Communicating results to community residents: lessons from recent ATSDR health investigations.

As a public health agency within the US Department of Health and Human Services, the Agency for Toxic Substances and Disease Registry (ATSDR) is responsible for implementing the health-related provisions of the Superfund Act. Much of its work is carried out to address health concerns in communities near sources of environmental contamination, usually in consultation with other local, state, and federal agencies. Over the last decade, ATSDR has considered, supported or conducted health investigations in a variety of different communities across the country. Communication with community residents has been an integral part of the process in all of these activities. The approach to communicating results needs to begin early by developing relationships and clarifying expectations, and it needs to remain flexible. Through examples taken from specific situations, we illustrate many of the lessons we have gained from trying to apply the principles of good community involvement to the design and conduct of health investigations and to the communication of study results.

Neurobehavioral evaluation for a community with chronic exposure to hydrogen sulfide gas.

In May 2000, the Agency for Toxic Substances and Disease Registry of the US government conducted a health investigation in response to community concerns regarding ambient and indoor hydrogen sulfide (H(2)S), odor, and health symptoms in Dakota City, Nebraska. The objective was to determine whether adult residents in an area with repeated exposure to H(2)S showed poorer performance on neurobehavioral tests than unexposed residents. Study participants were required to meet age (#10878;16 years of age) and length of residency (2 years) eligibility requirements. A battery of computer-assisted standardized neurobehavioral tests was administered in English or Spanish. A questionnaire was used to collect information about participants, demographic and health status. Three hundred forty-five people agreed to participate. After the exclusion of 10 persons, analyses were conducted on 335 participants; 171 residents in the target area and 164 residents in the comparison area. The two groups were comparable in demographic characteristics and various health conditions. Overall, neurobehavioral test results for the target and comparison groups were similar. Residence in the H(2)S-exposed area was associated with marginally poorer performance on a test of memory, namely, match to sample score, and a test of grip strength. However, these differences were not significant. Deficits in overall neurobehavioral performance were not associated with exposure to H(2)S in this study.

Ambient hydrogen sulfide, total reduced sulfur, and hospital visits for respiratory diseases in northeast Nebraska, 1998-2000.

This analysis examined associations between total reduced sulfur (TRS) and hydrogen sulfide (H(2)S) levels, and hospital visits for respiratory disease among residents of Dakota City and South Sioux City, Nebraska, from January 1998 to May 2000. For reference, the association between TRS, H(2)S, and digestive diseases was also examined. Time-series analyses of daily hospital visits in the selected outcome categories and measures of TRS and H(2)S were performed using generalized additive models with a Poisson link. TRS and H(2)S levels were categorized as high if at least one of the daily 30-min rolling averages was > or =30 ppb and as low if every rolling average was <30 ppb. Loess smoothers allowed for flexible modeling of the time effect and the effect of temperature and relative humidity. The measure of association used was the mean percent change in the average number of hospital visits recorded following a day with a high exposure versus a day with a low exposure. For children less than 18 years of age, a positive association was found between asthma hospital visits and 1-day lagged TRS levels. For adults, a positive association was found between asthma hospital visits and H(2)S levels on the previous day. A positive association also was found between hospital visits for all respiratory diseases, and H(2)S and TRS levels on the previous day for children but not for adults. No association was found between contaminant levels and hospital visits for all digestive diseases. These findings suggest that TRS or H(2)S levels may be associated with exacerbations of asthma or other respiratory diseases among the residents of Dakota City and South Sioux City.