United States
Environmental Protection
Agency
Waste, Pesticides &
Toxics Division
(D-8J)
EPA 905-R-00-003
June 1,2000
Proceedings
Workshop On Actions To Take
For Children's Health
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U.S. Environmental Protection Agency
Region 5, Library (PL-12J}
77 West Jackson Boulevard. 12th Floor
Chicago. IL  60604-3590

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Ms. Linda Ruskowski from the Marion County
Asthma Community Development Group (ACDG)
and Mr. Ron Burke of the American Lung
Association of Metropolitan Chicago provided
advice about asthma management in schools. Dr.
Steven Potsic from the U.S. Department of Health
and Human Services spoke about asthma
initiatives and asthma statistics for residents of
Chicago.
 Asthma Management in Schools
J
Ms. Linda Ruskowski presented information on the
ACDG Program she has been involved within
Marion County, Ohio.  The group consists of
people from hospitals in Marion County and
employees of the local health department and lung
association.  The goals of the group are to identify
asthma problems in the community and to try to
prevent them. The ACDG offers four different
asthma education workshops, including those
targeting school staff and those targeting school
children.

Ms. Ruskowski focused on the workshop for school
staff.  The group gives folders to teachers
containing material on how to manage students
with asthma. The information  is presented in a
mandatory teachers' meeting held at the beginning
of the school year and is free of charge.

Information presented during the workshop
includes common asthma triggers in the school
setting.  Which may include:

<»  Perfume, lotions, and deodorants
*  Pet animals, including furry pets and birds
*  Clapping chalkboard erasers
*  Dusty carpets
<»  Construction
<»  Opening windows during lawri maintenance
                                                     To reduce asthma triggers, Ms. Ruskowski
                                                     suggests using wipes instead of chalkboard
                                                     erasers to prevent chalk dust and cleaning the
                                                     rooms regularly to thoroughly eliminate dust.

                                                     Ms. Ruskowski stressed the  importance of
                                                     community education. Members of the community
                                                     can stating the teachers and  parents, can be more
                                                     informed about asthma triggers and be better
                                                     prepared to help prevent asthma attacks.
                                                      Chicago Asthma Initiative - A Chicago
                                                      Area Intervention Project
                                                     J
Dr. Steven Potsic of the U.S. Department of Health
and Human Services presented information on the
mission and general model of public health
initiatives, asthma initiatives for the U.S.
Department of Health and Human Services, and
goals for the Chicago Asthma Initiative.

Dr. Potsic spoke about the general responsibilities
to public health as being assessment, assurance,
and policy development.  He stated that evolving
public health priorities include maintaining a global
approach and eliminating social disparities.  Dr.
Potsic spoke about  a model that should be used in
general public health studies. The Chicago
Asthma Initiative project followed this model, which
consists of the following:

1.  Define the problem
2.  Measure and assess the problem
3.  Determine risk factors
4.  Develop and implement intervention strategies
5.  Evaluate the effectiveness of the strategies

Dr. Potsic also spoke about the current initiatives of
secretary of the U.S. Department of Health and
Human Services to  help prevent and manage
asthma. These initiatives include determining the
causes of asthma, reducing the burden of asthma
for people with the disease, improving the means
for managing asthma, and tracking and assessing
the effectiveness of asthma programs. The
department has targeted  goals to (1) reduce the
asthma death rate to no more than 14 per million in
the United States and (2) reduce asthma
hospitalizations to 10 out of every 10,000 people in
the general population. Between 1993 and 1995,
the number of deaths due to asthma was 18 per
million population.  In 1980, the self-reported
percentage of the U.S. population that had asthma
was 3.1 percent.  That percentage rose to 5.4
percent between  1983 and 1994.

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In response to EPA Administrator Carol Browner's
National Agenda to Protect Children's Health from
Environmental Threats (1996), President Clinton's
Executive Order 13045, Protection of Children from
Environmental Health Risks and Safety Risks
(1997), and the establishment of the U.S.
Environmental Protection Agency (EPA) Region 5
Children's Health Team (the "REACH Team,"
Regional Environmental Actions for Children's
Health") (1997), the Region hosted a children's
environmental health workshop. The workshop,
entitled, "Environmental WATCH" (Workshop on
Actions to Take For Children's Health) was
sponsored by EPA Region 5, U.S. Department of
Health and Human Services (HHS), and the
Agency for Toxic Substances and Disease Registry
(ATSDR). The Environmental WATCH workshop
was held July 20-21, 1999 at the Metcalfe Federal
Building in Chicago, Illinois.

EPA Region 5 has a goal to effectively integrate
pollution prevention -concepts into the children's
environmental health initiative.  Under the Pollution
Prevention Act of 1990, Congress established a
national policy that pollution should  be prevented
or reduced at the source whenever feasible.
Pollution prevention is defined as any practice that
reduces the amount of any hazardous substance,
pollutant, or contaminant entering any waste
stream or otherwise released into the environment
prior to recycling, treatment, or disposal; and
reduces the hazards to public health and the
environment associated with the release of such
substances, pollutants, or contaminants. Pollution
prevention tools and resources were emphasized
at the Environmental WATCH.
Workshop participants listened to various speakers
during two plenary and 22 breakout sessions
during the two-day workshop. Participants also
developed recommendations on how to strengthen
community efforts to protect children's
environmental health through pollution prevention.
The recommendations will form the basis for a
regional action plan to protect children's
environmental health through prevention,
intervention, education, and collaboration. The
action plan is in development.  EPA Region 5 will
ensure that this action plan is used as the
foundation for its planning and funding decisions to
support local activities to protect children's
environmental health. Other regions may use this
model to integrate pollution prevention into
community-based efforts to protect children's
environmental health. EPA is committed to
ensuring that action plans are implemented, and
prevention of pollution at the source becomes the
fundamental way that our children's environmental
health is protected.

This document contains a summary of discussions
and presentations during  each  of the plenary and
breakout sessions. More information about EPA
Region 5 efforts to protect children's health, can be
found on the world wide web at
http://www.epa.qov/r5ptb/reach/watch.
CONTACT:
Maryann Suero
U.S. Environmental Protection Agency
Region 5
77 W. Jackson Boulevard (T-13J)
Chicago, IL 60604
(312) 886-9077
E-mail: suero.maryann@epa.gov

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        Plenary Sessions
The two-day workshop kicked off with two plenary
sessions.  During the sessions, speakers
representing academia, various state and federal
agencies,  and a nonprofit organization, spoke
about issues pertaining to:

*  preventing children's health problems,
*  the importance of education and collaboration
    in addressing children's health issues,
»:•  tools for success in protecting children's health,
    and
*  comprehensive approaches to addressing
    multiple children's health issues
  Opening Remarks
j
Ms. Phyllis Reed, Chair of the EPA Region 5
Children's Health Team, and Ms. Hannah
Rosenthal, Regional Director of the U.S.
Department of Health and Human Services (HHS),
welcomed participants and provided opening
remarks. Ms. Reed discussed EPA's intent to
provide support after the workshop and to help
participants carry out the action plan  that would
result from discussions during the plenary and
breakout sessions.  She explained that EPA had
set aside some funds to help communities begin
implementing the action plan; EPA requested that
community groups provide a written summary of
their plans for using the money by July 23, 1999.

Ms. Reed pointed out that interagency cooperation
and partnerships have been a benefit of the
Children's health initiative. Ms. Rosenthal
explained that HHS had been working in
partnership with  EPA on many issues, including
those pertaining to children's health.
  Prevention, Intervention,
  Education, and Collaboration

 Dr. Barbara Sattler, Assistant Professor and
 Director of the Environmental Health and Education
 Center, University of Maryland, began her
 presentation by explaining that children's
 environmental and health issues surfaced as a
 focal point in the mid-1980's.  This, she explained,
was a shift from the earlier focus on natural
habitats and adults.  Dr. Sattler's presentation
included a discussion of:

<»  lead poisoning
<•  the need to better educate families about
    pesticides commonly found in and around
    homes and their effects on children
«:»  indoor air quality issues
*  water quality issues
*  opportunities for community activism

Lead Poisoning
Dr. Sattler pointed out that although most people
think their homes are "safe havens," over 50
percent of homes have lead-based paint. This
problem is particularly common in homes of poor
families in substandard living conditions.  Dr.
Sattler explained that lead can cause a variety of
health problems for children,  including:

<»  kidney damage
*  cardiovascular problems
<»  anemia
*  learning disabilities
*  higher incidents of aggressive behavior in
    adolescence

In addition, she pointed out that many cases of
lead poisoning in kids are not diagnosed. These
children surfer twice because the undiagnosed lead
poisoning often causes learning problems. When
parents and teachers do not  know about the lead
poisoning, they tend to alter their expectations for
the child's learning.  This can lead to children being
placed in learning disability classes, for instance,
when, in fact, their problem is not limited learning
capacity but lead poisoning.

Dr. Sattler pointed to a pilot study in Rhode Island
as an example of ways to address the problem of
lead poisoning in children. As part of the pilot
study, if a child is found to have lead poisoning,
health professionals can "do the equivalent of
writing a prescription to have children's homes
evaluated for lead contamination." The evaluations
are paid for with health department dollars.  Dr.
Sattler noted, however, that the Rhode Island
program begins with a lead-poisoned child and
focuses, therefore, on responding to the problem
versus  preventing it.

 Pesticides
 Dr. Sattler explained that pesticides are poisons;
 most, however,  have never  been tested to see
 how they affect fetal or children's nervous systems.

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She discussed how stuffed animals, pillows, and
rugs become "wicks" for pesticides when people
use roach "bombs" and other similar items in their
homes. This is an area where greater community
education is needed.

Major issues of concern regarding pesticides and
their effects on children include:

*  the risk of leukemia for children increases 3.8
    times when pesticides are used in the home
*  the risk of leukemia for children increases by
    6.5 times when pesticides are used on lawns
*  children in families living in suburban areas are
    particularly at risk because of the number of
    lawns on which chemicals are used
*  current standards for pesticide exposure are
    based on adult white males.  To compare
    fetuses and children to adult males is like
    "comparing apples to oranges."

Air Quality
Dr. Sattler stated that traffic is the number one
cause of air pollution. She stressed that we need
to adjust our ways of thinking to consider the
impacts of our actions on children's health. Vice
President Al Gore is currently leading an effort to
rethink how to plan for growth in  a way that is less
harmful on human health.

Schools present another set of potential problems
with respect to children's health.  Some of these
problems include:

*  poorly ventilated schools with synthetic
    products that  give off chemicals that pose
    health problems.
•!•  school carpets contribute to poor indoor air
    quality and asthma
*  some schools are adjacent to Superfund sites

Dr. Sattler explained that risks to the female
reproductive system are posed by a variety of
environmental factors, such as:

*  smoke stacks caused by waste incineration
    (which  is a particular problem caused by U.S.
    hospitals)
*  the creation of the by-product dioxin, generated
    from  the burning of  plastics (dioxin is a
    carcinogen that looks to the body like estrogen;
    therefore, it has the potential to disrupt
    endocrine systems)

Water Quality
During her presentation, Dr. Sattler pointed out that
under the Safe Drinking Water Act, every public
drinking water supplier will be required to produce
a consumer confidence report. This requirement
becomes effective in October 1999. The reports
will have to identify contaminants in water, their
levels, and probable sources. This information  will
be included in water bills.

Community Activism
Dr. Sattler concluded her presentation by noting
that many opportunities exist through community
activism to protect children's health. She said
"although we  are in a crisis situation, it is exciting
that we are thinking about opportunities to make
the world safer. The work of devising  solutions for
our children and our children's children is Very
noble' work".
 Tools for Success in Protecting
 Children's Environmental Health
J
Ms. Angela Spittal, Chief of Staff, Indiana
Department of Environmental Management
(IDEM), presented information on an IDEM
initiative focused on children's health issues. The
initiative, "Bright Beginnings for Indiana's Children,"
is being carried out in collaboration with many
partners.
Ms. Spittal explained that in 1996, Indiana
Governor Frank O'Bannon established a multi
agency work group focusing on children's health
issues. The initiative began in fall 1997 with the
following goals:

»t»  reduce children's exposure to toxic chemicals
*  educate families
*  involve children
*  achieve a tangible outcome

Reducing Children's Exposure to Toxics
Ms. Spittal explained that this aspect of I OEM's
efforts to reduce children's exposure to toxics
consisted of a multi pronged approach focusing on
lead, toxic chemicals, mercury, and ozone and
particulate matter.  Means to achieve the overall
goal of reducing children's exposure  included:

Lead
*  establish lead education grants for priority
    neighborhoods
«>  enhance protection from lead in drinking water
*  train  100 people as lead risk assessors
                                                      Toxic Chemicals

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*•   expand toxics monitoring network
«>   announce Governor's toxic reduction challenge
    (which was a challenge to  business and
    industry to voluntarily reduce their toxic air
    emissions)
Mercury
*   reduce the use of mercury by ventilation
    contractors
*   offer a "mercury collection  day" in every county
Ozone and Paniculate Matter
•*   establishment of seven regional ozone steering
    committees

Educate Families
To meet the initiative's goal of  educating families
as a step toward reducing children's exposure to
contaminants,  IDEM developed a "simple steps for
families" effort, which included launching an
outreach campaign, complete  with place mats,
billboards, posters, and public  service
announcements.

In addition, Ms. Spittal explained that other efforts
were launched, such as:

»:»  a self-assessment program for child care
    centers, including the development of a "how-
    to" manual
<•  a 5-star environmental recognition program for
    child care centers
*  efforts to reduce the number of combined
    sewer overflows (CSO) in  Indiana and
    educating  parents on ways to keep children
    away from CSOs
•>  an outreach program and  1-800-number for
    children's health issues
»:•  development and distribution of "simple steps
    to get the lead out" material

Involve Children
Efforts to involve children have included getting
15,000 students involved in providing IDEM with
environmental information, and educating the
students on the difference they can make in
creating a safer environment.

Achieve a Tangible Outcome
Ms. Spittal mentioned a variety of specific
accomplishments that have been achieved through
IDEM.'s initiative, including:

»:•  $620,000 distributed for lead education and
    mercury education
<•  2,100 pounds of mercury  recycled
*   Distribution of more than 20,000 educational
    brochures, place mats, magnets and other
    items
*   Increased partnerships
*>   Changed behaviors
«:«   Reduction of toxics
*   Prevention of lead poisoning
«>   Improvement of children's lives

Ms. Spittal closed her talk by encouraging
participants to be persistent in their children's
health efforts, and she shared the following lessons
learned by IDE:M:

*   set achievable goals
*   expand existing partnerships
*   involve partners in goal setting
*   recognize factors beyond your control
*   make children's health a priority
<•   realize that you can't do everything, but you
    should do something

More information about I OEM's children's health
initiative can be obtained on their web site
www state.in.us/idem/kids. Or, by calling Angela
Spittal  at 317/233-3043.
  Comprehensive Approaches to
  Addressing Multiple Children's
  Health Issues
Dr. Robert Amler, Chief Medical Officer, ATSDR,
presented information based on the foundation that
"Children are Not Small Adults." In his
presentation, Dr. Amler explained that the fact that
children are not small adults is a basic tenet to
pediatrics; however, the concept of treating
children as different from adults from an
environmental perspective is a  relatively new
concept.

Pointing out specific differences between children
and adults, Dr. Amler stated that:

*  Pound for pound of body weight, children drink
    more water, eat more food, and breath more air
    than adults
*  Children are more likely to come in contact with
    a variety of media
*  Children are less empowered than adults
*  Children are completely dependent on adults
    for risk management, access to child care, and
    other decisions

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Dr. Amler urged participants to see the differences
as an opportunity, not a problem, and spoke of the
following major issues, summarized below that
affect children's health.

*  Saturation of mercury vapors into toys and
    blankets
*  Thousands of children being rushed to
    emergency rooms for health problems caused
    by use of roach spray in their homes (and most
    are misdiagnosed)
*  Fish contaminated by mercury and other
    contaminants from industry operations (a
    particular issue for tribal and other communities
    who rely on fishing as a means for sustenance)
«:»  Nearly 1 million American children have
    excessive lead levels in their blood
*  Early exposure to trichloroethylene and RGBs
    result in less mature neonatal reflexes and
    diminished IQS
*  50 percent of lifetime pesticide ingestion occurs
    in the first 5 years of life
*  Asthma death rates have doubled in American
    children since 1980 (asthma is the most
    common admission diagnosis in most
    Children's hospitals)

ATSDR's Children's Health Initiative
Dr. Amler explained that ATSDR began  its
children's health initiative about two years ago.
ATSDR has worked closely with the EPA Office of
Children's Health Protection. Basic tenets of the
ATSDR program include (1) emphasis on children's
health in ATSDR's own programs, (2) educating
ATSDR staff, (3) formation of an Office of
Children's Health, with a message that "Children
are not small adults!"

Major activities of ATSDR's Office of Children's
Health:

*  pediatric referral units
*  expert workgroups on pediatric assessment
*  children's environmental health  and  safety task
    force
»3>  a web site
»:«  partnerships with non-government entities
    (medical associations, national Parent
    Teacher's Association (PTA), children's health
    environmental coalition, National Association of
    Children's Health Organizations (NACHO)

Discussing one partnership as an example of
training children to be risk communicators, Dr.
Amler described an ATSDR partnership  with the
Girl Scouts of America.  Girl scouts can earn a "No
Lead" badge by investigating the history of mining,
health education, or historical problems caused by
lead in their communities.
 thought of. Greater awareness ii'aeeded* Most
 physicians specMiangiQ enviioflffieatal medicine
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«:•   Neurological and developmental problems
    prevail (lead, mercury, and endocrine
    disrupters)
»:»   Disconnect exists between environmental
    programs and children's health. Questions
    should be asked such as: Are programs
    continuing to achieve health goals? Do
    programs reflect new science regarding health
    goals?  What health goals are we trying to
    accomplish?

Mr. Neltner expressed concern about the amount
of time it takes to build new scientific developments
into regulatory standards.  He made the following
points:

»:»  Disconnection  is most significant at the
    regional and state level: the focus is on
    implementation, not assessment
«t»  Piecemeal delegation leads to
    departmentalization
*  Environmental agency separated from the
    public health agency is an example of weak
    institutional links
*  Bureaucratic obstacles and lack of regulatory
    momentum exist because of a" we've always
    done it that way" mentality
*  Cautious programs with minimum standards
    (Example: ozone standards were done
    cautiously and defensibly, however, agencies
    are slow to identify and respond to new issues)
*  Federal programs focus on "regulatable
    sources" that are able to be commanded and
    controlled
»>  Paternalistic system prevails in government
    agencies ("we know best!" mind set, while
    forgetting that standards are only minimum)
*  Poorly understood but potentially significant
    hazards exist:  toxics, and endocrine disrupters
    (We need to get information out on what we do
    know about these hazards)

Mr. Neltner pointed out that information gaps do
exist in many areas regarding health risks in
general and children's health risks in particular. He
suggested, however, that agencies and
organizations "embrace right-to-know" to fill in the
gaps.  He offered several models of success in this
area, including:

Toxics Release Inventory data
Worker right-to-know/hazard communication
Risk management planning
Fish consumption advisory data
Mr. Neltner suggested that organizations who
generate children's health threats should
communicate those threats directly to those
threatened. Government agencies establish
requirements and ensure quality, but they should
not necessarily relay all information. He pointed
out that a key issue is trust ~ and, in particular,
whether those with the information believe that they
can trust parents and guardians with the
information. Agencies and organizations often
believe that parents and guardians will "over react"
to information about health threats. Instead of
allowing mistrust to prevail, Mr. Nelter said that key
information should be disseminated, and (partial or
complete) answers to the following questions
should be provided:

What is known about the hazards?
What precautions should be taken?
What critical information gaps exist?

Mr. Neltner explained that proactive notice and
information dissemination should be a focal point of
organizations and agencies, to put the control  in
the parents' hands. He also pointed out that
threats to sensitive populations need to be taken
into account (those who are not representative of
the population, chemically-sensitive individuals,
and sick children).

CONTACT:
Tom Neltner
Improving Kids' Environment
5244 Carrollton Ave.
Indianapolis,  IN 46220
Phone: (317)  442-3973
Fax:(317)283-6111
e-mail: neltner@in.net
 Consumer Product Labeling

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Participants in the Chicago Asthma Initiative
include employees at the U.S. Department of
Health and Human Services, researchers at the
University of Illinois, Circle Campus, and members
of the Chicago Asthma Association. The goals of
the initiative are as follows:

*  Facilitate outreach and education about
    asthma in communities
<»  Assist in asthma prevention
<•  Provide education and preventive services to
    families suffering from asthma
*  Offer services to communities that have a
    greater risk of asthma
<•  Train and employ  members of the community
    to help spread  asthma education and
    prevention
 Asthma Train-the-Trainer
Mr. Ron Burke from the American Lung Association
of Metropolitan Chicago discussed some of the
association's programs for schools and students
that focus on education about and prevention of
asthma. Some of the programs include Open
Airways for Schools (OAS) and the Sesame Street
A is for Asthma Childhood Asthma Awareness
Program.

The OAS program is directed at children with
asthma aged 8 to 11. It is based on the idea that
children learn by doing. The OAS program
includes six curriculum lessons, flipcharts, an
instructor's guide, and numerous handouts about
asthma triggers and prevention tips.  OAS has
documented that children have fewer and less
severe asthma attacks after completing the
program. In addition, parents have taken more
steps to help control their children's asthma. OAS
has been implemented in 40 schools in the
Chicago area.

The Sesame Street A is for Asthma Childhood
Asthma Awareness project is geared toward
children ages 3 to 6. A kit developed for the project
includes a videotape in English and Spanish,
posters, and a caregiver's guide. The goal of the
project is to increase awareness about asthma.
The program has been implemented in 30 sites in
Cook County, Illinois, and over 2,000 children have
been given the program. In addition, over 250 kits
have been distributed in the Chicago metropolitan
area.
Mr. Burke also discussed several barriers
encountered during the implementation of these
programs, including getting parents involved,
having program volunteers report results, getting
into schools, and obtaining financial support.
 Facilitated Discussion
J
Mr. Randy Cano of the U.S. Environmental
Protection Agency (EPA) Region 5 facilitated a
discussion on asthma prevention. The following
key issues were raised during the discussion:

1.   Need for overall public awareness about
    asthma
2.   Need for parental behavioral changes
3.   Education of physicians and clinics about
    asthma
4.   Generation of community activism with regard
    to air quality
5.   Exploration of holistic options and alternatives
    to asthma management
6.   Awareness of policy makers and government
    to asthma problems

CONTACTS:
Steven R. Potsic. M.D.. M.P.H.. FACPM
U.S. Department of Health & Human Services
105 West Adams Street, 17th floor
Chicago, Illinois 60603-6201
Phone:(312)353-1385
Fax:(312)353-0718

Ron Burke
American Lung Association of Metropolitan
Chicago
1440 West Washington Blvd.,
Chicago, Illinois 60607-1878
Phone:(312)243-2000
Fax:(312)243-3954

Linda Ruskowski. R.R.T.
Community Hospital South
1402 E. Co. Line Rd. S.
Indianapolis, Indiana 46227
Phone:(317)887-7402
Fax:(317)887-4770

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Mr. Phil Nixon of the University of Illinois, Mr. Todd
Okamoto of the U.S. Environmental Protection
Agency (EPA) Region 5, Ms. Amy Brown of the
University of Maryland, and Mr. Steven Brachman
of the University of Wisconsin presented several
approaches to reducing pesticides exposure of
children in the United States.
  Preventing Pesticide Exposures at
  Home
J
Mr. Phil Nixon, an entomologist from the University
of Illinois Extension Service, discussed how to
prevent pesticides exposure in residential lawns and
in the home.

Mr. Nixon described the "golf course standard" that
many homeowners strive toward when maintaining
their lawns.  In most cases, he said, homeowners
apply too much pesticides to achieve a "perfect"
lawn completely free of weeds.  He posed the
question of whether a beautiful lawn has to be
weedless or pestless.  He showed a photograph of
a tree at a golf course that was infested by leaf
hoppers to demonstrate that even golf courses are
not perfect.  He reported that many so-called plant
pests are actually not very harmful. Another
photograph showed that a tree infested by the
Japanese beetle still served as a good shade tree.

Mr. Nixon then turned his attention to insects in the
home. He asserted that many nuisance pests such
as winged ants and spiders are not harmful and
therefore do not have to be eradicated with
pesticides.  He recommended simply vacuuming up
the nuisance pests and disposing of them outside,
which eliminates the problem and does not leave
harmful chemical residues in the home.

Mr. Nixon reported that as median income rises, so
does intolerance to pests.  More affluent
neighborhoods generally have better-manicured
               lawns and homes free of nuisance pests. These
               conditions are maintained primarily by the use of
               many pesticides.  He stressed the need to change
               the general attitude toward weeds and pests.  He
               stated that not all weeds or pests have to be
               eradicated with harmful chemicals.

               Mr. Nixon introduced the concept of integrated pest
               management (IPM), which he defined as the
               combination of environmentally compatible and
               economically feasible management methods.  He
               referred to subsequent presentations for more
               details on IPM. He stated that when pesticides
               must be used, applicators should keep the tips
               below in mind.

               *  Read the label on pesticides products carefully.
               *  Wear protective clothing such as gloves when
                  using pesticides.
               *  Store pesticides where children cannot reach
                  them.
               «>  Triple rinse empty pesticides  containers before
                  disposing of them.
                                                       Insecticidal Chalk in Chicago
Mr. Todd Okamoto of EPA's Office of Pesticide
Programs described an illegal chalk product from
China that has resulted in the hospitalization of one
Chicago child who ate it.  He stressed the need to
bring awareness of this toxic chalk to the Asian
community. When asked what active ingredients
comprise the chalk, Okamoto stated that permethrin
was probably one of them, but he was unsure
because it is an unregistered product. The chalk is
currently not illegal in China, and it is being imported
into the United States.

A town meeting on insecticidal chalk was held in
Chicago to discuss ways to educate businesses and
residents about health risks associated with using
the illegal product. The meeting brought together
the following groups:

<«   Chicago Asian community groups
»>   Chicago African-American community groups
*   Chicago Hispanic community groups
*   Minority advocacy groups
*   Community business groups
*   Poison control specialists
*   Import brokers
*   U.S. customs agents
»»»   University of Illinois Extension Service
»:•   Federal and state pesticide regulators
•>   Concerned parents

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 Educating Parents, School Staff, and
 Nurses about Prenotification
 Application
newsletter, and provides links to pesticides-related
references and resources.
Ms. Amy Brown, entomologist from the University of
Maryland, described a new law in Maryland that
mandates school IPM programs and requires the
posting of signs in school areas where pesticides
are being used. She reported that pesticides are
widely used in schools because of the perceived
need that insect pests need to be controlled in that
environment.  School IPM programs are currently
also required  in Louisiana, Michigan, Texas, and
West Virginia.

Ms. Brown and her colleagues at the University of
Maryland conducted a survey of  pesticides control
strategies in schools. Survey respondents included
staff members and parents of children at Anne
Arundel Public Schools. The schools have initiated
a voluntary prenotification program that involves
informing school staff and parents of anticipated
pesticides application activities at the beginning of
the school year, followed by another notification
immediately prior to the application.

Preliminary results of the University of Maryland's
1999 survey showed that about 50 percent of the
parents and 30 percent  of the staff surveyed did not
remember receiving prenotification within the past
year. In terms of actions taken in the response to
notification, 44 percent of parents and 16 percent of
staff members watched  for possible symptoms in
the children.  About 86 percent of parents and
90 percent of staff did not notice  symptoms
associated with the application, but 3 percent of
parents and 4 percent of staff thought they did. Of
the 3 percent of parents who  noticed symptoms in
their children, 30 percent brought their children to
the doctor; 56 percent of the parents did  not have
their children diagnosed. Most respondents
preferred prenotification at the beginning of the
school year, as well as another notification
immediately prior to the application. Half of the
parents and 64 percent  of the staff surveyed stated
that the school provided enough  information about
the pesticides application.

Ms. Brown reported that the University of Maryland
and the Maryland Department of Agriculture have
jointly developed resource guides and conducted
training  for pesticide applicators. For more
information on the University  of Maryland's pesticide
education and assessment program, Brown
directed the audience to the following web site:
http:\\www.pest.umd.edu. The web site currently
features information on  the impacts of pesticides on
migrant and seasonal laborers, includes  a pesticide
                                                       Neighborhood Spray Notification,
                                                       Education, and Prevention Program
Mr. Steven Brachnnan, a waste education and
management specialist at the University of
Wisconsin Extension Service, presented a
discussion of Wisconsin's landscape registry and
how it can improve children's health. Brachman
stated that the registry contains names and
addresses of homeowners who hire commercial
pesticides applicators to treat their lawns and the
contact information for their neighbors. Under the
program, pesticides applicators are required to
notify others in the neighborhood prior to spraying.

The program was established in 1993 in response
to concerns about over spraying of herbicides and
potential children's health risks. It ensures that
residents are notified about pesticides applications
in their neighborhoods so that they can take the
necessary steps to protect themselves and their
children. Brachman reported that the registry has
grown from 500 households in 1993 to over 1,000
households today. Dane and Milwaukee Counties,
the two most populous counties in Wisconsin,
comprise over half of the state registry. The
program is currently promoted primarily by word of
mouth

Mr. Brachman stated that the registry has a strong
potential to increase educational awareness about
the risks posed  by pesticides application and ways
to reduce exposure. He stressed the need for
stronger partnerships with educational organizations
and increased outreach efforts on the matter.  He
suggested that targeted pilot studies may generate
more information about pesticides use.
 Facilitated Discussion
J
Ms. Sue Brauer and Mr. Peter Murchie of EPA
Region 5 facilitated a discussion on pesticides
prevention around the home, school, and
neighborhood. The following key issues were
raised during the discussion:

*  Expand the scope of pesticides education
    awareness programs to include pesticides use
    from all sources, not just landscape
    improvement
*  Identify funding opportunities on the regional
    and federal levels to promote awareness of
    pesticides

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*  Change the public perception of the need for
    the "perfect lawn"
*  Consider alternative ways to control pests
*  Compile a children's environmental health
    clearinghouse or compendium of information
    (for example, on the EPA homepage) that links
    to efforts on the state and local levels
*  Educate parents, school nurses, primary care
    physicians, and politicians, among others, about
    risks associated with pesticides and how to
    reduce the exposure of children
«>  Continue to work with county extension
    agencies and collaborate with local efforts on
    reducing pesticide use (an EPA role)
*  Explore other avenues and programs to
    increase awareness about pesticides risk and
    use
*  Increase attention on this issue, especially
    among private applicators, by increasing the
    focus on cost, in addition to health, issues

This list of discussion topics was narrowed down to
the following three to be considered for the action
plan:

*  Need for clearinghouse of information
*  Incorporation of pesticides awareness into
    educational programs for public and pesticides
    users
*  Broaden view of pesticides awareness to
    include more than landscape management

CONTACTS:

Phil Nixon
University of Illinois at Urbana-Champaign
1103 W. DornerDr.
Urbana,IL61801
Phone(217)333-6650
Fax (217) 244-1507

Dr. Amy Brown
Associate Professor, Department of
Entomology
Coordinator, Maryland Pesticide Education &
Information Programs
University of Maryland,
College Park, Maryland 20742
Phone:(301)405-3913
Fax:(301)314-9290
Steven D. Brachman
University of Wisconsin-Extension, Solid &
Hazardous Waste Education Center
161 W. Wisconsin Ave., Suite 6000
Milwaukee, WI 53206-2602
Phone(414)227-3160
Fax (414) 227-3165
e-mail: brachman@uwm.edu

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&"     #?
Ms. Jane Storey and Ms. E.J. Schumaker, from the
Lincoln-Lancaster County Health Department,
provided advice for training day care and health
care workers in environmental health issues and
discussed their own efforts.  Dr. Daniel Hryhorczuk,
an environmental health physician, spoke about the
role of doctors in environmental health and the
barriers to training physicians in this environmental
health specialty.  Issues discussed are summarized
below.
  Starting an Environmental Health
  Program for Health Care and Day
  Care Providers
Ms. Storey offered the following advice for people
seeking grants to set up environmental health
training programs with health care and day care
centers.

*  Make a list of all health care and day care
    centers and providers in your area.
*  Ascertain which centers and providers already
    have environmental health or related programs
    and which ones you can contribute to.
*  Find out which laws apply to health care and
    day care providers in your state.
*  Work with the general public through activities
    such as  sending mailings to parents  of children
    at day care centers.
*  When applying for grants from the U.S.
    Environmental Protection Agency (EPA), get a
    mentor from the agency who will help you
    through the grant application process.

Ms. Schumaker works with a program called Kids in
Touch Environmentally (KITE).  She discussed her
experience with establishing a food safety outreach
program for children at day care centers. She uses
games, pictures and other activities to show day
                                                      care providers how to relate food safety to children.
                                                      The goal of the food safety program is to encourage
                                                      children to be proactive and think about cleanliness.
                                                      The KITE program includes five other topics,
                                                      including a program on lead.
                                                        The Role of Physicians in
                                                        Environmental Health
Dr. Hryhorczuk spoke about the following roles of
physicians in environmental health:

*  To provide care and advice for individuals;
«>  To be advocates for individuals by
    communicating with employees, the public,
    environmental health authorities and landlords;
*  To be involved with the community and to
    advise and educate citizens; and
*  To participate in environmental health policy
    making.

Dr. Hryhorczuk also pointed out that there are
several barriers faced by doctors wanting to
become involved in the environmental health field,
including a lack of training in the field, little
reimbursement and time for practicing
environmental health, and addressing legal and
administrative burdens. There are several "core
clinical competencies" in the environmental health
field with which doctors should be familiar; these
include understanding the influence of the
environment on human health, being able to elicit
an environmental  history from a patient, and
understanding the legal and ethical issues involved
in seeing patients with environmental health
problems.

Environmental health resources in the Great Lakes
area are listed below.

*  National Institute of Occupational Safety and
    Health (NIOSH) Education and Research
    Center, which offers health  hazards evaluations
    for communities.
*  National Institute of Health (NIH) Fogarty
    Center.
*  World Health Organization (WHO)
    Collaborating Center.
•>  Toxicon, which offers 24-hour access to a
    toxicologist, at the University of Illinois.
»>  Center of Environmental Health (CEH).

Dr.  Hryhorczuk informed the audience that the CEH
works with parents, and the other centers are for
health care professionals.

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The attendees broke out into groups and then
identified the following three action items:

1.  To provide stable funding for an accurate
   center, with a repository of resources, for health
   care and day care providers. This repository
   should include both web-based and hard
   copies, include both EPA and non-EPA
   resources, and include case studies and list
   uses for each of the resources.
2.  To train the trainer in an ethically and culturally
   specific manner.
3.  As a prevention strategy, to use environmental
   issues to seek economic justice.

CONTACTS:

A. Jane Storey
Environmental Health Specialist
Environmental Health Division
Lincoln-Lancaster County Health Department
3140 "N" Street
Lincoln, NE 68510
Phone: (402)441-8025

E.J. Schumaker
Grant Coordinator
Environmental Health Department
Lincoln-Lancaster County Health Department
3140 "N" Street
Lincoln, NE 68510
Phone.: (402)441-8638
Daniel Hryhorczuk
Cook County Hospital, Division of
Occupational Medicine
1900 West Polk Street, Suite 500
Chicago, IL 60612
Phone(312) 633-5310
Fax (312) 633-6442

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During this workshop, Ms. Marge Altergott,
Mr. Victor Ceballos, and Ms. less Aldrich spoke
about environmental education relating to children's
health issues. Ms. Altergott is from Health
Organizing through Popular Education (HOPE),
which deals with community wellness issues.
Mr. Ceballos works with the Little Village
Environmental Justice Organization on a project
called the Bucket Brigade that deals with air quality
issues and with  schools built on contaminated land.
Ms. Aldrich works at the Alivio Medical Center in
Chicago with the Child to Child health program.
Child to Child is an international health promotion
program founded on the belief that children have
the power to effect change in their lives.  Founded
in 1979, the program has spread to 80 nations
worldwide.
 Popular Education
J
Ms. Altergott provided an overview of the concepts
behind popular education. A simple definition of
popular education is education "of the people, by
the people, for the people." Popular education
depends on the six key principles summarized
below.

Education is not neutral: People who teach have
their own political agenda. Education can either
maintain the status quo by teaching people the
values or culture of the majority, or liberate people
by helping them become creative and free.

Content comes from the participants: One
cannot know what the issues are and keep them
relevant to the people if the members of the
community are not involved. People will act on
issues they feel strongly about; therefore, educators
should start by identifying  issues that local  people
feel strongly about.
               Dialogue: By participating, people shape the
               content of a program through working together
               cooperatively.  Each person has something unique
               to bring to a discussion. Everyone needs to be a
               learner and a teacher.  Education is a mutual
               learning process.

               Problem-posing education: A facilitator can help
               participants learn by asking questions rather than
               lecturing. In this way, people can learn to develop
               skills in critical analysis.

               Reflection and Action: The information people
               share is reflected by a body of knowledge called
               "popular knowledge," which develops from group
               work.  This leads to discussion of planning, which
               eventually leads to action. This process of reflection
               and action is ongoing and given time, will lead to
               transformation.

               Transformation: Ultimately, popular education is
               aimed at transformation.  Education  should work to
               transform the quality of each person's life, the
               environment, community, and entire society.

               Popular education is an ongoing creative process
               that may take years to flower in a community.
                Popular Education and the Child to
                Child Health Program
Ms. Aldrich provided a brief overview of how the
Child to Child health program uses popular
education to promote public health through children.
Child to Child came to the United States in 1983
and was started in Chicago at the Pilsen Little
Village neighborhood.  The Child to Child health
program process is summarized below.

*   Children name the health issues that they feel
    affects them the most or are their biggest
    concerns through an interactive activity.
•>   After learning about that topic,  children plan an
    action to help educate other people in their
    communities, schools, and families about the
    topic. Activities range from making up skits,
    posting flyers in public places, to writing letters
    to community leaders.
<»   All the activities are planned and implemented
    by the children themselves. In this way, the
    children become the "owners" of the program.
    The children are referred to as "health
    promoters." This gives them a sense of
    responsibility and pride.
*   Each program is unique because the children
    pick the issues that they want to learn about.

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 Popular Education and the Little
 Village Environmental Organization
Mr. Victor Ceballos provided a real-life example of
how popular education is working for the Little
Village Environmental Organization. The Little
Village Environmental Organization was established
in 1997 as a response to proposals to build new
elementary schools on or near Brownfields, drum
recyclers, and other unsafe areas.

In 1997, Mr. Ceballos worked with high school
students, grammar school students, and two
second-year medical students to prepare a short
skit aimed at educating community members  about
the dangers of a nearby Brownfields site. The
children went door to door for 2 weeks speaking to
their neighbors about the site and inviting them to a
community meeting. Members of the community
met in one of the high school student's back yard.
The meeting started with a skit about how
contamination from the Brownfields site can enter
the homes of community members.  A 2-hour
community discussion followed the skit in which
members discussed the health hazards associated
with the Brownfields site and educated each other
about related issues.

The Little Village Environmental Organization
example shows how popular education can help
people of all ages identify health issues that affect
them and educate other members of the community
about these issues.
CONTACTS:

HOPE
Ms, Joyce Bowen
Phone:  (773)942-2451

Marjorie Altergott PhD.
Health Organizing Through Popular Education
(HOPE)
4022 N. St. Louis
Chicago, IL 60618
Phone: (773) 583-6876
Fax: (773) 509-9725


Victor Ceballos
General Wood Boys and Girls Club
2950 W. 25th Street
Chicago, Illinois 60623
Phone: (773) 247-0700


Tess Aldrich
Alivio Medical Center
5417N. Glenwood
Chicago, IL 60640
tessa  12(g),hotmail.com


Mary Nelson
Bethel New Life, Inc.
367 N. Karlov
Chicago, IL 60624
Phone: (773) 826-5540
Fax: (773) 826-5728

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Mr. Matt Schullick of the Chicago  Health  Corps,
Dr. Vicky Persky of the University of Illinois Chicago,
and Mr. Terry Allen of the Cuyahoga Board of Health
spoke about respiratory ailments and approaches to
educating the community about these ailments.
  Clean Air for Schools Campaign
J
Mr. Matt Schullick from the Chicago Health Corps
discussed the Clean Air for Good Health in Schools
project  that  focused  on  increasing  community
knowledge about  indoor air  quality  (IAQ)  in five
Chicago area schools.

The goals of the project were: (1) to raise awareness
about IAQ and its relationship to health outcomes, (2)
educate school  communities,  and  (3)  perform
environmental assessments.

Mr.  Schullick described the importance of  IAQ
because people  in the United States spend 90
percent of their time indoors. IAQ problems can lead
to spread of infectious diseases and increased long-
term  and  short-term health  problems,  including
respiratory  conditions and tissue irritation.   With
respect to  schools, IAQ problems  can  lead to an
unfavorable learning environment, reduced student
productivity, and accelerated school deterioration.

A clean air checklist was developed to determine the
main pollutants in  the classroom.  This one-page
checklist, to be filled out by teachers, asks questions
regarding   classroom  cleanliness,  presence  of
animals,  excess  moisture,  thermal   comfort,
ventilation,  renovation,  and  chemicals  used  for
maintenance  and  cleaning.    Project  volunteers
informed the school staff about what they could do to
improve IAQ.   Teachers  were told  they should
communicate classroom IAQ issues to engineering or
maintenance staff, report spills and smells, remove
chemicals  from   the   classroom,  and   report
temperature differences.
                                                      The project team conducted a chemical inventory in
                                                      each  classroom  of  each  of the  five  schools
                                                      participating in the study. The team did an analysis
                                                      and  summary  of  findings  to  determine  safe
                                                      alternatives for hazardous chemicals and to develop
                                                      a proper storage plan.  Results were shared with
                                                      school staff. In addition, the school airways and vent
                                                      shafts were cleaned of foreign material.

                                                      Finally,  Mr. Schullick discussed  lessons learned
                                                      during the project.  Establishing good relationships
                                                      with the schools was very important,  and technical
                                                      expertise  was  only  secondary.     Mr.  Schullick
                                                      suggested that  schools encourage parents to get
                                                      involved and establish interactive clubs  that would
                                                      educate students about respiratory ailments.
                Asthma Education
Dr. Vicky Persky of the University of Illinois Chicago
discussed educating communities about asthma and
asthma prevention.

Dr. Persky reported that the prevalence of asthma is
increasing yearly.   Risk factors include  low  birth
weight,  smoking,  and  a  young  maternal age.
Hospitalization for asthma is higher in younger age
groups and higher after increased ozone levels and
high pollen counts.  Asthma is more widespread in
poverty-stricken neighborhoods.

Persky focused on asthma in schools and discussed
several  ways schools can help prevent asthma.
Schools should provide a medication policy, training
about asthma for nurses, a  protocol for teachers,
presentations for parents and school staff, and take-
home brochures for parents.

Dr.  Persky  discussed  the  Community  Asthma
Prevention Program  (CAAP)  Asthma Association.
The goal of CAAP is to increase asthma knowledge
in communities to help prevent the disease.  CAAP
has educational programs based on the Head Start
program,  Catholic  and   public  schools,  and
community-based health centers. CAAP volunteers
developed culturally sensitive materials to distribute
within communities as well. The program trained peer
educators to work with parents. The peer educators
and  asthma  experts  made  presentations   in
communities   and   schools   to  spread  asthma
education. These presentations were well received by
families.  The CAAP  program has helped reduce
hospitalizations related to asthma by 50 to 75 percent
in communities.

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 Infant Mold Disease: Community
 Education and Intervention
Mr. Terry Allen from the  Cuyahoga County  Ohio
Board of Health described infant mold disease and
discussed options for prevention  of and education
about the disease.

Infant mold  disease is also described as "bleeding
lung  disease"  and is associated with  pulmonary
deterioration and hemorrhage. The Board of Health,
in conjunction with the Centers for Disease Control,
the Ohio Department of Health, and the Cleveland
Department of  Public Health, studied 43 cases of
infant mold disease. Thirty of the cases occurred in
males, and fifteen of the cases resulted in death. The
cases occurred in the poorest parts of the county.

Mr. Allen reported that infant mold disease occurs
because of  mold and water problems in buildings.
Mold can form  on dry wall, and water can  be  a
problem from leaking roofs and condensation.  He
discussed ways to control moisture and mold to help
prevent infant mold disease.

Mr. Allen stated that the keys to the success of the
study were  the full cooperation of medical, public
health,  and  housing agencies, and the  building of
personal  relationships  and sharing   successes
between the agencies.
 Facilitated Discussion
J
Mr. Randy Cano of  EPA  Region 5 facilitated  a
discussion on respiratory ailments. The following key
issues were raised during the discussion:

1.   Link housing and public health agencies with
    medical groups.
2.   Create  community  coalitions   to   address
    respiratory issues.
3.   Involve the community, parents, and schools to
    address asthma issues.
              CONTACTS:

              Dr. Victoria Persky
              University of Illinois - School of Public Health
              2121 W.Taylor Street
              Chicago, IL 60612-7260
              Phone:(312)996-4783
              Fax:(312)996-0064


              Matthew Shullick
              Environmental Health Coordinator
              Project Director, Clean Air for Good Health in
              Schools Project
              Chicago Health Corps,
              845 South Damen Avenue, 11th Fl.
              Chicago, Illinois 60612-8945
              Phone:(312)413-7892


              Terry Allan
              Cuyahoga County Board of Health
              One Playhouse Square
              1375 Euclid Ave, 5th Floor
              Cleveland, Ohio 44115-1882
              Phone:(216)698-2380
              Fax:(216)443-5655
              e-mail: tallan@netincom.com

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                                                     Mr. Lame identified the three questions below which
                                                     be addressed when implementing an IPM program.
Mr. Marc Lame of the Indiana University-Bloomington,
Ms. Karen Delahault of the University of Wisconsin
Madison, and Mr. David Rountry of the Washington
State Department of Ecology discussed integrated
pest management (IPM) programs in schools. Issues
discussed are summarized below.
 Pollution Prevention and IPM in
 Schools
J
Mr. Marc Lame, an entomologist and faculty member
at the  School of Public  Environmental Affairs at
Indiana University-Bloomington, discussed IPM at
child-sensitive facilities, including day care centers
and  elementary, middle,  and  high  schools.  He
described  a  study  that  he  and his colleagues
conducted that introduced IPM to schools in the
Monroe County Community School Corporation. He
touted IPM as a "win-win" situation.

Mr. Lame reported that IPM is mandatory in several
states,  including  Louisiana, Michigan,  Texas,  and
West Virginia,  and added that Illinois and Montana
are also experimenting with voluntary IPM programs.
He stated he prefers the voluntary approach because
legislative  mandates  of  IPM in schools  can give
special interest groups the opportunity to subvert IPM,
and  IPM laws have generally resulted  in  unfunded
mandates.

Mr. Lame stated that there has been a recent shift in
the pesticides management paradigm.  Specifically,
the focus has moved from the traditional approach of
hiring commercial pesticides applicators to the new
approach  of  educating  support  staff (including
custodians,  maintenance  workers,  kitchen staff,
administrators, and teachers) and students about the
risks associated with the use of pesticides.  Similarly,
there has been  a movement  towards IPM, from
cultural, chemical, and  mechanical  controls  to
monitoring, prevention, and treatment.
               *
                                                         What action needs to be taken?
                                                      :»  Who should take those actions?
                                                      >  Are  resources  available  to implement
                                                         actions?
                                                          the
He described the implementation of IPM in schools as
a five-step process involving the following:

1.      Awareness - Disseminate information about
       pesticides use through mass  media  and
       interpersonal communication.
2.      Persuasion - Communicate  evidence  that
       IPM will meet the community's needs.
3.      Decision - Demonstrate that IPM will meet
       the community's needs by using results from
       model and pilot programs.
4.      Implementation - Communicate the process
       of matching the positive attributes of IPM with
       mitigating the negative attributes of pests.
5.      Confirmation - Communicate the fact that the
       decision to adopt the program worked.

Mr. Lame reported that the approach used in his study
on schools in the Monroe County Community School
Corporation resulted in the reduction of pesticides use
by 92 percent in participating schools over a 3-year
period.  He listed the following recommendations
when implementing IPM in schools:

*  Coordinate and communicate about policies and
   the   implementation  plan   among  agencies
   involved in  the management of child-sensitive
   facilities
•>  Increase  outreach to school district decision-
   makers.
*  Continue  analyzing  the  costs  and  benefits
   associated with IPM in schools.
*>  Adopt  pesticides   application   prenotification
   policies.
*  Explore means to fund IPM programs (currently
   no funding sources).
*  Coordinate  existing IPM resources for national
   use (do not  "reinvent the wheel").
*  Feature IPM programs at annual meetings  and
   workshops.

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 Reducing Pesticides Use in Turf
J
Ms. Karen Delahaut, an IPM outreach specialist at the
University of Wisconsin Madison, discussed ways to
reduce pesticides use on school athletic fields.  She
acknowledged that pesticides use reduces the risk of
children tripping  and  falling.   Pesticides  usage on
school fields may be a source of pesticide exposure
to children.

Ms. Delahaut stated that a study of school grounds
personnel has   shown  that  many  do  not  have
appropriate training in pesticide application.   She
reported that although lawn care companies and farm
cooperatives  are required to be  certified, school
custodians whose primary responsibility is not to apply
pesticides do not  undergo pesticides application
training.

Ms. Delahaut along with others at  the University  of
Wisconsin created an IPM manual for schools
and initiated a pilot, hands-on IPM program this year
that included a range of communities and  scenarios
(eg., urban and rural communities). By the year 2000,
she aims to expand the IPM program to include 25
schools.   A  trainer's manual is  currently  being
developed for distribution to other agencies.

Ms. Delahaut stated that the IPM manual for schools
and the trainer's manual that is being developed will
be on the Internet at: http:\\ipcm.wisc.edu.
 Community Partnerships for Safer
 Pest Control at Schools
Mr.  David  Rountry from  the Washington State
Department of Ecology began his presentation by
distributing a blue book entitled "Calculating the True
Costs of Pest Control," which was recently released
by the Hazardous Waste and Toxics Reduction
Program of his agency the previous week (Publication
99-433). He described the resource as a compilation
of  IPM  success  stories.    He  reported  that
demonstration sites are showing the success of IPM
and new practices.  He redefined IPM as "intelligent"
pest management.

Mr. Rountry described Washington State's 5-year-old
IPM program.  He added that the U.S. Environmental
Protection Agency (EPA) Region 10 is involved in his
state's program. He described Washington's Master
Gardeners Program as an example of an effective
IPM  program.     The  program   promotes
environmentally prudent horticultural practices and
attempts to identify alternatives to conventional pest
eradication methods.

Mr. Rountry also described a workgroup on statewide
IPM programs in schools. He stated that EPA Region
10 provided funds and a representative to facilitate
the workgroup's discussions.  He emphasized that
IPM goes beyond  pest control — it measures the
ability of members in a community to cooperate. He
reported that by working with various stakeholders at
workgroup meetings,  clear objectives are identified
from the start.  The workgroups focus on outcomes,
not just actions.
                Facilitated Discussion
                                       J
               The session ended  with a  discussion about IPM
               facilitated by Ms. Sue Brauer and Mr. Peter Murchie
               of EPA Region 5.   Brauer and  Murchie reviewed
               issues raised and asked for suggestions of issues to
               consider for the action plan. The following key issues
               were raised during the discussion:

               *  Consolidate resources into a national database.
               *  List resource people and have them talk with
                  stakeholders on the local level.
               *  Funnel more funds to states for IPM program
                  implementation.
               *  Consider a child-specific environmental budget
                  line item.
               »>  Explore  methods  of  information  delivery  to
                  department heads of buildings and maintenance
                  at schools.

               CONTACTS:

               Marc L.  Lame
               Indiana  University,   School   of  Public   &
               Environmental Affairs
               Bloomington, Indiana 47405-2100
               Phone:(812)855-7874
               Fax: (812) 855-7802
               e-mail: mlame(a),indiana.edu

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Karen Delahaut
University of Wisconsin-Madison
Department of Entomology
1630 Linden Drive
Madison, WI 53706
Phone: (608) 262-6429
Fax: (608) 262-3322
email: kadelaha@facstaff.wisc.edu
David D. Rountrv
Washington State Department of Ecology
P.O. Box 47600
Olympia, Washington 98504-7600
Phone: (306) 407-6749
Fax (360) 407-6715
e-mail: drou461 @.ECY.WA.GOV

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Duringthisworkshop.Ms.TamiJohnsonfrom
thelndianaDepartmentofEnvironmental
Management(IDEM),Ms.KadiRowfromthe
NationalHome*A*SystProgram,andMs.Sally
PatrickfromtheMinnesotaPollutionControl
Agency(MPCA)spokeaboutresources
availabletocommunitymemberstohelpreduce
theamountoftoxicchemicalschildrenare
exposedto.lssuesdiscussedaresummarized
below.
 Self Assessments for Child Care
 Facilities to Prevent Health Risks
Ms. Johnson of IDEM introduced the Indiana
Five-Star Environmental Recognition Program
for child care facilities. This program focuses on
preventing environmental threats to health and
safety and includes tools such as a user-friendly
self assessment to identify risks and take
specific actions to reduce those risks. This plan
focuses on the three core issues summarized
below.

Environmental Threats: Preventing exposure
to hazardous substances such as asbestos,
radon,  mercury, pesticides, mold, tobacco
smoke, and lead.

Health and Safety: Providing training on
building safety, fire and emergency planning,
chemical safety, and bloodborne pathogens.

Environmental Stewardship Opportunities:
Providing education to families on topics such as
recycling and energy efficiency.

The Five-Star program has the following
characteristics:

*  Completely voluntary: It will have no
    licensing bearing on the child care facility.
<»   Not a new set of regulations: Some activities
    outlined in the program are already required
    by law. The program aims at providing easy-
    to-understand, inexpensive steps to
    decrease health and safety environmental
    risks.
*   An educational tool: This program should
    promote awareness of which environmental
    toxins can exist at various child care facilities
    and what can be done to educate the child
    care staff about toxins used at work.

The five components of the Five-Star program
are summarized below.

1.   Environmental Pledge: A commitment health
    care providers must make to protect children
    from environmental  threats.
2.   Self Assessment: Steps outlined in an easy-
    to-understand publicly available booklet that
    allows health care centers to give
    themselves a high or low risk rating.
3.   Five-Star Recognition: An award bestowed
    upon child care facilities to recognize their
    accomplishments. Facilities can receive 1, 3,
    or 5 stars depending on their condition. The
    star rating needs to  be renewed every 2
    years.
4.   Confidential On-Site Telephone Assistance:
    A toll-free assistance number for facilities
    that have questions regarding the application
    process, technical terms, or any other
    program-related questions.
5.   Guidance Manual: Detailed  information for
    child care facility managers. The manual
    includes easy-to-understand explanations
    and demonstrations of environmental health
    regulations.

Over 50 child care facilities in Indiana currently
participate in the Five-Star program.
 National Home Assessment Program
Ms. Kadi Row of the Nat'l Home *A* Syst
Program spoke about using the National Home
Assessment Program (Home*A*Syst).
Home*A*Syst is a national educational program
based at the University of Wisconsin at Madison.
It targets parents, renters,  and homeowners and
challenges them to look at environmental risks in
the home.  The program was designed to help
an individual conduct a whole home
environmental and health audit.

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The program is driven by a comprehensive guide
book that each state can adapt to fit individual
state needs.

Health issues described in the manual include
drinking water, pesticides and other hazardous
products, indoor air quality, lead, and  food
safety. Each chapter starts with background
information on each issue and an explanation of
why the issue is of concern. An assessment
checklist follows that individuals can use to rate
risks in their homes as low, medium, or high.
The manual also guides the user to create an
action plan to decrease health risks in "high"
rated areas.
 Roots of Hazard: Household
 Hazardous Waste School Educational
 Tool
Ms. Sally Patrick of the MPCA spoke about an
interactive, computer-based school educational
tool she helped develop to inform children about
household hazards. Roots of Hazard is a free
CD-ROM software developed for use in
Minnesota schools. It is a game that helps
children explore the proper use, storage, and
disposal of household hazardous products.

Roots of Hazard was developed through a grant
and intended for license-free use on individual
computers and computer laboratories.

The game was tested on 5th and 6th grade
students. After the first session, students were
able to recall at least one of the main learning
objectives.

Roots of Hazard is also easy to install.  A single
copy of the CD-ROM can be used to install  the
software onto an unlimited number of
computers.  Through the use of puzzles,
problem-solving activities, and matching games
students can accomplish the following:

*     Learn to identify different types of
       hazardous household products.
*     Understand the importance of label
       reading and signal words.
*     Develop and improve their computer
       skills by using interactive courseware.

Over 5,000 CD-ROM disks of the Roots of
Hazard were printed. Of these disks, two copies
were sent to each school district in Minnesota,
500 were sent to Hamline University, 250 were
sent to science museums, and 500 stayed at the
MPCA.

The project has been effective. When tested, 38
percent of students recognized signal words
(caution, warning, danger, and poison), 24
percent understood hazard levels, and 30
percent could recognize hazard symbols.

CONTACTS:

Tami Johnson
Indiana Dept. of Environmental
Management
P.O. Box 6015
Indianapolis, Indiana 46206
Phone:(317)233-5628
Fax:(317)233-5627
e-mail: tsjohnson@,dem.state.in.us

Kadi Row
Home*A*Syst Program
University of Wisconsin-Madison, B142
Steenbock Library
Madison, Wisconsin 53706
Phone: (608) 265-2774
Fax: (608) 265-2775
e-mail: krow(o>facstaff. wisc.edu

Sally Patrick
Minnesota Pollution Control Agency
520 Lafayette Rd.
St. Paul,  Minnesota 55155-4194
Phone:(651)297-8326
Fax:(651)297-8676
e-mail: sally.patrick(5),pca.state.mn.us

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^T^t
S^oS^S^

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Ms. Jura Scharf of the Chicago Asthma
Consortium, Ms. Maggie Butterfield of the Health
Education Center of Wisconsin, Ms. Jackie Reed
of the Westside Health Authority, and Ms. Mary
Nelson of Bethel New Life discussed their
experiences in coalition building.
  Discussion Forum on Coalition
  Building: Learning by Example
J
Ms. Scharf of the Chicago Asthma Consortium,
reviewed the findings of a study conducted by
the Health Resources and Services
Administration (HRSA) in 1998. The study
determined that coalitions were effective in
changing health status and health systems if
they followed certain rules, such as having a
clear goal and monitoring progress towards it.
Ms. Scarf listed  the seven steps below to
coalition success.

1.   Have a clear vision and mission.
2.   Create community ownership.
3.   Solidify the coalition structure.
4.   Recruit and  retain active, diverse members.
5.   Develop leadership.
6.   Focus on action and advocacy.
7.   Market the coalition.

Ms. Butterfield of the Health Education Center of
Wisconsin discussed  one of the projects she
works on: Awesome Asthma Days.  The goals of
the asthma coalition are as follows:

*   To identify kids with asthma,
*   To assess the impact of asthma on home
    care,
*   To increase understanding and self-care of
    asthma, and
*   To increase control of asthma symptoms.
The Awesome Asthma School Days project
takes fourth-graders on field trips to teach them
about asthma and provide them with ways to be
proactive about their own care.

Ms. Reed of the Westside Health Authority,
spoke about how she founded the Westside
Health Authority in Chicago. Her goal in
founding the center was to listen to people and
provide  programs based on their needs. For
example, the community with which she worked
needed  jobs, so the Westside Health Authority
set up a program to train people for careers as
health care providers.  Ms. Reed found  that it
was important to create specific goals and build
a vision. She also pointed out that the bottom
line in coalitions involves relationships, and she
offered the four pieces of advice below to
coalition-builders.

1.   Listen to people.
2.   You need to need, but not overwhelm,
    people.
3.   Give people credit.
4.   Avoid hidden agendas-get issues on the
    table and be clear.

Ms. Nelson of Bethel New Life talked about
creating a community development corps (CDC),
which works with communities to provide livable
wages,  housing, education, and healthy families.
She noted that a sustainable community needs
the following:

1.   Economic security;
2.   Environmental quality;
3.   High quality of life; and
4.   Public participation and accountability in
    decision-making.

Her CDC initiatives include Brownfields
development, community outreach, small
business development, and local worker training.
Bethel New Life also spearheads a coalition of
CDCs called Accelerating Community
Transformation (ACT). Ms. Reed's advice to
people founding CDCs or coalitions is to invite all
groups to join from the beginning, to make data
user-friendly, and to have someone keeping the
communication lines open.

The attendees broke out into action groups and
answered the following question: Based on the
presentations and your knowledge, what should
others remember about coalition building when
they develop action plans?
                                                  The groups identified the following three topics:

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1.  Goals and missions of the coalition;
2.  Relationships; and
3.  The process of coalition-building.

CONTACTS:

Jura S. Scharf
Chicago Asthma Consortium
1440 W. Washington Blvd.
Chicago, Illinois 60607
Phone:(312)243-1560
Fax:(312)243-3954

Maggie Butterfield
Health Education Center - Children's Health
System
1533 No. Rivercenter Dr.
Milwaukee, WI 53212
Phone: (414) 765-9355
Fax: (414) 765-0996

Jacqueline Reed
Westside Health Authority
5437 W. Division
Chicago, IL 60651
Phone: (773) 378-0233
Fax: (773) 378-5035
email: MRSREED@WORLDNET.AH.NET

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Mr. Joe Schirmer of the Wisconsin Department
of Public Health and Family Services, Mr. Mark
Ramion of the Milwaukee Health Department,
Ms. Placida Venegas of the Minnesota Pollution
Control Agency, Mr. Myron Falcon of the
Minnesota Department of Health, and Ms.
Susan Gust of Phillips, Minnesota, spoke about
lead poisoning, focusing in particular on
education, reduction, and prevention of lead
poisoning. Topics discussed are summarized
below.
 Lead Poisoning Prevention
J
Mr. Joe Schirmer from the Wisconsin
Department of Public Health and Family
Services stated that limitations to lead poisoning
prevention include using an old definition of
lead poisoning, lack of resources to screen
children for lead, weak enforcement
mechanisms for remediating lead, and an
unresponsive bureaucracy. To be successful at
lead poisoning prevention, "infected" children
must be identified.  Ways to identify children
that may have high lead levels involves
cooperation of medical groups, parents, and
state legislatures.  Assessment would be easier
if there was a universal reporting requirement
for lead levels in children's blood streams.
Educational materials about lead poisoning
should be distributed to housing areas with high
lead levels; these materials should be
informative and easy to read.

Mr. Schirmer stated that lead poisoning
prevention is a phased approach involving an
action phase and a hazard control phase. The
action phase includes inspecting and locating
lead hazards inside and on the exteriors of
houses. During the hazard control phase, the
goal is to abate lead hazards.  For example, in
Wisconsin, the U.S. Environmental Protection
                                                   Agency and the U.S. Department of Housing
                                                   and Urban Development provided funding for
                                                   high efficiency particulate arresting (HEPA)
                                                   vacuums to clean lead dust and chips. The
                                                   funding was also used to treat damaged exterior
                                                   paint containing lead and replacing windows
                                                   with lead paint trims. After only 1 year, lead
                                                   dust levels decreased significantly.  Cleaning is
                                                   only a temporary measure; however, the study
                                                   in Wisconsin shows that if lead dust levels are
                                                   controlled using HEPA vacuums, lead blood
                                                   levels in children will decline significantly.
             Lead Hazard Education and
             Reduction Strategies

Mr. Mark Ramion from the Milwaukee Health
Department discussed the effectiveness of
education and lead hazard reduction strategies
to reduce lead levels in Milwaukee.

Between 1994 and 1998 in Milwaukee, blood
lead level trends were examined.  The percent
of lead in children's blood decreased from 35 to
17 percent as a result of lead hazard reduction
strategies and education. Based on studies
where only  lead poisoning education materials
were used,  blood lead levels declined 18
percent.  Based on studies where educational
materials about lead were used in combination
with lead hazard reduction strategies, blood
lead levels declined 24 percent.

Treatments for lead hazards include scraping
and repainting walls and window sills to
eliminate lead hazards, and enclosing window
wells and floors to isolate lead hazards. In the
Milwaukee study, several intervention strategies
were used,  including cleaning, scraping, and
painting, window replacement, and window well
wrapping.

A primary prevention project was conducted by
the Lisbon Neighborhood Development. The
goals of the project were to educate and
mobilize community members about lead
poisoning and reduce lead hazards. Of the
houses inspected, 88 percent had lead hazards.
The average cost of hazard reduction was 12
percent of the average assessed value of the
house. Target areas for the  project were rental
units and pre-1950s housing. Lessons learned
as a result of the project are summarized below.

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*   Community-based strategies must be
    flexible.
«:*   Risk-reduction training for renters in low-
    income housing is necessary.
*   Multiple strategies for lead poisoning
    prevention need to be implemented,
    evaluated, and revised.
 Lead Waste Disposal in Minnesota
Ms. Placida Venegas of the Minnesota Pollution
Control Agency explained the properties of lead
and its uses.  Lead is a naturally-occurring, toxic
metal that gives luster to and makes paint
durable and long lasting.  It is soft and can be
easily bent. It is used in  paint, gasoline, solder,
and batteries, as well as a component of
weights and sinkers, medical devices, and
ammunition. Lead has hazardous effects on
both children and adults.  In children under 6
years of age, common health effects may
include shortened attention span, hyperactivity,
aggressive behavior,  reading disabilities, mental
retardation, convulsions, and even death.  In
adults, exposure to lead can affect the nervous
system, kidneys, bones,  heart, and reproductive
system.

Minnesota's residential lead hazard  reduction
program is a cooperative effort between the
following:

«>  U.S. Department of Housing and Urban
    Development (funding),
*  Minnesota Department of Health (licensing,
    certification, and enforcement),
*  Minnesota Legislature (lead laws),
<•  Minnesota Pollution Control Agency (proper
    lead waste disposal),
•*•  Minnesota Housing Finance Agency
    (information clearinghouse), and
<»  Cities of Duluth, Minneapolis, and St. Paul
    (implementation of lead program).

Minnesota has several state laws designed to
control lead hazards and enforce proper lead
waste disposal: the Childhood Lead Poisoning
Act, Lead  Poisoning Prevention Rules,
Residential Lead Paint Waste Disposal,
Abrasive Blasting of Lead Paint from
Residential and Steel Structures, and
Hazardous Waste Disposal Rules.  Under these
laws, any person whose activities produce lead
waste is responsible for proper disposal of the
waste. Management responsibility is not
transferable to the occupant of a structure with
lead-based hazards.  Waste produced by
activities of the occupant must be managed as
provided by household hazardous waste laws.

Categories of waste generated from lead paint
removal projects include paint chips, paint dust,
demolition debris, solvents, rinse water,  rags,
mops, scrapers, and materials used for testing
and cleanup.  Ways to contain lead waste
include sealing the waste in a  heavy-duty plastic
bag and wrapping doors, windows, frames, and
trim in polyethylene sheeting.  All waste  should
be stored in a secured area.

Ms. Venegas also describes methods for
handling and transporting waste.  At the end of
each working day, contractors and workers
should conduct the following activities:

1.   Categorize and separate waste into lead
    paint chips, solid debris, and demolition
    debris;
2.   Store lead paint chips in a durable, tightly-
    covered container;
3.   Store solid debris in a durable, tightly-
    covered container;
4.   Store demolition debris in  a covered drum;
    and
5.   Filter wash water on site to separate any
    debris or paint chips present.

All lead waste should be transported in a
covered vehicle to prevent blowing and loss of
material. If loss does occur, the  material must
be picked up immediately and  returned to the
vehicle or container, and the area must be
properly cleaned.  For shipments within
Minnesota, a Residential Lead Abatement
Notification and Shipping form is required.  For
shipments out of state, a manifest may be
required by the state(s) through which the waste
will be transported.

Ms. Venegas discussed the authorized
management methods allowed by Minnesota. A
homeowner or occupant of a residence must
bring lead paint chips to a household hazardous
waste collection site.  A contractor may take the
lead paint chips to a local smelter to be
reclaimed or recycled. Wastewater containing
lead should be filtered with a 5-micron filter
sack to remove lead debris prior to discharge to
a sewer system.  Options for placement of solid
lead waste include the following:

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*   A lined landfill with liner and leachate
    collection system,
<»   A hazardous waste facility,
*   A permitted demolition debris facility for
    woodwork, walls, and windows, or
*   A solid waste incinerator ash landfill.

Ms. Venegas also discussed methods of lead
waste management that are prohibited by
Minnesota statutes.  Lead waste must not be
incinerated at a mixed municipal solid waste
landfill, disposed of at an unlined landfill, left at
a residence, or placed in a municipal solid
waste compost or refuse-derived fuel facility.
 Interagency Efforts to Reduce Lead
 Poisoning - Present and Future
Mr. Myron Falcon of the Minnesota Department
of Health and Ms. Susan Gust, a citizen of the
city of Phillips, Minnesota, discussed
interagency efforts to reduce lead poisoning in
Minnesota.

Mr. Falcon discussed how the Minnesota
Department of Health works with the
Department of Human Services,  Medicaid
agencies, medical providers, and local agencies
to identify areas that are at risk for high blood
lead levels. High risk areas were mapped using
Geographic Information Systems (GIS)
software.  GIS was also used to identify sites
that may have high lead levels but were not
targeted.  Data was shared among agencies
through development of environmental and
medical case management software. A
prevalence study for high lead levels was
performed in three counties.

Ms. Gust discussed how changes in lead
prevention and education in her community
have influenced lead prevention efforts in
Minnesota. Ms. Gust stated that Phillips,
Minnesota, is a very ethnic community. People
in the community got together and dropped their
own agendas to focus on the health issues of
the children in Phillips. They lobbied for money
from the University of Minnesota to study lead
poisoning and lead hazard prevention in the
city.

The goal of the study was to determine how
many children in the community are poisoned
by lead.  The community volunteers for the
project started at the local medical center to
identify children that had elevated blood lead
levels.  However, the data on the blood lead
levels was not organized and much of the data
had to be collected again.

The city worked with Americorps and
community volunteers to identify the children in
the community who were at risk. Using their
resources from the University of Minnesota, the
core project members trained peer teachers
about lead hazards. These peer teachers
approached people in the community with
culturally-specific materials to educate the
community about lead hazards. Children at risk
were identified and tested.

The project also researched the effect that lead
has on the brains of infants and toddlers.  It was
determined that children become more
aggressive when exposed to lead. The
volunteers took the project a step further by
providing guidance to parents on how to deal
with children that have lead poisoning and brain
damage as a result of exposure to lead.

Ms. Gust stated that the project was a learning
experience and a success. By putting the
community in charge of the project, the city of
Phillips reaped the results of the research.
Many relationships were built as a result of the
project and people in the community actively
worked together to learn about lead hazards
and lead prevention and in turn educate their
peers about the subject.
 Facilitated Discussion
J
Ms. Patty Krause of EPA Region 5 facilitated a
discussion on lead poisoning prevention and
education of lead hazards .  The following key
issues were raised during the discussion:

* Instigate more collaboration among
   communities and the government for
   developing action agendas.
* Improve information dissemination.
* Mandate lead blood level screening in all
   children.
* Recognize local leadership in addressing
   lead issues.
<• Shift from a medical model (screening blood
   lead levels) to a housing model (prevention
   and cleanup of lead hazards).
* Increase awareness of safe work practices.

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Promote a national annual program for
increasing awareness of lead poisoning.
Provide for sustainability of lead prevention
activities and funding grants from the U.S.
Department of Housing and Urban
Development.
CONTACTS:

Joseph Schirmer
Wisconsin Division of Public Health
1414 E. Washington Ave., Room 96,
Madison, Wisconsin 55703
Phone: (608) 266-5885
Fax: (608) 267-0402

Mark A. Ramion
City of Milwaukee Health Department
3141 South 34th Street,
Milwaukee, Wisconsin 53215
Phone:(414)286-5171
Fax:(414)286-0715

Placida L. Venegas, J.D.
Major Facilities Section, Policy & Planning
Division
Minnesota Pollution Control Agency,
520 Lafayette Rd. N.,
St.Paul,MN 55155-4194
Phone: (651)297-8370

Fax:(651)297-8676,
E-Mail: placida.venegas@,pca.state.mn.us
                                           Mvron Falken MS, MPH. PhD
                                           Minnesota Department of Health
                                           121 E. Seventh Place, Suite 220, P.O. Box
                                           64975, St. Paul, MN 55164-0975
                                           Phone(651)215-0877,  Fax(651) 215-0975

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Ms. Louise Fabinski of the Agency for Toxic
Substances and Disease Registry (ATSDR), Mr.
Al Stenstrup of the Wisconsin Department of
Natural Resources (WDNR), Mr. Steve
Skavroneck of the Pollution Prevention
Partnership, Mr. Ken Runkle of the Illinois
Department of Public Health (IDPH), and Dr.
Ying Feng of the Ohio Department of Public
Health (ODH) described examples of education
and outreach programs on the impacts of
mercury. Issues discussed are summarized
below.
 Educational Materials for Prevention
 of Mercury Exposure
J
Ms. Louise Fabinski of ATSDR reported that in
1997, ATSDR and the U.S. Environmental
Protection Agency (EPA) issued a combined
alert about mercury, increasing awareness that
the mercury issue goes beyond mercury in fish
tissue. She reasserted the point made by Dr.
Robert Amler during the Plenary Session that
children are not small adults. She also
suggested that parents and guardians may also
be bringing mercury into the home.
 Mercury Exposure Prevention
 Curriculum
J
Mr. Al Stenstrup of the WDNR began his
presentation with a Jeopardy game, where he
involved audience members in revealing
information on mercury. He stated that the
Jeopardy game was part of the training on
mercury that he and his colleagues conducted
for educators and high school students.

Mr. Steve Skavroneck of the Pollution
Prevention Partnership reported that of the 5,000
pounds of mercury collected last year, 3,000
            pounds came from schools. As Mr. Stenstrup
            distributed a training manual jointly developed by
            WDNR and the Pollution Prevention Partnership
            entitled "Mercury: In Your Community and the
            Environment" (1998), Mr. Skavroneck described
            the following  activities that comprise the mercury
            curriculum):

            * Case study of mercury contamination in a
              community.
            * A local survey about mercury.
            <• School mercury audit.
            «!» Home mercury audit.
            * Trade-offs exercise.
            * Mercury in fish.
            •:• Community action projects.

            The training promotes awareness of the risks
            associated with mercury which includes lesson
            plans and hands-on exercises.
             Health Hazard Evaluation of the Ritual
             Use of Mercury in Chicago, Illinois

Mr. Ken Runkle of IDPH described the ritual use
of mercury in Hispanic communities in Chicago.
Specifically, items that contain mercury have
been found in stores called botanicas, which sell
health and religious ritual items such as statues
and icons, natural herbs, folk remedies, annulets,
and rosaries. The Chicago Department of Public
Health conducted a study in which 16 botanicas
visited sold mercury in one of the following
different forms:

»:» Caplets containing 0.5 milliliter (mL) (about
   6.5 grams [g]) of mercury
•> Caplets containing 1  mL (about 13 g) of
   mercury
»> An unmeasured amount in amulets of various
   shapes and  sizes

Mr. Runkle stated that mercury is used ritually to
obtain good luck, acquire money, acquire love, to
control others, or for heating.

The ritual use of mercury includes the following:

* Sprinkled around the home and in beds
* Burned in candles
* Used in cleaning water
«:» Rubbed onto skin
<» Ingested
«> Carried on person

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Multiple health hazards are associated with
mercury. The primary route of mercury
exposure is inhalation. Mr. Runkle
acknowledged that because mercury vapor is
dense and is present closer to the floor, children
are more susceptible to mercury poisoning.  He
listed the following symptoms of mercury
exposure:

* Headaches
* Trembling
* Blurred vision
* Personality changes
»:» Memory loss
* Neuromuscular problems
»J» Acrodynia

IDPH is conducting an exposure study to
evaluate the health significance of ritual mercury
use. The study involves the following aspects:

* Approximately 100 participants from 20
   homes.
«:» Air screening with a Jerome mercury vapor
   analyzer.
* Air sampling with sampling tubes and pumps.
* Urine sampling of residents in the morning
   and afternoon.
* Monitoring of carbon dioxide levels to gauge
   air exchange rate.
<« Distribution of educational materials.

Ms. Runkle reported the problems below
associated with recruitment for the IDPH study:
   Potential participants do not want others to
   know.
   Identity and immigration issues arise.
   Participants mistrust the government.
   Religious reasons encourage mercury use.
   There is no financial incentive to cooperate.
 Mercury Exposure Prevention
 Outreach

Dr. Ying Feng of ODH described mercury
outreach efforts being conducted by ODH.  She
reported that one of the largest mercury spills
occurred in Springfield, Ohio in 1997, which
prompted the establishment of a mercury spill
prevention program.  Dr. Feng recounted the
story of a group of teenagers breaking into
Tower Metal Alloy Recycling Station, an
abandoned metal recycling facility, in October,
1997. The teenagers found a 5-gallon drum of
metallic mercury. They poured mercury into
plastic soda bottles, which they removed from
the premises and brought home, spilling the
contents along the way. The mercury was
subsequently spilled in their homes and yards,
on their clothes, and brought to school the
following day.

The incident resulted in the following:

* Sixteen homes were contaminated and
   required cleanup procedures,
»:» Sixty-nine residents had to leave their homes
   for 3 to as long as 25 days,
* 162 urine specimens were collected from
   area residents, and
«:» Five  students had  mercury levels above 20
   micrograms per  liter, the ATSDR benchmark
   for children.

The emergency removal action involved EPA,
the Ohio Environmental Protection Agency, the
Clark County Combined Health District, the
Springfield Fire Division, the City of Springfield,
the Springfield Emergency Management Agency,
the local Red Cross, and ODH. Dr. Feng stated
that 200 pounds of  mercury were retrieved from
contaminated residences in 28 days,  resulting in
a $500,000 cleanup effort. Displaced families
were allowed to return to their homes by late
November,  1997. The incident prompted the
realization that a mercury spill prevention
program was needed to (1) reduce mercury
sources, (2) change the public's behavior toward
mercury, and (3) develop guidance to respond
to mercury spills.

Dr.  Feng described a mercury recycling program
that her department jointly developed with the
Ohio Dental Association.  There is no charge for
mercury collection,  and fourteen collection
stations have been  established around the state.
She reported that 838 pounds of mercury have
been collected so far.

Dr.  Feng also described a mercury training
program that ODH is developing with the Ohio
Environmental Health Association. Regional
seminars are being held in four locations around
the state. In addition, the ODH Site Assessment
Section  has developed educational materials
including a fact sheet titled "Mercury Spill Fact
Sheet for Schools."

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 Facilitated Discussion
Mr. William Massie of EPA Region 5 facilitated a
discussion on mercury use and exposure. The
following key issues were raised during the
discussion:

*  Consider replacing all mercury thermometers.
*  Overcome perception of scientific accuracy of
   mercury in thermometers; perceive it more as
   a human health risk.
*  Develop standard response to cleanup and
   spills.
*  Educate the public on the cumulative effects
   of mercury.
*  Conduct outreach efforts to policy makers.
<*  Encourage medical facilities to reduce use of
   mercury.
<*  Consider alternative outreach, (e.g., culturally
   appropriate educational materials for fish
   consumption advisories).
*  Eliminate abandoned mercury stockpiles.

This list was narrowed down to the following
three topics for inclusion in the action plan:

*  Educate society about the effects and
   consequences of mercury exposure using
   culturally appropriate methods and tools.
*  Encourage and mandate mercury use
   reduction.
*  Discourage unregulated recycling of collected
   mercury to eliminate abandoned stockpiles.

CONTACTS:

Louise Fabinski
Agency for Toxic Substances and Disease
Registry
77 W. Jackson Boulevard
Chicago, IL 60604
Phone:(312)886-0840
email: fabinski.louise@,epa.gov
Al Stenstrup
Wisconsin Department of Natural Resources
P.O. Box 7921, 101 S. Webster
Madison, Wisconsin 53707
Phone: (608) 264-6282
Fax: (608) 264 - 6293
email:  stensa@dnr.state.wi.us


Ken Runkle
Illinois Department of Public Health
525 W. Jefferson St.
Springfield, IL 62761
Phone: (217) 782-5830
Fax:(217)785-0253
email:  krunkle@idph.state.il.us


Dr. Ying Feng
Ohio Department of Health
246 North High Street
Columbus, OH 43215
Phone:(614)644-6447
Email: YFENG@gw.odh.state.oh.us
Steve Skavroneck
Environmental Consultant
346 E. Wilson St.
Milwaukee, Wisconsin 53207
Phone:(414)486-1613
e-mail: cranehousesp@msn.com

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                                                   Outreach and Education
Ms.EllynMcKenzieoftheSixteenthStreet
CommunityHealthCenterandMs.Sarah
SchubertoftheMilwaukeeHealthDepartment
spokeabouttheirexperiencesworkingwith
agenciesandcommunitiesinsuccessful
partnerships.Ms.JulieMoriartyEPA'sOfficeof
PublicAffairsEnvironmentalEducationGrant
Program)gaveadviceonhowtoapplyfor
grants.
 Successful Partnerships
J
Ms. McKenzie of the Sixteenth Street
Community Health Center discussed the
Center's work with the Brownfield Environmental
Assessment Program (BEAP). The Center
worked with the Wisconsin Department of
Natural Resources and community members to
clean up and develop an old factory site.  Ms.
McKenzie noted that the features that led to
success of the project included the following:

*     The agency gained the trust of the
       community,
*     There was a common point of contact
       for  multiple parties, and
*     The agency had site-specific processes
       with long-term goals.

Ms. McKenzie also mentioned the following
other programs:

«:»     Child Health Champion National
       Initiative by EPA which provides grants
       for  community programs in eleven cities.
*     Milwaukee Community Health Center
       (CHC) project involves communities,
       parents, and children in an effort to help
       kids cope with asthma.
            Ms. Schubert of the Milwaukee Health Dept.
            offered insights from her experience in dealing
            with community groups. She is a specialist in
            the lead poisoning program at the Milwaukee
            Health Department. A telephone survey
            conducted by the lead poisoning program found
            that there is a general awareness of the risks
            associated with lead in  housing, especially in
            high-risk areas, and that an important step in
            reducing lead poisoning was increasing
            knowledge of risk reduction behaviors through
            outreach and education programs. Based on the
            findings of the survey,  and a focus group, the
            lead poisoning program center has developed a
            community plan to provide people with the ability
            to reduce their risk of lead poisoning. When
            working with a community, Ms. Schubert noted
            that the following factors are important:

            *  Be flexible
            *  Be involved
            *  Listen to people
            *  Be honest
            *  Be available
                                                   Grant Applications
            Ms. Moriarty, of the U.S. EPA,  provided hints on
            how to prepare a grant application for EPA. The
            most important part of grant-writing is creating a
            plan for the organization.  Ms. Moriarty
            suggested considering the following  objectives
            when preparing a grant application.

            *   Define what your organization is and what its
                goals and strengths are.
            *   Identify funding agencies.
            *   Focus on a specific problem your
                organization will address.
            *   Be realistic in you goals.
            •>   Show what partnerships your organization
                will form.
            *   Demonstrate sustainability.

            One of the participants stated that some
            partnerships are created only because they are
            required in order to be eligible for a grant and are
            not necessarily for useful purposes.  Although
            this is sometimes true, the speakers pointed out
            that partnerships should benefit all parties.

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CONTACTS:

Ellvn McKenzie
Sixteenth Street Community Health Center
1337 S. Cesar E. Chavez Dr.
Milwaukee, WI 53204
Phone:(414)672-1315
Fax:(414)672-9190
Email: Ellyn.McKenzie@SSCHC.ORG

Sarah Schubert
Milwaukee Health Department
1230 West Grant Street
Milwaukee, WI 53215
email: sschub@ci.mil.wi.us

Julie Moriarty
U.S. EPA Region 5
77 W. Jackson Boulevard (P-19J)
Chicago, IL 60604

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At this workshop, Ms. Diana Fleming, a
children's advocate and activist, and Ms. Clare
Hintz, from Safer Pest Control Project spoke
about integrated pest management (IPM.) IPM
is a method of preventing and controlling pests
in a way that is the least hazardous to human
health and the environment.

IPM uses information about the pest's biology
and habitat to get to the root of the pest problem.
Pesticides are used sparingly, if at all. Topics
discussed are summarized below.
 Perceptions and Misconceptions of
 Environmental Activism and IPM: A
 Case Study
Ms. Fleming described how she became an
activist. She helped pass one law requiring
schools to notify parents and staff prior to
pesticides applications on school grounds and is
currently working on getting a law passed that
would require schools to adopt IPM programs.
She spoke about her personal journey to
becoming an activist and gave advice to the
audience about becoming a tactical activist. Her
top ten rules of tactical activism are summarized
below.

* Avoid fighting a battle on your opponent's
   terms.
* Pursue a proactive agenda rather than a
   defensive response to your opponent's
   plans.
* Define the problem and learn the issues.
* Establish a goal.
* Recognize a strategy.
* Define tactics to support the strategy
* Assess a campaign's success.
* Be a tactical activist-listen, be tenacious,
    creative, and willing to make mistakes.
*  Remember that tactical activists never fail—
    they only make mistakes and learn from
    them.
*  Be cautious of the media.

The common perception that governments are
too burdensome for environmental change
campaigns to succeed is a misconception.
Becoming a tactical activist to promote positive
change is a viable solution. Ms. Fleming also
spoke about the importance of using IPM from a
firsthand experience. She stressed the huge
impact of the use of hazardous chemicals on
children at school and stated that adults need to
do a better job of protecting children from these
dangers.
 Roach Control Using IPM
J
Ms. Clare Hintz of Safer Pest Control Project,
spoke about her research with regard to roach
control. It is important to have a cockroach-free
home because they can release allergens into
the home that can make many people sick.
These allergens can also trigger asthma attacks.
Ms. Hintz described simple techniques to reduce
roach populations in the home without
pesticides. These techniques are summarized
below.

*  Seal  all entrywavs into the home.
    Cockroaches can get into a home through
    cracks around baseboards and holes in the
    walls where plumbing or heating ducts come
    through. Cockroaches hide in cardboard
    boxes that people carry inside.
*  Keep food away from cockroaches.
    Cockroaches need food to stay alive.
    Keeping crumbs out of the kitchen and food
    in sealed containers will cut off the roaches'
    food supplies.
*  Wash dirty dishes promptly, and vacuum
    regularly.
*  Have leaks repaired: Cockroaches also
    need water to live. Leaks provide all the
   water roaches need to stay alive.
*  Reduce clutter: Clutter is hard to clean
    around and offers lots of hiding  places for
    roaches.
*  Use hot, soapy water to scrub away roach
    droppings. Roach droppings attract other
    roaches  and can cause allergies.

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Ms. Hintz stressed that IPM is a technique that
anyone can implement to reduce cockroach
problems without using pesticides.

CONTACTS:

Clare Hintz
Safer Pest Control Project
17 E. Monroe St. - Suite 212
Chicago, IL 60603
Phone:(312)641-5575
Fax:(312)641-5454
Email: spcp(o),iname.com

Diana Fleming
Phone: 630-323-2821
Fax 630-323-5908

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Ms.lngaBackofthelnter-TribalCouncilof
Michigan,Ms.LisaSchneideroftheChicago
HousingAuthority(CHA),andDr.HelenBinnsof
Children'sMemorialHospitalandtheChicago
AreaHealthProfessionalsLeadConsortium,
spokeaboutleadeducationandprevention.
 Tribal Lead Education
Ms. Inga Back from the Inter-Tribal Council (ITC)
of Michigan talked about lead education and
prevention for Tribes in Michigan. The purpose
of the ITC lead education program was to
develop Tribal-specific material about lead
hazards and conduct educational and outreach
activities to inform the Tribes about lead.

Ms. Back described five basic areas of lead
education:

1.  Sources (hobbies and occupational hazards);
2.  Risk groups (children  under 6 years and
   pregnant women);
3.  Health effects (affects the central nervous
   system);
4.  In-home hazards (paint dust and chips,
   remodeling debris); and
5.  Protecting children (testing for lead and
   reducing exposure through thorough
   cleaning).

To educate Tribes about lead, Ms. Back used
tribal-specific brochures,  materials from the
Center for Disease Control, and materials from
EPA. Several groups were targeted for
education: health care professionals, housing
authorities,  parents,  environmental groups, and
day-care and school staff. Ms. Back said it is
important for health care professionals to
educate the public about lead screening policies.
Clinics can develop a targeted screening policy
based on at risk areas. The Tribal housing
facilities need to be educated about U.S.
Department of Housing and Urban Development
requirements regarding lead in older housing
units. Monetary incentives should be provided to
encourage parents to get involved, and health
and housing fairs should be held. Teachers and
school staff should be informed about activities
they can offer to children to help them learn
about lead hazards. Also, Head Start centers
should be brought on board to establish early
blood lead screening policies.

ITC visited 10 out of 11 Tribes in Michigan.
Presentations about lead hazards and lead
poisoning prevention were given at eight health
clinics, eight Head Start centers, and one health
fair. Four new blood lead screening programs
were established and an existing screening
program was strengthened.

Ms. Back stated that future activities included
expanding presentations about lead hazards to
junior high schools and procuring funding for
testing blood lead levels.
                                                    Lead Prevention Activities in Chicago
Ms. Lisa Schneider of the CHA spoke about the
CHA's lead prevention efforts in Chicago public
housing units.

The CHA has approximately 39,000 units
throughout the City of Chicago. About 66,000
individuals live in public housing.  In 1995, no
lead prevention activities existed at the housing
units.  Lead hazards are present in many of the
family housing developments.  CHA assembled
a lead poisoning prevention taskforce to create a
lead poisoning prevention campaign.
Participants and partners in the campaign
included resident environmental community
groups,  the University of Illinois at Chicago, the
Chicago Department of Health, and the Chicago
Legal Clinic.

The goals of the campaign  were to educate
residents prevention techniques such as good
nutrition and daily cleaning. The CHA began a
lead hazard notification program.  The CHA
tested soil, water, paint, and dust at the housing
developments and sent mailings to all residents
where lead was to be found. Within each
mailing,  residents received a $5.00 rent credit for
verifying they received and read the materials.
All residents were invited to a party to be held at
the housing development.

CHA then held a "Lead Awareness Party" to
educate about lead hazards and lead poisoning
prevention. Participation was encouraged by
providing free t-shirts, lunch, and free blood lead
screening. Adults at the party were schooled on

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cleaning and nutrition while the children learned
about lead hazards through videos and games.
Ameri-Corps and the Chicago Department of
Health helped to support the Lead Awareness
Parties.

Ms. Schneider reported that the CHA
established an additional program for resident
education about lead. Occupants living in the
housing developments were paid to go door-to-
door to educate their neighbors about lead
hazards.  The program's goals were to increase
the number of blood lead level screenings,
increase parental knowledge about lead
hazards, and decrease the number of children
with elevated blood lead levels.  The peer
educators were paid livable wages and
underwent a 3-week intensive training course to
learn about safety, nutrition, lead hazards, and
lead prevention. The peer educators did home
visits and collected data on follow-up visits to
monitor retention of the information
disseminated. In 6 months, over 400 initial visits
and 200 follow-up visits were conducted. An
increase in lead prevention and hazard
knowledge decreased blood lead levels in
children by anywhere from 30 to 50 percent.

Ms. Schneider reported that CHA declared the
program a success.  CHA hopes that lead
poisonings were prevented and blood lead levels
decreased. The CHA committed substantial
resources and paid their employees and
partners. Ms. Schneider said that, in retrospect,
the CHA would have eliminated follow-up visits
by the peer educators to save money and
clarified program goals to avoid unnecessary
financial expenditures.
 Engaging Physicians in Lead
 Poisoning Prevention
J
Dr. Helen Binns of Children's Memorial Hospital
and the Chicago Area Health Professionals Lead
Consortium spoke about educating medical
doctors and health professionals about lead
poisoning prevention.

Dr. Binns reported that changes in clinical care
are hard to bring about. Dr. Binns found that
more lead screening and information
dissemination is done by young doctors than
older doctors. First, health care professionals
must be schooled in lead hazards and lead
poisoning prevention. Then, the clinics must
transfer the knowledge to their patients and
families.
            Dr. Binns stressed that information should not
            just be mailed or handed out at the clinic.
            Information is more successfully transferred by
            encouraging  patients and their families to visit
            hospitals and clinics. Clinical acceptance and
            screening patterns vary extensively.  Clinics
            need to stress to patients that lead poisoning
            can cause several problems and that blood lead
            level screening is a logical step if the patient may
            be at risk of exposure to lead.  To help clinics
            identify patients that may be exposed to lead
            hazards, information should be provided to
            hospitals and clinics regarding high-risk zip code
            areas that have old housing and a history of high
            blood  lead levels.
             Facilitated Discussion
                                       J
            Ms. Patty Krause of EPA Region 5 facilitated a
            discussion on lead poisoning prevention and
            education of lead hazards. The following key
            issues were raised during the discussion:

            *  Focus on older and low-income housing
               areas that are at high risk for lead.
            «3>  The need for increased awareness about
               lead hazards in the medical community.
            •:»  The need for increased awareness in parents
               and children.
            *   Provide permanent funding for voluntary
                lead analysis in high risk homes.
            *   Mandate blood lead level screening for
                young children.
            *   Create a lead awareness program.
CONTACTS:

IngaBack
Inter-Tribal Council of Michigan, Inc.
3601 Mackinaw Trail
Sault. Ste. Marie, MI  49783
Phone: (906) 635-4208
Fax: (906) 635-4212
e-mail: ingab@up.net
            Lisa Schneider
            Chicago Housing Authority
            626 W. Jackson Boulevard, 6th floor
            Chicago, IL 60661-5601
            Phone:(312)791-8500
            Fax:(312)454-5883

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Helen J. Binns. MD. MPH
Division of General Academic Pediatrics
Children's Memorial Hospital, 2300
Children's Plaza #208
Chicago, IL 60614
Phone:(312)880-4281
Fax:(312)880-8337
e-mail: hbinns@nwu.edu

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                         x6^
  "    *<^01fr**  ^
^
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*  Special injury prevention projects;
•:•  Alcohol injury reduction projects;
»>  Driving-under-the-lnfluence (DUI) reduction
    projects;
•*  Roadside hazard evaluation;
*  Car seat distribution;
*  Smoke detector distribution; and
*  Bicycle helmet distribution.

Mr. Etchison reported the national statistics
summarized below from the Center for Disease
Control for 1984 through 1995.

«:•  Injury is the leading cause of death among
    children more than 1 year old.
»>  Motor vehicle crashes rank first or second as
    the cause of  death for children aged 1
    through 19.
*  Pedestrian deaths comprise 73 percent of
    the total deaths among children.
*  Other causes of death among children
    include homicide, suicide, fire, and
    suffocation.

In comparison, a  database maintained at Bemidji
for the years 1986 through 1997 reports  the
statistics below.

*  Falls are the  primary cause of injury  for
    children aged Oto 14.
*  Motor vehicle crashes are the primary cause
    of death, almost twice the national average.
*  Children less than 1 year old are primarily
    dying from suffocating, choking, or
    submersion.
  Collaboration of Health and
  Environmental Tribal Resources:
  A Case Study
 Ms. Carol Rollins, Director of Environmental
 Health with the Ho-Chunk Nation in Wisconsin,
 described experiences of the Ho-Chunk Nation's
 Environmental Services Program, which is
 based in the health department. She stated that
 the Ho-Chunk Nation is located in central
 Wisconsin and consists of scattered Indian  lands
 across 14 counties. Because of this spread, it is
 difficult to deliver health services. Ms. Rollins
 reported that the health department currently
 manages six community water systems and six
 wastewater treatment systems throughout the
 Reservation.

 Ms. Rollins acknowledged Mr. Jim Dunning, an
 environmental specialist sponsored by the U.S.
 Environmental Protection Agency (EPA), who set
 up the Ho-Chunk Nation's water monitoring
 program. Several challenges that Mr. Dunning
 encountered at the start of his efforts included a
 high turnover rate among plant operators and
 unsophisticated water systems. Ms. Rollins
 stated that the success of the Reservation's
 casinos provided funds for newer pumphouses
 with filtering and monitoring equipment.  The
 upgrade has taken place over a period of about
 5 years.

 Ms. Rollins then described joint efforts between
 her environmental department and the public
 health department to deal with open dumping in
 a ravine on the Ho-Chunk Nation's grounds.
 Attempts to close the dump site were
 unsuccessful in the past.  The primary public
 health concerns included  rodent infestation  and
 children climbing into the ravine and getting
 injured. Using grant money from the Bureau of
 Indian Affairs, the two departments excavated
 what they could and filled the ravine with soil.
 Manholes and piping were installed to drain the
 landfill. The flattened area was then covered
 with clay and seeded.  Ms. Rollins showed a
 recent photograph of the site, now covered with
 grass.

 Ms. Rollins also described several public works
 projects that are also funded by casino profits.
 The environmental services program strives to
 be involved in construction of buildings to ensure
 that health codes are met. Joint funding by  the
 Indian community and a Wisconsin medium-
 security prison resulted in the construction of a
wastewater treatment plant to serve both places.
The plant relies on oxidation and ultraviolet

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disinfection to decontaminate water before
discharging it into the Black River.

CONTACTS:

Eli O. Hunt
Leech Lake Band of Ojibwe
6530 U.S. Highway 2 NW
Cass Lake, MN 56633
Phone:(218)335-8225
Fax:(218)335-8309


Captain Bruce M. Etchison
U.S. Public  Health Service, Indian Health
Service
Bemidji Area Indian Health Service,
522 Minnesota Ave. NW
Bemidji, MN  56601
Phone:(218)759-3360
Fax:(218)759-3504


Carol L. Rollins. R.S.
Director of Environmental Health
Ho-Chunk Nation, P.O. Box 636
Black River Falls, WI 54615
Phone:(715)284-1548
Fax:(715)284-9592
           *
Cross-train health and environmental
professionals in both areas.
Suggest having more localized fish
advisories in addition to the regional ones
and target the primary fish eaten by
individual Tribes.
Start educating youth in environmental areas
of concern.
 Facilitated Discussion
J
Ms. Dolly Tong and Ms. Peggy Donnelly of EPA
Region 5 facilitated a discussion on bridging
Tribal environmental health and public health
programs.  The following key issues were raised
during the discussion:

»;»   Coordinate county, state, federal, and Tribal
    entities and their health concerns without
    compromising sovereignty.
*   Explore available resources for Tribes to
    implement joint environmental and health
    programs.
*   Address environmental justice concerns.
•>   Strive for sustainable economic
    development.
*   Promote conferences such as
    Environmental WATCH to bring together
    county, state, federal, and Tribal
    representatives.

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Ms.M.E.SjolinfromtheUniversityofWisconsin
ExtensionFamilyLivingProgram.Ms.Faith
CovicifromlnsureKidsNow.Ms.PegDublin
andMs.AnitaSandersfromtheChicagoHealth
Corps, andMs.DeniseTaylorfromHealthyKids,
HealthyMindsspokeaboutresourcesavailable
tocommunitiestoimprovechildren'shealth.
Issuesdiscussedaresummarizedbelow.
 Family Living Programs: Cooperative
 Extension
Ms. Sjolin presented information on the
Cooperative Extension program she has been
involved with at the University of Wisconsin
Extension.  The following program areas are
under the Wisconsin Cooperative Extension
program:

*     Agricultural and Natural Resources
*     Community Natural Resources and
       Economic Development
*     Youth Development
*     Family Living Education

This program is supported by three groups: the
state university, the county, and the federal
government.

Ms. Sjolin works in the family living department.
The department's  mission in family living
education is to provide education, improve family
strengths, and help communities to become
positive environments for families.  Family living
goals are as follows:

*     Encouraging family self sufficiency,
*     Helping people manage transitions in
       their lives,
*     Improving parent education and
       community partnership, and
*     Improving community nutrition, health,
       and safety.
                                                   The family living program uses many different
                                                   media including radio, television, newspaper,
                                                   newsletters, and web sites, to educate families in
                                                   the community.

                                                   Cooperative education programs exist in all
                                                   states and can be contacted for further
                                                   information.
                                                    Insure Kids Now: Health Insurance for
                                                    Children

Ms. Covici gave an overview of the Children's
Health Insurance Program in Region 5. The
Insure Kids Now initiative is a nationwide effort to
enroll kids in low-cost or free health insurance
programs.  About 11 million children in the
United States do not have health insurance, and
6 million of those children are eligible for free or
low-cost health insurance through state
programs. Insure Kids Now wants to make sure
that these eligible children are enrolled in health
insurance programs.

The Children's Health Insurance Program is a
$20 billion program created in 1997 to  extend
the age eligibility for children's insurance up
through age 18. States have the option to
expand their current Medicaid programs or to
create new state-specific programs. In Region
5, the individual programs are as follows:

Illinois - Kid Care
Indiana - Hoosier Health Wise
Michigan - My Child
Minnesota - Minnesota Care
Ohio - Healthy Start
Wisconsin - Badger Care

Insure Kids Now is striving to enroll eligible
children  in these new health care programs.
Members of the workshop spent time
brainstorming different ways they could help
spread the word about these health insurance
programs.  Ms. Covici noted that it is important
that organizations dealing with public health
issues have information about their state's health
care program available to the families they
serve.

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  Chicago Health Corps: An Integrated
  Approach to Outreach
                                            promoting Kid Care.  Through working at the
                                            clinic and conducting home visits, she is trying to
                                            educate families about health issues.
Ms. Dublin and Ms. Sanders presented
information about Americorp and the Chicago
Health Corps.

Ms. Dublin spoke about Americorp, which is the
domestic Peace Corps. There are about 350
Americorp programs in the United States
covering the following four major areas:
1.
2.
3.
4.
Human needs
Education
Public safety
Environment
Ms. Dublin is a staff member of the Chicago
Health Corps, which is based at the University of
Illinois at Chicago and partnered with the College
of Nursing and the Illinois Area Health Education
Centers Program. The program focuses on
asthma management and lead poisoning
prevention.

The training curriculum for members of the
Chicago Health Corps is summarized below.

Primary Health Care Framework:  This is an
approach to health care that examines health
promotion and sickness prevention through
collaboration of the community and health
professionals.

Public Health Issues: Corps members learn
about different health issues and how to relate to
people, promote trust, and build relationships
using poplar education techniques.  Corps
members are trained on the following topics:

<•     Health promotion
*     Skill building
•>     Team building
•>     Workplace expectations

Through this training, Corps members learn to
see people in a holistic way by realizing that the
families they serve have a variety of needs and
assets.

Ms. Sanders is a Chicago Health Corps
volunteer. She spoke about experiences she
had during her first year in the corps. Ms.
Sanders works in a medical clinic that serves
low-income families in Chicago. She deals with
asthma prevention, lead poisoning issues, and
                                             Case Study: Healthy Kids, Healthy
                                             Minds

Ms. Taylor is the director of the Chicago Public
Schools Healthy Kids Healthy Minds Program.
This program is a citywide initiative designed to
increase access to primary health care services
linking each of the city's 589 public schools to a
federally qualified health center, hospital-based
clinic, or other community provider. She spoke
about her first-hand experience with enrolling
children in health care programs in Chicago.
She estimates that about 180,000 children in
Illinois are eligible for Kid Care but are not
enrolled.

The Chicago Public School System has many
health resources available to children in school,
including psychologists, social workers,
counselors, youth outreach workers, and crisis
intervention teams. Unfortunately, these people
usually rotate between two or three schools and
do not always have the time to make follow-up
visits.

Chicago Public Schools is trying to collect health
data information on all the schools in Chicago.
With information such as the percentage of
students without health insurance and average
number of days missed per student, particularly
needy schools can  be targeted.

The future goals of Healthy Kids, Healthy Minds
are as follows:

*     To assign all Chicago public schools to a
       consistent health care provider
»:•     To develop a policy of procedures
        manual so that health care procedures
       are formalized and  clear
*     To establish community based councils
       backed by local schools in
       neighborhoods
*     To plan a citywide Healthy Kids, Healthy
       Minds conference in 2000.

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CONTACTS:

Faith K. Covici
Health Insurance Specialist
Health Care Financing Administration
U.S. Department of Health and Human
Services, 105 W. Adams
Chicago, IL 60603
Phone:(312)353-7385
Fax:(312)353-5927
e-mail: Fcovici@shcfa.gov

Peg Dublin
Chicago Health Corps
845 S. Damen, Room 1114,
Chicago, IL 60612
Phone:(312)996-7393
Fax:(312)996-8945

Denise Taylor
Chicago Public Schools
125 S. Clark Street - 8th floor
Chicago, IL 60603
Phone:(773)553-1839

M.E. Sjolin
Clark County  University   of Wisconsin
Extension
Box 68
Neillsville, WI 54456
Phone:(715)743-5121
Fax:(715)743-5154
Email: mesiolin(S),facstaff. wisc.edu

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.     ' -

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Ms. JoAnne Chiakulus from the Illinois Department
of Health, Center for Minority Health Services, led
a discussion of how to successfully deliver health
or environmental services within the context of a
community's culture.
 Cultural Issues
Ms. Chiakulus pointed out that cultural issues are
becoming increasingly important in today's society
because the number of non-Caucasian children is
growing rapidly.   Furthermore, different cultural
groups still receive disparate health care.

A survey of people from various cultural  groups
found that the main reason people often did not go
to health care providers was cost. Other reasons
included several cultural issues related to  service
received from health care providers, including

*  Perception of cultural bias,
*  Offensive communication,
*  A lack of understanding of values, and
«>  Language barriers.

A member of the public commented that in his
experience,  health care providers often show a
lack of manners when dealing with patients.
Various members of the audience, as well as Ms.
Chiakulus, discussed this issue.  Some felt that
people from other cultural backgrounds may take
a lack of manners as  a personal affront.   Ms.
Chiakulus pointed out that this issue was a matter
of perception.

Ms. Chiakulus defined  perception as a process
through  which  people  select  and interpret
information from their environment.  One issue
discussed was that  intragroup differences are
often greater than intergroup differences and that
treating a patient in one fashion simply because of
his or her ethnic background is an  example of
stereotyping.     The  audience  discussed
stereotypes, and concluded that everybody forms
them to some extent.

Ms. Chiakulus  listed  the  following  barriers to
communication:

*  Differences in perception
*  Listening ability
*  Interpretation
*  Status
*  Bias
•>  Gender differences
*  Organizational climate
*  Cross-cultural differences

During further audience discussion, the need for
cultural competency training was discussed.  Ms.
Chiakulus  listed  several   steps  to  culturally
competent care, including the following:

*  Identify possible issues,
*  Ask appropriate probing questions,
•>  Include appropriate family members,
«:•  Involve  social   service  staff   from   the
   community  in the diagnosis  and treatment
   plan when necessary,
*  Address  language  barriers  by  providing
   trained and culturally appropriate interpreters,
•>  Incorporate the patients' medical beliefs and
   practices that will add value to the treatment
   plan,
*  Be aware that  cultural differences are not
   always the only cause for the problem,
*  Make an effort to include diverse people in
   your groups,
*  Treat people with dignity.

CONTACTS:

JoAnn Chiakulas
Illinois Department of Public Health - Center
for Minority Health Services
100 W. Randolph, Suite 6-600
Chicago, IL 60601
Phone:(312)814-2608
Fax:(312)814-1503

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Ms. Jane Neuman  of the U.S. Environmental
Protection Agency facilitated the asthma action
plan development working session.  Participants
discussed  various  issues  related to  asthma
prevention that had  been brought up during the
workshop. The group narrowed its discussion to
the following four important actions items:

•>  Build  coalitions  to  address  respiratory
    concerns made up  of  people from many
    different community groups (such as medical,
    community, parent, environmental, housing,
    school groups)
*  Improve education
*  Promote socio-economic and  racial justice
    and equality
*  Implement holistic approaches

The group voted to build a coalition. The driving
force behind this decision was that morbidity and
mortality from asthma are too high. The problem
statement agreed upon was:  There is a lack of
commitment and understanding in communities to
take measures to reduce asthma and a lack of
collaboration among the stakeholders (such as
families, child  care facilities, and environmental
agencies).

Charts were then drawn up and summarized to
describe actions that should be taken to develop
an asthma coalition  and who would need to be
contacted to complete the actions.

Identify the stakeholders:  It was decided that
each   community   could   identify   who  the
stakeholders were separately.

Gather background  data:   Data  must  be
standardized and gathered by reputable bodies
such as schools and hospitals.
Disseminate information: Informative literature
and success stories  should  be available to all
localities.

The coalition should  be effective at penetrating
communities with  community outreach.  It  is
important to find the  people  of most  need and
organize closest to them.   The coalition should
also educate parents and the  community through
mass media and other routes about coping with
asthma  attacks, preventive behavior,  and other
issues.

At the end of the session, participants spoke about
the success of the Chicago Asthma Coalition and
suggested other communities that could  model
similar organizations after it,

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About 12 participants attended the pesticides and
mercury action  plan breakout session.   This
breakout session  provided  an  opportunity  for
participants to recommend actions that will drive a
regional effort to protect children from exposure to
pesticides  and  mercury.    The  ideas  and
recommendations generated during this breakout
session  transpired  from  concurrent  session
discussions held prior to this one.

Ms.  Cynthia  Curtis of the U.S. Environmental
Protection Agency (EPA)  Region 5 facilitated the
discussion  on  issues raised during previous
presentations on pesticides and mercury, and the
group  ultimately decided on the issues  to be
addressed in the action plan. Issues discussed
are summarized  below.
  Mission
J
The attendees decided to focus on a Regional/
National  Children's   Environmental   Health
Clearinghouse (Clearinghouse) for the action plan.
The Clearinghouse would encompass all children's
health  issues; however, the group focused  on
pesticides and mercury for the purpose of creating
a model that can ultimately be used for other
children's environmental health issues.
 Components of the Clearinghouse
J
The purpose of the Clearinghouse is to develop a
resource that provides "one-stop shopping" for all
target audiences.  This resource will distribute all
information regarding child health issues such as
pesticides and mercury.  In order to accomplish
this  mission, the following  components were
proposed:
            *  Central location to house all resources relating
                to pesticides and mercury
            *  Master resource list or database
            *  Hotline and referral hotline for diagnosis and
                treatment
            *  Internet access
            *  Dual-language material

            Concerns relating to the Clearinghouse include the
            following:

            *  How to target all audiences,  such as the
                community, professional, official, and parent
                audiences.
            *  How   to    geographically   divide   the
                Clearinghouse (for  example,  by  state or
                region).
            *  How accessible the Clearinghouse will be to
                all target audiences.
             Core Elements Needed to Address
             the Issue

The  group  discussed  the  following  tasks
fundamental  to   successfully   creating   a
Clearinghouse:

1.  Conduct  research  and  gather  technical
    information regarding pesticides and mercury.

2.  Institute the  Clearinghouse  as a source to
    distribute information regarding pesticides and
    mercury health concerns for children.

3.  Establish key players to execute a pesticides
    and mercury program, including the Agency
    for Toxic Substances and Disease Registry
    (ATSDR) and  EPA's  Office  of  Children's
    Health.

4.  Follow the   lead  of other  pesticides and
    mercury program success stories, including
    success stories of the Indiana Department of
    Environmental Management (IDEM) Mercury
    Program, the Seattle King County Mercury
    Program, and the Santa Monica  Pesticides
    Program
While developing the Clearinghouse for the action
plan,  the group  identified barriers that may be
encountered. To counter the barriers, the group
also  devised  solutions.    The  table below
summarizes these barriers and solutions.

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 Barriers
Cost, advertising, and the media
Political climate
Industry (for example, the agriculture business)
Information overload
School board association (in Minnesota)
Ritualistic and personal uses
Reintroduction of recycled products into commerce
 Solutions
Encourage use of alternative methods (product development)
Improve access to grant reports
Provide more accessible and free hazardous waste drops and mercury collection
Introduce public service announcements on consumption offish
Legislate elimination of the mercury in manufacturing of items such as shoes
using mercury
Provide cash incentives and pre-disposal fees for hazardous materials
Require reclamation by manufacturer (extended producer responsibility)
Implement creative solutions for outreach
Institute train-the-trainer programs (for example, educate health care
professionals)
Develop better marketing strategies (for example, advertise in Parents magazine)
Share materials (for example, among states)
In the end, the attendees devised the following
"ideal solution" statement for the action plan:

Implement collaborative initiatives involving both
public and private sectors that educate a target
audience about the need to replace less desirable
or less sustainable products and practices with
safer alternatives and  offer opportunities and
incentives to actually do so.

-------
Mr. John Perrecone of the U.S. Environmental
Protection Agency (EPA) facilitated a discussion of
the problems  faced  by  environmental health
groups   attempting   to  foster   community
involvement. The participants devised an action
plan to address these problems. Issues discussed
are summarized below.
 The Problem
I
The  participants  determined  the following four
major issues pertaining to the community efforts
they  had undertaken:

* Dissemination of information to the community
* Hesitation   to   talk  about   community
   involvement
* Lack of willingness of the community to "come
   out" to meetings and other activities
* Lack of "ownership" of environmental health
   issues on the part of the community

The  group then identified more specific barriers
and problems related to community involvement in
environmental and health issues.  These barriers
and problems are summarized below.

* Communities  lack  access  to resources,
   including computers, transportation, money,
   and networks of other people.
* Government   institutions,  well-intentioned
   advocacy groups, and funding  groups often
   fail to work with "existing resources" within a
   community.
»> There  is a lack of trust by communities of
   "outside groups,"  especially those  that offer
   funding for short-term programs. Community
   groups often feel that 1-year grants do not last
   long enough for a problem to be adequately
   addressed.
                                                     Community groups sense a lack of cultural
                                                     sensitivity and cultural competency on the part
                                                     of advocacy groups and institutions.
                                                     There is a lack of coordination of resources
                                                     among Federal agencies.
                                                   The Solutions
                                                  J
The  participants  discussed  ways  for  groups
working  within  communities   to  encourage
involvement of community members. They agreed
that  environmental health advocates have to
become part  of the community.  Some  people
suggested attending  meals  and  other  social
occasions in  the community.  Ms. Susan Gust
(Sustainable  Resources  Center,  Minneapolis)
reported that  the Sustainable Resources Center
pays community members to attend meetings.

Participants also discussed sources of information.
One  person  suggested  that churches were  a
source of information about community  issues.
Another suggested using the Internet to gather
information about issues.
                                                   Successes
            Several participants identified their past successes
            in  encouraging  community involvement.   The
            successful programs mentioned  included the
            following:

            *  The Integrated  Pest  Management  (IPM)
               program implemented by high school students
               in Detroit, to teach  residents  about  basic
               issues involved in pest management
            *  The Phillips  Neighborhood Health Housing
               Collaborative
            *  A Head Start program  to teach community
               members about nutrition, sanitary skills, and
               raising children to become good parents and
               leaders
            *  The Tulane  University  Lay Health Advisory
               Program.
            •*  The Chicago Asthma Initiative
             The Action Plan
            The participants  determined  that  they should
            create an action plan in order to:

            1.  Promote  community leadership to address
               local environmental and health issues and

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2.   Look to communities to lead themselves, with
    less government involvement.

The five objectives of the Action  Plan were as
follows:

1.   Increase two-way sharing; do not separate
    people by "class" or technical ability.
2.   Identify communities with limited resources to
    ensure economic justice.
3.   Develop strategic partnerships with corporate
    and academic America to aid  in addressing
    environmental issues.
4.   Use environmental and health  issues to
    further economic and environmental justice in
    communities.
5.   Transfer knowledge of current success to a
    wider market.
Workshop members then decided that the most
important  objective  was  to  develop strategic
partnerships with corporate and academic America
to aid in addressing environmental issues. They
brainstormed the following potential methods for
achieving this objective:

«> Conduct   educational    seminars   for
   communities
«> Conduct train-the-trainer seminars
* Identify community organizations that have a
   stake in environmental and health issues
<» Identify "informal"  community leaders who
   know how to "get the word out"
* Integrate community "assessment mapping"
   into planning steps
* Involve  community  entities  in  program
   planning and evaluative-type research
* Promote community  economic growth  by
   paying  community  members who work to
   address environmental and health issues
* Look beyond the status quo and the members
   of the community who usually get involved
* Facilitate community dialogue

The group also made a list of the people who
should be involved in the  implementation of the
action plan and the  skills  they could contribute.
This list is summarized below.
People
Parents of school-aged children
Grandparents and senior citizens
Teachers and school administrators
Faith communities
Maintenance people
Elected officials
Technical experts
Children
Parents of all-aged children
College students
Academic community
Religious leaders
Others
Skill Mixes
May have time to do work during the day
Provide historical perspective of community




Can coordinate and offer management, technical and legal skills
Can be involved if adults are not sensitive about the amount of
time the children are asked to spend working
Nurturers; can provide refreshments


Spiritual civility
Perform public and community relations activities
Write grant applications
Provide writing or media skills
Can be visionary and passionate about the issues
Can provide wealth, work, and wisdom

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The participants devised the following action items
to achieve the objective of the action plan of
developing strategic partnerships with corporate
and academic America  to  aid in  addressing
environmental issues.

EPA staff were tasked with the following action
items:

•:»  Attend the Head Start National Conference,
    and conduct environmental workshops
«:»  Attend state-wide teacher meetings to present
    environmental information on workshop.

Other actions items include the following:

*  Develop a handbook to synthesize existing
    work around this  WATCH Conference.  A
    suggested title  is "Promoting  Community
    Leadership."
*  Collaborate with the medical community on
    "basic" environmental  concerns  such as
    medical education for physicians, nurses, and
    health service providers.
*  Collaborate with  community  housing and
    neighborhood organizations in order to create
    links  between  environmental  health  and
    housing, energy and  "green" architecture.

Finally, the group presented a challenge to the
entire WATCH forum:  "Walk the walk,  talk the
talk!"

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Ms. Dolly long and Mr. Derrick Kimbrough of the
U.S.  Environmental  Protection Agency  (EPA)
facilitated  a discussion of environmental  health
and tribal  issues.  During the working  session,
attendees discussed the following issues from the
morning session:

1.  Coordinating with state,  Federal, local,  and
    county representatives without compromising
    tribes' sovereignty
2.  Identifying and maximizing available resources
    among agencies
3.  Creating  a needs assessment  to identify
    environmental risks on tribal lands

The  attendees discussed the coordination of
agencies and noted that it is also necessary for an
agency to be aware of actions taken  by other
agencies.  The attendees then turned to the issue
of the needs of people on the reservations.  The
following four main action items were developed:
                                                   3.
4.
Better   coordination   with  tribes'  internal
departments.
Identify   components   of   tribes'   needs
assessments by considering the particular
tribe's  poverty  level,  demographics,  and
segments  with  high  risk.   The   needs
assessment should  include baseline data
collection,   information   about   perceived
threats,  and a map of pollution sources and
pathways of contamination.
Determine what roles and  resources other
entities   could  provide  for   the   needs
assessment and for correcting the problems
Use community  outreach  and  education
programs
An EPA representative pointed out that any tribal
program should  include  identification  of the
following three elements:

*   Problems faced by the tribe
*   Solutions
«>   Potential actions to implement the solutions

The attendees also discussed ways of providing
environmental health information to tribal people,
such as including facts about pollution on electric
bills and making  information available at local
clinics.

The attendees identified the following  sources of
information that could be used  for  the  needs
assessment:
Resource
Toxic Release Inventory
Health care data
Drinking water data
Injury data
Non-major emitter data
Emergency response capabilities
Lead level in blood of tribe members
Pesticide use
Radon and lead in homes
Demographics and data on children
Poverty level and income data
Mapping
Agency or Group
EPA
Indian Health Service (IHS) and tribes
Tribes
Center for Disease Control (CDC) and IHS
States
Counties and the Bureau of Indian
Affairs (BIA)
Women, Infant, and Children (WIG), Medicaid, and states
States and agricultural departments
Department of Housing and Urban Development (HUD)
and IHS
Census Bureau, schools, BIA, and tribal enrollment
Tribes
Toxic Release Inventory (EPA)

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      Action Plan Development
       Working Session: Lead
Mr. Chad Cliburn and Mr. Dale Luecht of
the U.S. Environmental Protection Agency
(EPA) facilitated the lead action plan
development working session. Participants
discussed various issues raised during the
previous presentations on lead, and
narrowed its discussion to lead awareness
and increasing lead poisoning prevention
behaviors.
 What Is the Issue?
J
Lead awareness is still low because of
relatively low priority with competing
problems, lack of knowledge, and difficulty
in changing people's behavior.
 Awareness
i
       Low Priority
       •      people think lead has gone
             away
             low prevalence
       •      compare to other problems
       Everyone needs more
       •      some may be more important
       Lack of knowledge
       Behavior change difficult
       Right people are not saying the right
       things
       No National Strategy because of
       targeted marketing
       WHO?
       •      Parents and older Siblings
       •      C.B. Housing Orgnanizations
       •      Doctors - move to behavior
             change introduce prevention
             message
       •      Anyone who has children
             their care kids
           Successes in Addressing Issue
                                 J
     Tap into existing resources - (i.e.,
     Lead Safe America)
     Take message to personal level
     Message to schools
     Speakers Bureau
     parents/grandparents of children
     with lead
     Lead poisoning awareness
     successes
     Caring attitude get children lead
     screened and follow-up
     Partner with community
     organizations to address lead issues
Barriers to Increasing Awareness of
Lead Poisoning

                 Competing Problems
                 People don't know what to do next
                 Pediatricians not receptive - use
                 referrals to local/community
                 organizations
                 Out of sight - Out of mind
                 Lead cannot be seen - out of sight
                 out of mind
                 Landlords and Renters  unaware of
                 lead in-home disclosure law and
                 hazards  of lead
                 Limited access to large groups of
                 very young children
                 Problem in getting results
                 How to contact pediatricians
                 People are too busy competing
                 demands
                 Organizations are disappearing -
                 lead is lower priority

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 Objective of Action Plan             I
                                                   Start with EPA
Increase lead poisoning prevention
behaviors in a targeted population.
 Solution to Achieve Objective        1
Show measurable increases in lead
poisoning prevention behaviors within a
targeted population.

»      Who would be involved - USE
       NATIONAL CAMPAIGN
       Different message for different
       audiences.
a      Alliance to End Childhood Lead
       Poisoning: 202-543-1147
       # for LEAD SAFE AMERICA
«      National Lead organizations
       promote lead hazard awareness
•      Who will pass out information
<•      Link with community health
       organization
«      Daycare workers/homes
       Train community workers and social
       workers
•      Mandate, enforce homeowners and
       landlords to eliminate lead hazards
«      City organizations are hesitant to
       become involved due to liability
 °      Multi-outreach to parents with
       prevention message -baby products
       - diapers, diaper wipes
  Resources
       Lead posters from lead hot line
       Get out message to use product
       "Cascade" to remove lead
       Use community organizations
       State resources
       Find out where are the resources

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Lead Action Plan
ACTION

Have doctor talk to groups of doctors
1.  Identify population; where is the population
2.  Provide GIS maps to community organization
and others; and vanguard community or other PR

What are current concerns of population:
- how do they receive information
- radio, billboard, product advertising

Where do you focus message.
What will work, message to groups, individuals.
How to structure campaign.

Involve community groups /people interest in lead
in developing campaign, form coalition

Policy-uniform state/lead law
Seek $$$$$$$

PHASE II
Lead screening as a means to measure lead
levels.

Disseminate information to organizations involved
in target communities, so they will disseminate
information:  Medicaid, food stamps, WIG, clinics,
churches.
WHO

State and Local health
departments
EPA
Marketing Agencies: who
will pay PSAs
Whoever disseminates
information; hospitals,
neighborhood groups.

Any stakeholder local
health department
Feds, Foundations,
Universities, Industry

Vans - health department
WHEN

Completed
GIS maps

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         Action Plan Development
     Working Session:  "New Ideas"
   Mr. Peter Murchie of the U.S.
   Environmental Protection Agency (EPA)
   facilitated a discussion of "new ideas" to
   develop a holistic framework for addressing
   children's health issues.  The group
   discussed how to develop a campaign
   theme that would draw people's attention
  towards children's health. The goal would
  be to increase all sector awareness,
  involvement, and action.  This would be
  encouraged by developing an imagery tool
  that would draw people's attention and get
  them to visualize the place and role for
  children's health.

  The group discussed barriers to achieving
  this holistic view of children's health
  Worker turnover, focus on single issues
  and lack of resources lead to continual
  problems with holistic awareness of
  environmental health issues. Communities
  may feel underpowered to solve problems
  hohstically. The group noted in order to
  encourage a community's involvement its
  culture needs to be factored into the
 approach to help people help themselves.

 The group suggested a "pledge" program
 that could help activate communities  One
 idea was to send out a pledge sheet with a
 membership card to people as an
 environmental reminder. To  ask people to
 pledge, a list of principles is needed  The
 group identified three:

 1)     Children's health is  our first priority.
       Children are the most valuable asset
       our planet has.
2)     In working towards children's health,
       I will respect others' opinion, culture,
      values and needs.
3)    Everything I do affects others and
      what they do affects me. "No one is
         an island."
  The group also suggested forming a
  regional advisory group for children's health
  that would encourage different entities to
  work together and overcome contention.
   Develop a Holistic Framework for
   Children's Health
  Tool
  a
 Goal
        Imagery, like Mississippi River,
        Woman's Breast, Seven
        Generations
        Everyone at table visualizing place
        and role for Children's Health
        Increase all sector awareness,
        involvement and action
 Barriers
 «      Lack of passion
 «      Turnover
 •      Conditioning
 •      Single issue focus
 9      Lack of human and $ resources
        Bias: "us" vs. "them"
 •       Unbalanced power
 •       Lack of knowledge
 9      Cultural differences
 •      Priority differences
       Turf

 Solutions
 •      All inclusive
 •      Involve people/ include in all aspects
 •      Promote "power with" vs. "power
       over"
•      Education at all levels (K-12 criteria)

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 Action Plan
ACTION
   WHO*
WHEN*
 Letters from EPA to medical
 professionals/organizations
 to get involvement
 -school systems
EPA/ATSDR
 Create Imagery/Symbol
 -ribbons to wear (green?)
This group and RAG
 Pledge with Children's
 Environmental Health(CEH)
 Principles
RAG, EPA, and HHS
 List serve/Internet/Web
 Marketing-Workshop on how
 to market CEH
Social Marketers
 Regional Advisory Group
 (RAG) for CEH
 •     $ involved for staff
       time, database
       development and list
       serve
 •     linkages
 •     all inclusive
 •     workgroups for
       individual topics
 »     Steer Committee and
       subgroups
 •     contact list for CEH
       entities
 «     speakers bureau
 •     clearinghouse
       (centralized) for CEH
       Federal agencies
       (USDA and FDA may
       be against
       environment issues,
       but it is good to get
       the "enemy" to the
       table.)
       NACHO
       Medical profession
       NEHA
       State agencies
       Industries
       APHA
       Workshop
       participants
       Chicago American
       Lung Association
       AEN Education

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Local tribes can identify other sources of data for
the needs assessment.

The IMS, with  input from  individual tribes, will
develop a draft needs assessment tool consisting
of two to three pages of questions by January
2000.
                                                                 •&U.S. GOVERNMENT HOOTING OFFICE: 2000 547-932

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