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INVESTIGATOR: Garner, K. F.

PERFORMING INSTITUTION:
ALABAMA A&M UNIVERSITY
4900 MERIDIAN STREET
NORMAL, ALABAMA 35762

ADVANCING EFFORTS TOWARDS ZERO PHARMACEUTICAL WASTE UTILIZING THE ONE HEALTH APPROACH

NON-TECHNICAL SUMMARY: The project aims to enhance and strengthen the quality of 'One Health' outreach programs offered by the Alabama (AL) and Tennessee (TN) Cooperative Extension Systems/Services (CESs) to respond to human, animal and environmental health issues related to pharmaceuticals and personal care products (PPCPs) in the environment. 'One Health' can be defined as a broad encompassing field where several disciplines contribute solutions to combating a universal problem. It unites environmentalists, human and animal health scientists, and other professionals to foster a better understanding of challenging issues and offers unique perspectives to assist in creative problem solving (Khan et al., 2013). Although it's not ultramodern, the approach is rarely utilized by CESs to address environmental problems. Clark Price, Deputy Chief of Mission from the U.S. Embassy in Armenia states, "Human health, animal health, and ecosystem health are inextricably linked" (Khan et al., 2013). No other issue is more central to this belief than that of excessive pharmaceuticals and personal care products (PPCPs) in the home and environment.The seriousness of this global issue is illustrated by EPA's identification of PPCP research as one of its top 14 short-term, cross-regional priorities and its formation of the Federal Inter-Agency Task Group on Pharmaceuticals in the Environment (PIE) (Mahoney, 2006; USEPA, 2006), and the alarming rates of prescription drug use and misuse. Although significant efforts are going into studying the potentially negative effects of PPCPs on public health (Daughton, 2010; Synder et al., 2003), it will be years before we attain any substantial results. To date, there is limited participation among minorities in local PIE initiatives, like the U.S. Drug Enforcement Administration's (DEA) National Drug Take-Back Initiative, which offers safe and responsible means of disposing of prescription (Rx) drugs (DOJ, 2016). Additionally, there is very little data available to assess why minority participation in PIE proactive measures is so minimal. Qualitative data has revealed a fear of being financially able to purchase up-to-date medicine in the future, and a lack of knowledge concerning PPCP societal and environmental impacts (SerPIE, 2014). Whatever the reason, drug use and/or misuse among young African Americans and Hispanics is rapidly rising (NIDA, 2015; Kopstein, 2003), and environmental pollution via pharmaceuticals is steadily increasing (Ramirez et al, 2009). Tremendous efforts are needed to improve environmental stewardship among those underrepresented populations that might be affected by poverty, illiteracy and other environmental factors (Benoit et al., 2015). Cases like the Flint, Michigan water crisis (Karimi and Tran, 2016) teaches us that as outreach educators we must apply a "precautionary approach" to risk management. For the most part, extension programs focused on PPCPs applying a 'One Health' approach are lacking and undeveloped at 1890 Universities. This project seeks to minimize PPCP impacts in Alabama and Tennessee utilizing the benefits of 'One Health'. Alabama and Tennessee lead the nation in most painkillers prescribed per person (Thompson, 2014) and that is problematic for communities and suggests a need for improvements in environmental and societal awareness among medical and educational professionals, agricultural producers, youth and the general public. Pharmacuticals in the Environment is a multidimensional problem and to combat it requires a nontraditional, multidisciplinary approach. Hence, development of the SerPIE-One Health Extension Program provides a platform for addressing multiple CBGP Priority Areas. Its impact will be far reaching, as it will reduce the quantities of Rx drugs entering our nation's waterways or being stockpiled in homes awaiting misuse or abuse; create solutions that lead to social transformation; and extend student-learning experiences in agricultural sciences. More importantly, it will serve as an outreach education model that is transferable and adaptable by other 1890 institutions. The approach is four-fold and aligns with EPA's strategy for addressing PPCPs in water. It entails 1) strengthening researched-based knowledge; 2) enhancing public understanding of PIE issues; 3) fostering partnerships that and promote stewardship opportunities; and 4) highlighting the need for increased regulatory action (EPA, 2015). The synergism achieved through this project will advance natural resource management for the 21st century and beyond by improving PPCP education, accelerating PPCP research discoveries, enhancing public health efficacy, and expanding scientific knowledge (Khan et al, 2013).

OBJECTIVES: The overall goal of this project is to enhance the capacity of the Alabama Cooperative Extension System's (ACES) Urban Affairs and New Nontraditional Programs (UANNP) unit at Alabama A&M University (AAMU) and the College of Agriculture, Human and Natural Sciences (CAHNS) Cooperative Extension Program (CEP) at Tennessee State University (TSU) CESs to provide 'One Health' programming that addresses human, animal and environmental safety issues related to PIE in an effort to achieve zero pharmaceutical waste. Currently, the Synergistic Efforts to Reduce Pharmaceuticals in the Environment (SerPIE) program is assimilated into the ACES Plan of Work and implemented via an Extension Team Project (ETP) in major metropolitan statistical areas (MSAs) throughout Alabama. Investigators will utilize a 'One Health' approach to augment SerPIE, creating the SerPIE-One Health Extension Program that links multiple disciplines and strengthens both AAMU and TSU CESs outreach capabilities. Therefore, the primary objective is to develop and build a multidisciplinary outreach program that fosters a greater understanding of PIE issues among underrepresented audiences and allows for creative problem solving through extension and outreach. The project will entail the following components:Component 1: Implementation of a questionnaire that accesses individuals' perceptions of PPCP and PIE issues and identifies barriers that impede their involvement in proactive efforts.Component II: Development of a 'One-Health' curriculum and resource toolkit that employs multidisciplinary "green strategies" to foster learning and reinforce PIE concepts.Component III: Develop a coalition to broaden collaborative linkages in establishing 'One Health' PIE initiatives that help individuals understand the safeguards germane to proper disposal of unwanted medicine.Component IV: Provide training forums for extension personnel and learning forums for at-risk clientele that lead to a healthier and safer Environment for All.Component V: Expansion of the PIE Prescreening Project: Phase II that provides baseline data for SerPIE-One Health and learning opportunities for underrepresented students.Component VI: SerPIE-ASEMP II: Expansion of the Agricultural Science and Extension Mentorship Program (ASEMP) that encourages youth to enter into science and Extension professions that focus on concepts, like PIE.Component VII: Produce higher-level degree graduates to strengthen the Nation's food, agricultural, natural resources and human science professionals and scientists.