FIGURE 1
The Exposure Investigation (EI) Process
R E C R U I T M E N T
• Invitation L etters • Phone C alls • D oor-to-D oor
• Sam pling and Analysis Plan • C onsent Form s • Q uestionnaires • O utreach Materials
Pack age sub m itted to O MB , as appropriate
E I R E P O R T AN D R E C O M M E N D AT I O N S P O S T O N AT S D R W E BS I T E
F I E LD W O R K
LABO R AT O R Y AN AL
C O M M U N I T Y R E S U LT S M E E T I N G
• C ollect Sam ples • C onsent Form s • Q uestionnaires
Note. ATSDR = Agency for Toxic Substances and Disease Registry; OMB = Office of Management and Budget.
• Identify the need for community education (e.g., assisting the community in under- standing how to reduce exposure). • Provide physician education in the form of grand round presentations and/or written clinician guidance. Methodology The process for determining whether to con- duct an EI is provided in Figure 1. Engaging the community is a critical first step to ensure that conducting an EI will work to address the concerns of the community and allows ATSDR to prepare an appropriate and fea- sible recruitment strategy for the investiga- tion. ATSDR may hold a kicko meeting in the community to provide information and begin recruitment. When the EI is complete, ATSDR conducts a public meeting to relay the results of the EI to the community. Determining an appropriate recruitment strategy is critical to ensure that the results of the EI fill the exposure data gap and meet the concerns and needs of the community.
ATSDR engages community leaders and local health agencies to determine the best way to recruit participants. Recruitment can include sending letters or postcards inviting residents to participate, making phone calls, going door-to-door, or using appropriate media (e.g., newspapers, social media) to engage the community. EIs typically focus on sampling the most highly exposed individuals or environmen- tal locations to determine the worst case for potential exposure in the community. The use of this strategy results in the sampling data only being applicable to the tested indi- viduals and the results not being generaliz- able to the community. After an EI request is accepted, ATSDR will prepare a protocol that provides appropriate consent forms, questionnaires, and outreach materials. Prior to collecting either biological or environmental samples, participants must complete consent forms (e.g., adult, parental permission, assent forms for adolescents) to ensure they are granting informed permis-
sion to partake in the investigation. Partici- pants may agree in the consent form to allow ATSDR to share de-identified results with other specified entities, as appropriate. Next, the team in the field administers questionnaires to participants, as needed, to collect exposure data needed to better inter- pret the results of the sampling. For instance, for an EI where we are measuring blood lead levels, we will ask about the amount of time spent in the yard by a child (if soil contamina- tion is an issue) and hand-to-mouth habits of children. For an EI where we are measuring per- and polyfluoroalkyl substances (PFAS) in environmental samples in homes, we will ask about the participant’s use of stain-resis- tant products and other household items that could contain PFAS. The administration of a questionnaire prompts the need to first prepare a Paper- work Reduction Act (PRA) package to sub- mit to the Oce of Management and Budget to ensure that participation in the EI does not overburden the public and that the time
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April 2023 • Journal of Environmental Health
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