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During two legionellosis outbreak investigations, one at a geriatric centre and the other in high-rise housing for seniors, it was observed that additional cases of legionellosis occurred in nearby smaller residential settings. This apparent geographical cluster of legionellosis occurred in the same general area of a community water storage tank. No potential airborne sources in or near the area could be identified, but a community water system storage tank that was centrally located among case residences spurred an investigation of water-quality factors in the identified investigation area. Conditions conducive for Legionella growth, particularly low chlorine residuals, were found. The rate of legionellosis among residents aged ⩾50 years in the investigation areas (61·0 and 64·1/100 000) was eight times higher than in the rest of the service area (9·0/100 000) and almost 20 times higher than the statewide annual average incidence rate (3·2/100 000). A water mains flushing programme in the area was launched by the water utility, and water samples taken before and during flushing found L. pneumophila.

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In 1995 the New Jersey Department of Health and Senior Services (DHSS) determined that the incidence of childhood cancer--specifically, brain and central nervous system cancer in children under the age of five--in a New Jersey community was significantly higher than expected. This finding, which confirmed public perceptions, as well as the location within the community of two Superfund sites generated a comprehensive undertaking by state and federal agencies to account for the observation and to determine possible etiologies. Beginning in 1997 the DHSS designed and conducted an epidemiologic study primarily for the purpose of identifying possible disease risk factors that might have led to the increased cancer incidence. In December 1999 the agency released an interim report of its findings. Although the interim report did not identify significant differences in potential exposures between cancer cases and appropriately chosen control groups, the DHSS cautions that the study remains incomplete and no conclusions should be drawn at this time. Other factors, including the source of the drinking water, residential proximity to hazardous sites, parental occupation, and purported exposure to sources of air pollution remain to be analyzed. The final report is due by the end of 2001. New Jersey Medicine associate editors Leah Ziskin, MD, and Alan Lippman, MD, met with James Blumenstock, MA, senior assistant commissioner; Jerald Fagliano, PhD, program manager; and Eddy Bresnitz, MD, assistant commissioner and state epidemiologist at DHSS. The following interview seeks to understand the motivation behind this comprehensive study and the methodologies that are used to evaluate a cancer cluster.

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To characterize volatile organic chemical (VOC) contamination in public water in New Jersey from 1978 through 1990, detailed GIS maps were developed, along with descriptive text and an associated contaminant database, broken into half-year periods. All water providers that served more than 500 service connections were mapped. Contamination status for nine VOCs, including total trihalomethanes (THMs), was estimated for about 90% of the state's population. Many water systems were partitioned into smaller subsystems in order to map service areas that were more homogeneous with regard to water quality in order to minimize exposure misclassification. Data used for this work included test results taken by the New Jersey Department of Environmental Protection or the water utilities (raw, plant, and distribution system samples), an analysis of probable water use and water flow (based on pumpage, population, system architecture, and advice from the water systems), and information on service area extensions during the period. Using GIS applications, these maps and databases were used to estimate the size of the population exposed to contaminants over time, demonstrating a dramatic decrease in exposed population after the New Jersey Safe Drinking Water Act was signed in 1984.

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Several previous studies of exposure to chromium waste in New Jersey have shown that Cr levels are elevated in household dust in homes adjacent to waste sites and that Cr levels in the urine of residents near sites are also elevated compared to control populations. It has not been possible until now, however, to examine these external and internal measures of exposure together in a large population to determine whether the external exposure is predictive of the internal exposure. We investigated the relationship between various adjusted and unadjusted measures of spot urine Cr concentration and household dust Cr from residents and residences adjacent to known Cr waste sites. Statistically significant bivariate relationships were found between log-transformed urine Cr concentration and Cr dust concentration (micrograms of Cr per gram of dust) but not Cr dust loading (nanogram Cr per square centimeter). Log-transformed urine concentration was used as the dependent variable in multiple regression analysis of the total population (n = 329), the population [less than/equal to] 10 years old (n = 67), and the population >10 years old (n = 262), with Cr dust concentration as a mandatory independent variable. Other potential direct influences on urine Cr were investigated as potential confounders of this relationship. In the final models for the entire population and those [less than/equal to] 10 years old, but not for those >10 years old, Cr dust concentration remained significant. This suggests that exposure of young children to Cr in household dust accounts for much of the relationship in the entire population.

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Chromium waste slag containing potentially hazardous levels of hexavalent chromium was used as fill material at more than 160 residential, industrial, and recreational sites. Persons living or working in the vicinity of the sites may have been exposed through inhalation, ingestion, or skin contact with contaminated soils and dusts. In 1992-1993, the New Jersey Department of Health and Senior Services (NJDHSS) and the Environmental and Occupational Health Sciences Institute (EOHSI) conducted a screening project to assess exposure to chromium and to provide medical evaluations to people living in 14 residential areas or working in 78 workplaces near chromium waste sites. The screening included a physical examination for irritant or allergic effects and a urine chromium test for recent exposure. Participants were referred for follow-up medical evaluation if specific criteria were met. Of 800 residents and 938 workers receiving the screening physical examination, 32 adults were referred for follow-up evaluation. Of 806 residents and 934 workers submitting a urine specimen for chromium analysis, 158 adults and children had levels exceeding specified criteria and were referred for follow-up evaluation. The proportion of persons referred on the basis of the urine chromium test varied among screened groups. Multiple linear regression models showed that average urine chromium differences between residents and a comparison group, adjusting for potential confounders, were highest in children under 6 years of age. Most of the persons undergoing the follow-up medical examinations revealed no apparent clinical effects attributable to chromium exposure. The screening results indicated the need for expanded environmental evaluation in specific residential areas and workplaces.

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Residents of a condominium building in Hoboken, New Jersey, were exposed to mercury contamination in indoor air. Elevated levels of mercury were detected in urine samples provided by the residents, and 69% of the urine mercury levels were 20 microg/l or greater. Urine mercury levels were correlated positively with the duration of residency in the building and with the time (i.e., h/d) residents spent in the building. Environmental and biomonitoring data indicated that the residents were being exposed to mercury levels that were cause for health concern. Local health authorities, therefore, declared the building to be unfit for habitation and ordered that the premises be vacated. Health officials monitored the personal belongings of residents for mercury contamination before the items were removed from the building. The residents were offered medical evaluations and support services as part of the relocation effort.

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Epidemiologic studies in New Jersey have examined the relationship between exposure to water contaminants and the occurrence of leukemias, non-Hodgkin's lymphomas, and adverse reproductive outcomes. Public drinking water supplies need to be monitored on a continual basis.

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>A study of drinking water contamination and leukemia and non-Hodgkin's lymphoma (NHL) incidence (1979-1987) was conducted in a 75-town study area. Comparing incidence in towns in the highest trichloroethylene (TCE) stratum (>5 microg/l) to towns without detectable TCE yielded an age-adjusted rate ratio (RR) for total leukemia among females of 1.43 (95% CI 1.07-1.90). For females under 20 years old, the RR for acute lymphocytic leukemia was 3.26 (95% CI 1.27-8.15). Elevated RRs were observed for chronic myelogenous leukemia among females and for chronic lymphocytic leukemia among males and females. NHL incidence among women was also associated with the highest TCE stratum (RR = 1.36; 95% CI 1.08-1.70). For diffuse large cell NHL and non-Burkitt's high-grade NHL among females, the RRs were 1.66 (95% CI 1.07-2.59) and 3.17 (95% CI 1.23-8.18), respectively, and 1.59 (95% CI 1.04-2.43) and 1.92 (95% CI 0.54-6.81), respectively, among males. Perchloroethylene (PCE) was associated with incidence of non-Burkitt's high-grade NHL among females, but collinearity with TCE made it difficult to assess relative influences. The results suggest a link between TCE/PCE and leukemia/ NHL incidence. However, the conclusions are limited by potential misclassification of exposure due to lack of individual information on long-term residence, water consumption, and inhalation of volatilized compounds.

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Chromite ore processing residue occurs at over 130 sites in Hudson County, New Jersey. Many of these sites are in urban residential areas. This waste is a result of 70 years of chromate and bichromate chemical manufacturing. At least 15% of the sites contain total chromium concentrations greater than 10,000 mg/kg, with hexavalent content ranging from about 1 to 50%. Continuing leaching of this waste results in yellow-colored surface water runoff and yellow deposits on the soil surface and inside basement walls. The chemistry, environmental fate, health effects, and human exposure potentials for this waste are described.

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An ecologic study was performed to examine the relation between the incidence of leukemias and the occurrence of volatile organic chemical (VOC) contamination of drinking water supplies within a study area comprised of subpopulations differentially exposed to drinking water VOCs (trichloroethylene and related solvents). Populations served by community water supplies were classified into exposure categories according to VOC contamination status based on 1984-85 sampling data. Leukemia incidence data (1979-84) were collected from a population-based cancer registry. For females, the standardized incidence ratio was elevated only in towns in the highest of three exposure categories. No association was observed in males in any of the exposure categories. A Poisson regression analysis of the data, using finer exposure strata, indicated an increase in risk among females with increasing level of contamination which appeared to be distributed evenly across all age strata. The rate ratio for females at the highest exposure stratum for total non-THM VOCs compared to the least exposed stratum was 1.68. The observed association appears to suggest that drinking water contaminated with VOCs may increase the incidence of leukemia among exposed females, but caution is advised in the interpretation of these results because of the uncertainties inherent in ecologic studies.

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