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© 2003 American Public Health Association
FIELD ACTION REPORT |
The authors are with the Environmental Health Office, Boston Public Health Commission, Boston, Mass.
Correspondence: Requests for reprints should be sent to Paul A. Shoemaker, MPH, Environmental Health Office, Boston Public Health Commission, 1010 Massachusetts Ave, 2nd Floor, Boston, MA 02118 (e-mail: paul_shoemaker{at}bphc.org).
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ABSTRACT |
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 TOP ABSTRACT THE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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Mercury is a growing environmental threat that can cause serious health problems and birth defects. Household thermometers are high-risk sources of mercury because most people lack the knowledge to properly dispose of one when it is broken. The Boston Public Health Commission’s Environmental Health Office, with local and national partners, created the Boston Mercury Thermometer Exchange Program to address this hazard.
Large central exchanges are successful, but multiple smaller targeted "microexchanges" can be another effective way to reach the general public and specific vulnerable subpopulations such as the elderly, the homebound disabled, or recent immigrants. By conducting exchanges in community health centers and public housing developments for the elderly and disabled, and by working through home health care providers, the program collected 4477 thermometers.
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THE THREAT OF MERCURY |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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Exposure to mercury through contaminated air, water, and food can cause birth defects and nervous system damage in adults and children. Symptoms can include sensory changes, impaired coordination, cognitive damage, and death.1,2 The Environmental Protection Agency (EPA) has determined that the Northeast has some of the nation’s highest annual rates of mercury deposition.3
Mercury thermometers contribute an estimated 17 tons of mercury each year to municipal solid waste, making them one of the main sources of discarded mercury.4 Although the worst-case scenario may be an oversimplification, the 1g of mercury in a household thermometer has the potential to contaminate over 5.1 million gallons of water above the EPA’s National Recommended Water Quality Criteria level of 0.051 µg/L.5 Above this level, it can be hazardous to drink the water or consume fish caught in it.
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PARTNERS AND PLANNING |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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The Boston Public Health Commission’s Environmental Health Office (EHO), an environmental enforcement, response, and educational program, formed the Boston Mercury Thermometer Exchange Program in partnership with Health Care Without Harm, the Boston Commission on Affairs of the Elderly, City Councilor Francis Roache’s office, the Boston Housing Authority, various health centers and pharmacies, and other programs of the Boston Public Health Commission. The EHO secured $20 000 in grant funding from the Massachusetts Environmental Trust.
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POPULATION AND AREA SERVED |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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During the 2000 census, the Boston population (589 141 people across 16 culturally distinct neighborhoods) was 14.4% Hispanic/Latino, 49.5% White, 23.4% Black, and 7.5% Asian. According to 2000 census data, 31.5% of the population spoke a language other than English, 10.4% (61 336) were aged 65 years or older, 19.5% had an income below the poverty level, and 19.7% reported having one or more physical, mental, or sensory disability.
Several subpopulations in Boston can have difficulty accessing services owing to language barriers, mobility problems, and other issues. Thus, the program’s target populations were the elderly, the disabled, recent immigrants, and those of low income. However, promotion of many exchange events was general in nature and all Bostonians were eligible to participate.
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THE EXCHANGE PROGRAM |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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The goal of the program was to protect public health and the Boston Harbor watershed by collecting more than 4000 mercury thermometers between September 2001 and June 2002 (see sidebar on page 1998 for exchange procedures). This objective was based on the results of a recent exchange in Burlington, Mass (with about one quarter the population of Boston), where 1100 thermometers were collected at neighborhood pharmacies.
Previous single-event exchanges have had mixed results. A 6-hour exchange at the New England Aquarium in Boston prior to this program collected about 2 dozen thermometers. Another 1-day exchange at 3 locations by the Brookline, Mass, health department collected over 2000 thermometers. Organizational and financial barriers have prevented the incorporation of thermometer collection into regular citywide household hazardous waste turn-in days in Boston.
Thus, the program worked to reach people "where they are" through "microexchanges"—multiple smaller exchanges (lasting 3–5 hours) at specific locations—in addition to more traditional exchanges through pharmacies and health centers. Locations for the microexchanges included lobbies of public housing developments and individual homes by partnering with home health care providers. In addition to controlling logistics by limiting the number of thermometers and replacements that had to be handled at any one time, this approach allowed the EHO to provide other educational materials and make meaningful contact with city residents.
GENERAL STEPS, IN CHRONOLOGICAL ORDER, FOR IMPLEMENTING ANY TYPE OF MERCURY THERMOMETER EXCHANGE PROJECT
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The first exchange sites were subsidized housing developments for elderly and disabled persons eligible for Medicare and Medicaid (Figure 1
). The residents of these developments, which are scattered throughout the city, reflect Boston’s diversity. Exchanges lasting 3 to 4 hours each were held in public areas of 24 developments. Building managers and resident opinion leaders advertised each event within the building by using multilingual signs and word of mouth.
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Neighborhood pharmacies were approached about the project, and 3 volunteered to host exchange events. Each used fliers and window posters to advertise a daylong event. Beyond this, 2 pharmacies volunteered to host continuous exchanges, staffed by their employees, and exchanged thermometers from September 2001 until May 2002. Notably, one pharmacy was located in Boston’s Chinatown—making the exchange accessible to a large population of recent immigrants.
The third group of partners included the Visiting Nurse Association of Boston and a community health center’s home health care program. They collected mercury thermometers from their staff and agreed to exchange thermometers for their clients during home visits. EHO staff provided training, digital thermometers, educational materials, and mercury spill kits to ensure safe and efficient collection. These in-home exchanges lasted 9 months and proved valuable in reaching a difficult-to-access population, the homebound elderly and disabled.
Finally, during the last week of January 2002, five community health centers agreed to host a weeklong exchange event. The EHO provided staff training, posters, fliers, and educational materials, while the health centers advertised in their neighborhoods and provided staff.
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RESULTS AND NEXT STEPS |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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Between September 2001 and August 2002, the program collected 4477 thermometers (Table 1
). The exchanges at public housing developments had mixed results, ranging from no thermometers collected to a high of 38 at one location. Overall, the 24 developments turned in 395 thermometers. The home visiting programs gathered 1464 thermometers from their staff and clients. More traditional exchange events at pharmacies, health centers, and other locations collected the remaining 2618 thermometers (Figure 2). In total, microexchanges resulted in 41.5% of the total thermometers collected.
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Clearly, microexchanges produce excellent returns as a supplement to traditional central exchange events. They are able to reach subpopulations that probably would not have been able to participate in centralized events—such as homebound patients with cancer or other severe illnesses or the elderly first-generation Russian immigrant residents of one public housing development. Exchanges were relatively easy to implement and provided an opportunity to forge new partnerships in the community and strengthen existing ones. The majority of funding was dedicated to purchasing replacement thermometers (sidebar this page), while most staff time was spent training health center and pharmacy staff and providing educational materials to participants at exchange events.
The EHO continues to collect mercury thermometers and provide digital thermometers for exchanges. The program remains available to assist other organizations wishing to conduct exchanges and reduce mercury contamination.
A ROUGH BUDGET BREAKDOWN OF THE PROGRAM
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KEY FINDINGS |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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- A total of 4477 mercury thermometers were collected between September 2001 and August 2002.
- Microexchange events were effective at reaching vulnerable populations, such as the elderly and disabled, who cannot always turn out for a more traditional large event. They also were a convenient method for providing these populations with other educational and outreach materials.
- The exchange program was a vehicle for strengthening partnerships or forming new partnerships with other health agencies. The EHO continues to work with the Boston Housing Authority to address other environmental health issues influencing their buildings and residents, and a second round of thermometer exchanges is planned, coupled with a mercury sphygmomanometer exchange.
- Microexchanges helped the program manage the logistics of supplies, storage, and transportation of thermometers and replacements owing to the smaller numbers involved at microexchanges than at larger central events. This also allowed compliance with Department of Transportation regulations regarding transportation of hazardous materials.
- Further action needs to be taken to prevent or reduce mercury contamination of the nation’s food and water supplies and to educate the public about existing risks.
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Acknowledgments |
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The Boston Mercury Thermometer Exchange Program was funded through a grant from the Massachusetts Environmental Trust.
The authors thank the directors and staff of the following organizations for helping to make the program a success: Health Care Without Harm, Boston’s Commission on Affairs of the Elderly, City Councilor Francis M. Roache’s office, the Boston Housing Authority, Sullivan Pharmacy, Tremont Drug, Upham’s Corner Health Center, Dimock Community Health Center, North End Health Center, Neponset Community Health Center, South Boston Community Health Center, Southern Jamaica Plain Health Center, and the Visiting Nurse Association of Boston.
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Footnotes |
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Contributors
P. A. Shoemaker wrote the first and final drafts of this report. P. A. Shoemaker and J. Ghaemghami collaborated on the design and implementation of the project as well as the data collection, presentation, and editing of several versions of the report.
Accepted for publication May 9, 2003.
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References |
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TOPABSTRACTTHE THREAT OF MERCURYPARTNERS AND PLANNINGPOPULATION AND AREA SERVEDTHE EXCHANGE PROGRAMRESULTS AND NEXT STEPSKEY FINDINGSReferences |
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1. Toxicological Profile for Mercury. Atlanta, Ga: US Dept of Health and Human Services, Agency for Toxic Substances and Disease Registry; 1989. Publication ATSDR/TP-89/16.
2. National Academy of Sciences. Toxicologic Effects of Methylmercury. Washington, DC: National Research Council; 2000.
3. Mercury Study Report to Congress, Volume 3: Fate and Transport of Mercury in the Environment. Washington, DC: US Environmental Protection Agency; 1997. Publication EPA-452/R-97-005.
4. US Environmental Protection Agency. Mercury Study Report to Congress. Science Advisory Board Review Draft, Vol 2: 4–19, ES-3. 1996. Cited in Mercury Thermometer FAQ page, US Environmental Protection Agency Web site. Available at: http://www.epa.gov/glnpo/bnsdocs/hg/thermfaq.html. Accessed September 28, 2003.
5. US Environmental Protection Agency. National Recommended Water Quality Criteria Notice Republication. Federal Register. December 10, 1998; 63:68354–68364.
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