Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112525

Sylvia Tan, MS¹, Carrie Nagy, MPH¹, Tamara Nichols, MPH, CHES¹, Noël Bazini-Barakat, RN, MSN, MPH¹, Janet Scully, MPH¹, Dickson Diamond, MD², and Cyrus Rangan, MD, FAAP, ACMT³. (1) Toxics Epidemiology Program, Los Angeles County Department of Health Services, Public Health, 695 S. Vermont Ave., South Tower - 14th Floor, Los Angeles, CA 90005, (213)738-3220, cnagy@ladhs.org, (2) Director, Psychological Programs, Los Angeles County Department of Health Services, Public Health Bioterrorism Preparedness Program, 695 S. Vermont Ave., South Tower--14th Floor, Los Angeles, CA 90005, (3) Director, Toxics Epidemiology Program, Los Angeles County Department of Health Services, Public Health, 695 South Vermont Ave., South Tower - 14th Floor, Los Angeles, CA 90005

Several members of a high school cheerleading team presented with a perceived ‘seizure-like' illness over two years. Both absence of definitive medical diagnoses and increasing numbers of affected students raised concern that this cluster was caused by an unknown toxic exposure on campus. School officials solicited the assistance of the Los Angeles County Toxics Epidemiology Program.

A school-based risk assessment was implemented to characterize a plausible toxicological profile to explain reported symptoms. Investigational components included reviews of pertinent Materials Safety Data Sheets, student medical records, and scientific literature; self-administered written surveys; and face-to-face interviews to assess person, place, and time factors. Results demonstrated a lack of a plausible toxicological exposure and significantly varying patterns of illness among ‘symptomatic' students. Students self-identifying as ‘symptomatic' also distinguished themselves in responses to questions about stress, fatigue, and nutrition habits, suggesting symptoms were associated with non-toxicological factors.

Subsequent risk communication required both dismantling school-wide perceptions of a common ‘seizure-like' illness caused by a toxic exposure, and a shift of focus toward individual lifestyle factors (high stress, increased fatigue, poor nutrition habits). The school was advised to institute less demanding activities into the cheerleading program. One-year follow-up verified symptoms were no longer visible on campus since 4 months after completion of the risk communication, and the perception of a toxin-induced illness cluster had been extinguished. This investigation was distinguished by its use of both epidemiologic and ethnographic techniques to assess health concerns regarding an unknown toxic exposure, accomplished within a larger context of health promotion.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Articulate the factors that suggest or refute a toxicological etiology for reported health symptoms.
• Apply both ethnographic and epidemiological techniques in a comprehensive risk assessment strategy.
• Utilize appropriate risk communication techniques that address health concerns regarding an unknown or perceived toxic exposure, within a larger context of health promotion.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF employment.

Recorded presentation