Suitability of public records for evaluating health effects of treated sewage sludge in North Carolina.

BACKGROUND: Exposure to potentially harmful agents because of waste disposal practices is receiving increased attention. Treated sewage sludge (TSS), or biosolid material, is the solid waste generated during domestic sewage treatment after it has undergone processes to reduce the number of pathogens and vector attractants. Application of TSS to land, which is the most common method for disposal, is promoted as a soil amendment and fertilizer. Few studies have examined the effects of land application on the health and quality of life of neighboring populations. We describe and summarize publicly available records that could be used to study the public health impact of practices associated with land application in North Carolina. METHODS: We abstracted public records from the North Carolina Department of Natural Resources Division of Water Quality, to determine the following activities associated with land application of TSS in 8 counties in central North Carolina: the process for obtaining permits, reported applications, violations, documented concerns of residents, and penalties assessed. RESULTS: The Division of Water Quality routinely collects records of permits and approvals for land application of TSS, amounts applied, and reported pollutant levels. Documentation was useful in summarizing land application practices, but lack of standardization in reporting was a concern. Research into the public health impacts of the land application program is hindered by inconsistency in documenting inspections and resident concerns. LIMITATIONS: We were not able to validate state records with direct observation of land application of TSS. CONCLUSIONS: Records from the Division of Water Quality would be of limited use in epidemiologic studies of the health effects of land application of biosolids. Information about locations, amounts, and dates of application are relevant to exposure potential, but additional information is needed for health investigations.

Health survey of workers exposed to mixed solvent and ergonomic hazards in footwear and equipment factory workers in Thailand.

A cross-sectional health study was performed at four footwear and one equipment factory in Thailand to evaluate the prevalence of chemical- and ergonomic-related symptoms in Thai factory workers and to investigate associations between these symptoms and exposures to organic solvents, isocyanates and ergonomic risks. A 10-page health questionnaire was administered to 1784 workers across the four footwear and equipment factories. A total of 1675 questionnaires were returned, yielding a 94% response rate. The questionnaires asked about age, gender, use of chemicals, use of personal protective equipment and health outcomes. Without exception, the percentages of workers reporting symptoms after being hired were higher than those reporting symptoms before being hired for all the factories. The highest symptom percentages were related to ergonomic stressors. Multiple logistic regression was used to calculate adjusted prevalence odds ratios and 95% confidence intervals. This study showed that adverse health effects experienced by footwear and equipment factory workers are associated with occupational exposures to chemicals (volatile organic solvents and water-based adhesives) and ergonomic hazards.

Community health and socioeconomic issues surrounding concentrated animal feeding operations.

A consensus of the Workgroup on Community and Socioeconomic Issues was that improving and sustaining healthy rural communities depends on integrating socioeconomic development and environmental protection. The workgroup agreed that the World Health Organization's definition of health, "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity," applies to rural communities. These principles are embodied in the following main points agreed upon by this workgroup. Healthy rural communities ensure a) the physical and mental health of individuals, b) financial security for individuals and the greater community, c) social well-being, d ) social and environmental justice, and e) political equity and access. This workgroup evaluated impacts of the proliferation of concentrated animal feeding operations (CAFOs) on sustaining the health of rural communities. Recommended policy changes include a more stringent process for issuing permits for CAFOs, considering bonding for manure storage basins, limiting animal density per watershed, enhancing local control, and mandating environmental impact statements.

Lessons learned from the Children's Environmental Exposure Research Study.

We examined 5 different ethical concerns about the Children's Environmental Exposure Research Study and make some recommendations for future studies of exposure to hazardous environmental agents in the home. Researchers should seek community consultation and participation; make participants aware of all the risks associated with the research, including hazards discovered in the home and uncertainties about the risks of agents under investigation; and take steps to ensure that their studies will not have unfair representation of the poor or people of color. Researchers should also avoid even the appearance of a financial conflict of interest in studies that are likely to be controversial and make it clear to all parties that studies will not intentionally expose subjects to hazardous environmental agents.

Income, income inequality, and cardiovascular disease mortality: relations among county populations of the United States, 1985 to 1994.

OBJECTIVES: Despite the major contribution of cardiovascular disease (CVD) to total mortality, and reports demonstrating strong relations between income and CVD, the joint relations of population-level income and income inequality with CVD mortality are not well described. This study was undertaken to describe relations among population-level income, income equality, and mortality due to cardiovascular disease, coronary heart disease, and stroke. METHODS: County income distributions were determined from 1990 census data, and CVD mortality rates were obtained from the Compressed Mortality File. Relations among income, income inequality, and CVD mortality were examined in stratified and Poisson regression analyses. RESULTS: County income was inversely related and income inequality was directly related to CVD, coronary heart disease, and stroke mortality. Relations were strongest for stroke. Relations of stroke mortality with income inequality were strongest in low-income populations. CONCLUSIONS: The CVD mortality experiences of county populations are related to both income and income distribution in a complex, disease-dependent manner. The authors' findings are especially relevant to the Southeast, a region of high income inequality, low income, and high stroke mortality.