ADVANCEMENT OF THE PRACTICE
spent participating is appropriate. The PRA package is only applicable if 10 or more par- ticipants are included in the EI. Anaconda Exposure Investigation In 2018, ATSDR conducted an evaluation of blood lead levels and urine arsenic levels in people living in Anaconda, Montana, a com- munity with past smelting activities. Soils in the city were impacted by the smelting of copper ore in the community. Community members were concerned about exposure to heavy metals as a result of direct contact with impacted soil or exposure to indoor dust. For lead exposure, ATSDR usually focuses on people who are at the greatest risk for harmful eects: children ≤6 years, pregnant individuals, and individuals of childbearing age. In Anaconda, older residents also were concerned about exposure because many of them have resided in Anaconda for their entire lives. Therefore, testing for the EI was oered to all Anaconda residents. A total of 367 residents were tested for lead in blood and arsenic in urine (Figures 2 and 3). Arsenic in urine was speciated to dier- entiate exposure to inorganic (i.e., might be associated with arsenic in the environment) and organic (i.e., associated with arsenic in seafood) forms of arsenic. ATSDR partnered with U.S. EPA to assist in prioritizing homes for soil remediation as well as remediation inside the home (e.g., attic). Test results were comparable to the national average reported in the 2015–2016 National Health and Nutrition Examination Survey (Centers for Disease Control and Pre- vention, 2023). This information was par- ticularly useful to participants, as the results showed no immediate health threats from direct contact with the impacted soil. Addi- tionally, U.S. EPA continued their cleanup eorts to further reduce potential for expo- sure. A health consultation of the EI was cre- ated, which is a verbal or written response from ATSDR to a specific request for infor- mation about health risks related to a specific site, chemical release, or presence of hazard- ous materials (ATSDR, 2019). EIs provide ATSDR with data needed to determine how people are exposed to con- taminants at a site. Community engagement is critical for planning the EI and for ensur- ing community concerns are understood and addressed through the EI.
FIGURE 2
Blood Lead Levels by Age in Participants of the 2019 Exposure Investigation in Anaconda, Montana
10.0
Exposure Investigation Follow-Up (5 µg/dl)
1.0
50th Percentile (Median) of NHANES Population
Gray Area is 90% of NHANES Population
0.1
0
25
50
75
Age (Years)
Source: Agency for Toxic Substances and Disease Registry, 2019. Note. NHANES = National Health and Nutrition Examination Survey.
FIGURE 3
Total Urinary Arsenic Levels by Age in Participants of the 2019 Exposure Investigation in Anaconda, Montana
Anaconda EI
NHANES 2015–2016
Source
E x p lan at i on O utlier
1, 000
W hiske r 75th Percentile
100
Median
25th Percentile Note. W hisk ers extend to the largest or lowest value within 1.5 times the interquartile range above the 75th percentile. Interquartile range is defined as the difference between the 75th and 25th percentile. The notch indicates the confidence interval for the median value.
10
1
1– 19
≥20
Age G rou p (Years)
Source: Agency for Toxic Substances and Disease Registry, 2019. Note. EI = exposure investigation; NHANES = National Health and Nutrition Examination Survey.
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Volume 85 • Number 8
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