The South Carolina Environmental Public Health Tracking Program's Role in Monitoring and Reducing Occupational Exposure to Lead: Public Health Actions in Collaboration with the South Carolina Occupational Safety and Health Administration.

Per South Carolina (SC) Law §44-29-10, all blood lead test records are reportable. The SC Environmental Public Health Tracking (SC EPHT) program is directly involved in blood lead surveillance in SC, as it maintains the blood lead record database. Although Adult Blood Lead Epidemiology and Surveillance funding from the Centers for Disease Control and Prevention was discontinued in 2013, SC EPHT has continued to monitor and record adult blood lead test records.In 2012, SC EPHT signed a memorandum of understanding with the SC Occupational Safety and Health Administration (SC OSHA). Per this agreement, quarterly reports of elevated adult blood lead concentrations (≥25 µg/dL) are supplied to SC OSHA, along with North American Industry Classification System codes of employers. This information is used for industrial inspections, mitigation, and abatement related to lead. The SC EPHT program's collaboration with SC OSHA has resulted in a number of public health actions that have improved the health and well-being of workers in SC. Of the 3 nationally accepted SC public health actions related to occupational lead exposure, 2 detail investigations and citations by SC OSHA. The other describes internal analyses conducted by the SC EPHT program regarding elevated blood lead levels in adults and associations with specific North American Industry Classification System codes.In this review, we outlined the role of SC EPHT related to adult blood lead surveillance in SC, including implementation of the memorandum of understanding with SC OSHA. We also examined demographics of adult blood lead records in SC for 2010-2015 and summarized public health actions related to occupational lead exposure in SC. Since federal funding for the SC EPHT program was initiated in 2009, the program has played an important part in lead surveillance in SC. The resulting health benefits to those with the potential for occupational exposure to lead are extremely important.

Potential sources and racial disparities in the residential distribution of soil arsenic and lead among pregnant women.

Exposure to arsenic (As) or lead (Pb) has been associated with adverse health outcomes, and high-risk populations can be disproportionately exposed to these metals in soils. The objectives of this study were: to examine if predicted soil As and Pb concentrations at maternal residences of South Carolina (SC) low-income mothers differed based on maternal race (non-Hispanic black versus white), to examine whether differences in predicted residential soil As and Pb concentrations among black and white mothers differed by socioeconomic status (SES), and to examine whether such disparities persisted after controlling for anthropogenic sources of these metals, including direction from, and distance to industrial facilities. Kriged soil As and Pb concentrations were estimated at maternal residences in 11 locations in SC, and models with maternal race and individual and US Census block group level SES measures were examined. US Environmental Protection Agency Toxics Release Inventory (TRI) facility As and Pb releases categorized by distance and direction to block groups in which mothers resided were also identified, as were proxy measures for historic use of leaded gasoline (road density) and Pb-based paint (categories of median year home built by US Census block group). Consistent racial disparities were observed for predicted residential soil As and Pb concentrations, and the disparity was stronger for Pb than As (betas from adjusted models for black mothers were 0.12 and 2.2 for As and Pb, respectively, all p<0.006). Higher road density and older homes in block groups were more closely associated with higher predicted soil As and Pb concentrations than on-site releases of As and Pb categorized by facility location. These findings suggest that non-Hispanic black mothers in this study population had elevated residential As and Pb soil concentrations, after adjusting for SES, and that soil As and Pb concentrations were not associated with recent industrial releases.

Associations between land cover categories, soil concentrations of arsenic, lead and barium, and population race/ethnicity and socioeconomic status.

The potential of using land cover/use categories as a proxy for soil metal concentrations was examined by measuring associations between Anderson land cover category percentages and soil concentrations of As, Pb, and Ba in ten sampling areas. Land cover category and metal associations with ethnicity and socioeconomic status at the United States Census 2000 block and block group levels also were investigated. Arsenic and Pb were highest in urban locations; Ba was a function of geology. Consistent associations were observed between urban/built up land cover, and Pb and poverty. Land cover can be used as proxy for metal concentrations, although associations are metal-dependent.

Temporal and spatial variation in residential soil metal concentrations: implications for exposure assessments.

Understanding temporal and spatial variation in soil chemicals is critical in exposure assessments. We measured eight metals in subsamples, duplicates (~0.3 m), and repeat soil samples taken 1-6 years after initial sampling (~5 m). We estimated variance components (VCs) of metal concentrations using nested analyses accounting for sampling area, land use and soil type, and calculated coefficients of variation (CVs) for repeat sample pairs. Total variance for all metals was similar, but VCs were proportioned differently by metal and sample type. Spatial variation explained the majority of variance in duplicate samples. CVs of metal concentrations were not significantly different over the long time interval, but repeat samples had larger VCs for unexplained error. Sampling area and land use were important for Ba and Mn, and Pb and Hg, respectively. Results suggest metals are stable over long times and suitable for exposure assessments, but that individual metal behavior should be considered.

Associations between soil lead concentrations and populations by race/ethnicity and income-to-poverty ratio in urban and rural areas.

Lead (Pb) is a well-studied environmental contaminant that has many negative health effects, especially for children. Both racial/ethnic and income disparities have been documented with respect to exposure to Pb in soils. The objectives of this study were to assess whether soil Pb concentrations in rural and urban areas of South Carolina USA, previously identified as having clusters of intellectual disabilities (ID) in children, were positively associated with populations of minority and low-income individuals and children (≤ 6 years of age). Surface soils from two rural and two urban areas with identified clusters of ID were analyzed for Pb and concentrations were spatially interpolated using inverse distance weighted analysis. Population race/ethnicity and income-to-poverty ratio (ITPR) from United States Census 2000 block group data were aerially interpolated by block group within each area. Urban areas had significantly higher concentrations of Pb than rural areas. Significant positive associations between black, non-Hispanic Latino, individuals and children ≤ 6 years of age and mean estimated Pb concentrations were observed in both urban (r = 0.38, p = 0.0007) and rural (r = 0.53, p = 0.04) areas. Significant positive associations also were observed between individuals and children with an ITPR < 1.00 and Pb concentrations, though primarily in urban areas. Racial/ethnic minorities and low ITPR individuals, including children, may be at elevated risk for exposure to Pb in soils.

Associations of estimated residential soil arsenic and lead concentrations and community-level environmental measures with mother-child health conditions in South Carolina.

We undertook a community-level aggregate analysis in South Carolina, USA, to examine associations between mother-child conditions from a Medicaid cohort of pregnant women and their children using spatially interpolated arsenic (As) and lead (Pb) concentrations in three geographic case areas and a control area. Weeks of gestation at birth was significantly negatively correlated with higher estimated As (r(s) = -0.28, p = 0.01) and Pb (r(s) = -0.26, p = 0.02) concentrations in one case area. Higher estimated Pb concentrations were consistently positively associated with frequency of black mothers (all p < 0.02) and negatively associated with frequency of white mothers (all p < 0.01), suggesting a racial disparity with respect to Pb.

HIV testing in women: missed opportunities.

OBJECTIVE: To investigate opportunities for early human immunodeficiency virus (HIV) testing of women. METHODS: A retrospective cohort study design linked case reports from HIV surveillance to several statewide health-care databases. Medical encounters occurring before the first positive HIV test (missed opportunities) were categorized by diagnosis/procedure codes to distinguish visits that were likely to have prompted an HIV test. Women were categorized as late testers (AIDS diagnosis <12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS >12 months of HIV diagnosis), of reproductive age (13-44 years old), and not of reproductive age (>44 years old). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to estimate risk and its statistical significance. RESULTS: Of 3303 HIV-infected women diagnosed during the study period, 2408 (73%) had missed opportunity visits. Late testers (39%) were more likely to be black than white (aOR 1.48, 95% CI 1.12-1.95), be older (>44 years old; aOR 7.85, 95% CI 4.49-13.7), and have >10 missed opportunity visits (aOR 2.17, 95% CI 1.62-2.91). Fifty-four percent of women >44 years old were also late testers. Women >44 years old had lower median initial CD4 counts (p<0.001). The top two procedures were the same for all groups of women but mammography was ranked fourth for women >44 years old and Papanicolau smear was ranked fourth for late testers. CONCLUSIONS: Feasibility and acceptability of routine HIV testing in nontraditional health-care settings, such as mammography and Papanicolau screenings, should be explored to identify late testers and older (not of reproductive age) HIV-infected women.

Identifying natural and anthropogenic sources of metals in urban and rural soils using GIS-based data, PCA, and spatial interpolation.

Determining sources of neurotoxic metals in rural and urban soils is important for mitigating human exposure. Surface soil from four areas with significant clusters of mental retardation and developmental delay (MR/DD) in children, and one control site were analyzed for nine metals and characterized by soil type, climate, ecological region, land use and industrial facilities using readily available GIS-based data. Kriging, principal component analysis (PCA) and cluster analysis (CA) were used to identify commonalities of metal distribution. Three MR/DD areas (one rural and two urban) had similar soil types and significantly higher soil metal concentrations. PCA and CA results suggested that Ba, Be and Mn were consistently from natural sources; Pb and Hg from anthropogenic sources; and As, Cr, Cu, and Ni from both sources. Arsenic had low commonality estimates, was highly associated with a third PCA factor, and had a complex distribution, complicating mitigation strategies to minimize concentrations and exposures.

Soil metal concentrations and toxicity: associations with distances to industrial facilities and implications for human health.

Urban and rural areas may have different levels of environmental contamination and different potential sources of exposure. Many metals, i.e., arsenic (As), lead (Pb), and mercury (Hg), have well-documented negative neurological effects, and the developing fetus and young children are particularly at risk. Using a database of mother and child pairs, three areas were identified: a rural area with no increased prevalence of mental retardation and developmental delay (MR/DD) (Area A), and a rural area (Area B) and an urban area (Area C) with significantly higher prevalence of MR/DD in children as compared to the state-wide average. Areas were mapped and surface soil samples were collected from nodes of a uniform grid. Samples were analyzed for As, barium (Ba), beryllium (Be), chromium (Cr), copper (Cu), Pb, manganese (Mn), nickel (Ni), and Hg concentrations and for soil toxicity, and correlated to identify potential common sources. ArcGIS was used to determine distances between sample locations and industrial facilities, which were correlated with both metal concentrations and soil toxicity. Results indicated that all metal concentrations (except Be and Hg) in Area C were significantly greater than those in Areas A and B (p< or =0.0001) and that Area C had fewer correlations between metals suggesting more varied sources of metals than in rural areas. Area C also had a large number of facilities whose distances were significantly correlated with metals, particularly Cr (maximum r=0.33; p=0.0002), and with soil toxicity (maximum r=0.25; p=0.007) over a large spatial scale. Arsenic was not associated with distance to any facility and may have a different anthropogenic, or natural source. In contrast to Area C, both rural areas had lower concentrations of metals, lower soil toxicity, and a small number of facilities with significant associations between distance and soil metals.

Application of encapsulation (pH-sensitive polymer and phosphate buffer macrocapsules): a novel approach to remediation of acidic ground water.

Macrocapsules, composed of a pH-sensitive polymer and phosphate buffer, offer a novel remediation alternative for acidic ground waters. To test their potential effectiveness, laboratory experiments were carried out followed by a field trial within a coal pile runoff (CPR) acidic contaminant plume. Results of traditional limestone and macrocapsule treatments were compared in both laboratory and field experiments. Macrocapsules were more effective than limestone as a passive treatment for raising pH in well water from 2.5 to 6 in both laboratory and field experiments. The limestone treatments had limited impact on pH, only increasing pH as high as 3.3, and armoring by iron was evident in the field trial. Aluminum, iron and sulfate concentrations remained relatively constant throughout the experiments, but phosphate increased (0.15-32 mg/L), indicating macrocapsule release. This research confirmed that macrocapsules may be an effective alternative to limestone to treat highly acidic ground water.

Metal concentrations in rural topsoil in South Carolina: potential for human health impact.

Rural areas are often considered to have relatively uncontaminated soils; however few studies have measured metals in surface soil from low population areas. Many metals, i.e., arsenic (As), lead (Pb), and mercury (Hg), have well-documented negative neurological effects, and the developing fetus and young children are particularly at risk. Using a Medicaid database, two areas were identified: one with no increased prevalence of mental retardation and developmental delay (MR/DD) (Strip 1) and one with significantly higher prevalence of MR/DD (Strip 2) in children compared to the state-wide average. These areas were mapped and surface soil samples were collected from 0-5 cm depths from nodes of a uniform grid laid out across the sampling areas. Samples were analyzed for As, barium (Ba), beryllium (Be), chromium (Cr), copper (Cu), Pb, manganese (Mn), nickel (Ni), and Hg. Inverse distance weighting (IDW) was used to estimate concentrations throughout each strip area, and a principal component analysis (PCA) was used to identify common sources. All metal concentrations in Strip 2, the MR/DD cluster area, were significantly greater than those in Strip 1 and similar to those found in more urban and highly agricultural areas. Both Strips 1 and 2 had a high number of significant correlations between metals (33 for Strip 1 and 25 for Strip 2), suggesting possible similar natural or anthropogenic sources which was corroborated by PCA. While exposures were not assessed and direct causation between environmental soil metal concentrations and MR/DD cannot be concluded, the high metal concentrations in areas with an elevated prevalence of MR/DD warrants further consideration.

Use of a general toxicity test to predict heavy metal concentrations in residential soils.

Significant clusters of developmental delay and mental retardation (DD/MR) were identified in children born in South Carolina. Although it is difficult to identify one factor that causes DD/MR, environmental insult including exposure of pregnant women to heavy metals can induce DD/MR in their children. Because it is expensive to measure the concentrations of individual metals in large numbers of environmental samples, the general Microtox toxicity test was used to identify highly toxic soil samples. Approximately 100 soil samples were collected from residential areas and analyzed to determine an effective concentration (EC(50)) of soil required to inhibit 50% light emission of the luminescent bacterial test organism (Vibrio fischeri). The EC(50) values were then transformed to relative toxicity units (RTU). A subset of 56 high and low toxicity soil samples was then analyzed by inductively coupled plasma-atomic emission spectrometry (EPA method 6010) for arsenic, lead, and chromium, which are known neurotoxins. The highest measured arsenic concentration was 30 times higher than the South Carolina residential soil limit. Significant correlations were found between the RTU and soil arsenic and chromium concentrations. Microtox also identified some low arsenic and chromium samples as toxic, presumably because additional unidentified toxicants were present in the soil. In general, however, the Microtox test was effective in identifying soils with elevated concentrations of arsenic and chromium, even in residential neighborhoods where limited soil toxicity was expected.