and Groundfall of JP-4 Jettisoned by USAF Aircraft. AFESC TR in preparation. (Unclassified).

  43. Agustin, RAC. Analysis of the Potential for Plant Uptake of Trichloroethylene and an Assessment of the Relative Risk from Different Crop Types. Government Reports Announcements & Index (GRA&I). Issue 01, 1995.

  44. Kirk, Lisa. 1994. Fruit and Vegetable Monitoring in Sunset. 649 Medical Group memo. Hill AFB, Utah. Hazleton Environmental Services, Inc. March 31.

  45. Radioactive Disposal Area Nos. 1 and 2. Installation Restoration Program. Zone 1 Remedial Investigation. Haliburton NUS Corporation. September 1991.

  46. Klaassen CD, Amdur MO, and Doull J. 1986. Casarett and Doull's Toxicology. Third edition. Macmillan Publishing Company. New York.

  47. Bagnell PC, Ellenberger HA. 1977. Obstructive jaundice due to a chlorinated hydrocarbon in breast milk. Can Med Assoc J 117:1047-1048.

  48. National Research Council. 1993. Pesticides in the Diets of Infants and Children. National Research Council. Washington D.C., National Academy Press.

  49. Dejoy DM. 1983. Environmental noise and children: Review of recent findings. J of Aud Res. 23:181-94.

  50. Weis BK and Susten AS. Groundwater Contamination by PCE and TCE: ATSDR's Approach to Evaluating Public Health Hazard. Unpublished manuscript.

  51. De Rosa CT, Stevens Y-W, and Johnson BL. 1998. Role of Risk Assessment in Public Health Practice.Toxicology and Industrial Health. 13(3):389-412.

  52. ATSDR. Cancer Policy Framework. U.S. Department of Health and Human Services. Atlanta, GA. January 1993.

  53. Johnson BL and DeRosa CT. 1995. Chemical mixtures released from hazardous waste sites: implications for health risk assessment. Toxicology 105:145-156.

  54. ATSDR. 1996. Draft - ATSDR and America's Children. U.S. Health and Human Services. Atlanta, GA. November.

  55. Schulze RH and Turner DB. 1996. Practical Guide to Atmospheric Dispersion Modeling. Trinity Consultants, Inc. 9620-007. Dallas, TX. April.

  56. U.S. Environmental Protection Agency. 1995. User's Guide for the Industrial Source Complex (ISC3) Dispersion Models. Office of Air Quality Planning and Standards Emissions, Monitoring, and Analysis Division. Research Triangle Park, North Carolina. September. EPA-454/B-95-003a

  57. U.S. Environmental Protection Agency.1987. Guideline on Air Quality Models (Revised) and Supplement A. Research Triangle Park, NC. EPA-450/2-78-027R.

  58. Huber AH and Sneider WH. 1976. Building Wake Effects on a Short Stack Effluent. Preprints Third Symposium on Atmospheric Diffusion and Air Quality. American Meteorological Society, Boston, MA. pp 235-242.

  59. Koontz M, Zarus G, Stunder M, and Nagda N. 1991. Air Toxic Risk Assessment. 84th Annual Meeting of the Air & Waste Management Association, Vancouver, BC.

  60. Zarus G and Stunder M. 1991. The AB2588 Risk Assessment for: NAS/NADEP, Alameda, CA, GEOMET.

  61. Air Toxics Hotspots Program: Revised 1992: California Air Pollution Control Officers Association.

  62. Pelton D, Stunder M, and Zarus G. 1991. Emissions Inventory Report: NAS Lemoore, CA, GEOMET.

Preparers of the Report
Author Reviewers
David A. Fowler, Ph.D. John Abraham, Ph.D.
Toxicologist Branch Chief
Division of Health Assessment and Consultation Division of Health Assessment and Consultation
Exposure Investigation and Consultation Branch
Exposure Investigation and Consultation Branch
Contributing Authors Susan Moore
  Section Chief
Dhelia Williamson, MS Division of Health Assessment and Consultation
Epidemiologist Exposure Investigation and Consultation Branch
Division of Health Studies
Health Investigation Branch
Laurie Ann Columbo, MPH Site Team Members
Community Involvement Specialist David A. Fowler
Division of Health Education and Promotion Laurie Ann Columbo
  Dhelia Williamson
Greg Zarus, MS
Environmental Health Scientist Cheryll Ranger, RN
Division of Health Assessment and Consultation Health Education Specialist
Exposure Investigations Branch Division of Health Education and Promotion
Technical Assistance Keith Hutchinson, MA
  Health Educator
Andrew Dent, MA Texas Department of Health
GIS Programmer/Analyst  
Spatial Analysis/Information Dissemination Section Roberta Erlwein, MPH
Program Evaluation and Records Information Service Environmental Health Scientist
  ATSDR Region 6 Representative
Greg Zarus, MS
Brian Kaplan, MS Jennifer Lyke
Environmental Health Scientist Environmental Protection Specialist
Division of Health Assessment and Consultation ATSDR Region 6 Representative
Federal Facilities Assessment Branch
  Maria Teran-Maciver
Edward Gregory, Ph..D. Community Involvement Specialist
Demographer Divisions of Health Assessment and Consultation
Federal Facilities Assessment Branch Community Involvement Branch
Division of Health Assessment and Consultation

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