Surveillance of Reproductive Outcomes
concerns related to hazardous waste sites in the state,
and Environmental Exposures--ATSDR has
conducted site-specific community education, and
supported the Centers for Disease Control and
developed and distributed fact sheets or resource
Prevention's (CDC) surveillance of reproductive
guides.
outcomes and environmental exposures in
Health Studies
Iowa since August 1986. Iowa began an active
Health studies are investigations conducted to deter-
birth defects registry in January 1987 covering
mine the relationships between exposures to hazard-
all 99 of its counties; record abstraction was
ous substances and adverse health effects. They also
undertaken retrospectively for all counties from
define health problems that require further investi-
1983 through 1986 so that complete data exist
gation through, for example, health surveillance or
from 1983. Between 1983 and 1990, more than
an epidemiologic study. Following are examples of
18,000 children with reportable birth defects were
health studies and investigations that ATSDR con-
registered.
ducted or supported in the state of Iowa:
As a part of this surveillance effort, a special
Hazardous Substances Emergency Events
project focused on ecologic studies of public
Surveillance System (HSEES)--HSEES
was established by ATSDR in 1990 to collect
in 18 small towns in southern Iowa. These
and analyze information about releases of
drinking water supplies were contaminated with
hazardous substances that need to be cleaned
several herbicides including atrazine, cyanazine,
up or neutralized according to federal, state,
metolachlor, and 2,4-dichlorophenoxyacetic acid
or local law, as well as threatened releases
(2,4-D). The project also evaluated the prevalence
that result in a public health action, such as an
of birth defects in counties and municipalities
evacuation. The goal of HSEES is to reduce
with and without NPL sites, and the prevalence of
the morbidity and mortality of first responders,
neural tube defects near the La Bounty dump site
employees, and the general public resulting from
hazardous substances emergencies. Fifteen state
growth retardation (IUGR) (using California
health departments, including Iowa, currently
norms), cardiac defects, urogenital defects,
participate in HSEES. HSEES captures data on
and limb reductions was elevated in the study
over 5,000 events annually. Of these, 80% occur
at fixed facilities, and 20% are transportation-
were inconclusive because of low statistical
related events. Most events occur between
power and poor exposure information. However,
8:00 AM and 5:00 PM on Monday through Friday.
counties with NPL sites containing heavy
Persons most often injured are employees.
higher prevalence of clubfoot without central
The HSEES system is used to generate
nervous system defects and a higher prevalence
information for use by states to conduct
of cleft lip. The final report was released in
presentations on planning prevention strategies
September 1992.
for industries that account for a significant
number of spills; conduct HazMat training
Association of Occupational and
courses, including information on the risk for
injury from methamphetamine labs; establish
Environmental Clinics
and maintain protection areas for municipal
ATSDR provides financial and technical support to
water systems; assist with the proper placement
members of the Association of Occupational and En-
of HazMat teams; develop fact sheets on
vironmental Clinics (AOEC). This support is provid-
frequently spilled chemicals or chemicals that
ed to improve education and communication related
cause a disproportionate number of injuries (e.g.,
to surveillance, diagnosis, treatment, and prevention
chlorine and ammonia); develop newsletters for
of illness or injury related to exposure to hazardous
industry, responders, and environmental groups;
substances. The member institution in Iowa is the
and conduct presentations for state and local
University of Iowa Occupational Medicine Clinic
emergency planners.
in Iowa City.
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