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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.

APPROACH: Ensuring measurable success throughout the project is important. The evaluation framework will consist of six interdependent steps: 1) engaging stakeholders; 2) describing the program; 3) focusing the evaluation design; 4) data collection; 5) analysis and interpretation; and 6) follow-up (CDC, 1999). A team of external and internal evaluators including the AAMU/TSU CES evaluation specialists will be assembled and IRB protocol will be adhered to. Benchmarks, input, output and impact indicators will be used to monitor progress and capture success. The design will include formative and summative processes to assess program effectiveness and value and the incorporation of ARS technology. Increases in participants' knowledge concerning PPCPs and 'One Health' concepts associated with PIE issues will be accessed utilizing pre/posttest measures. Post-delayed surveys will be sent 6 to 12 months later to measure behavior changes as demonstrated by adoption of BMPs. Impact surveys and questionnaires will also be utilized to improve the quality of programming. Specific evaluation elements [e.g., building program capacity in delivery and technology utilization (20% weight); learning outcomes (30% weight); increased knowledge gained (30% weight), assessment of participant behavioral changes (20% weight)] will be utilized. Measurable outcomes gauging program success and learning will be participant driven and include, but not be limited to the number of participants involved in training workshops, symposiums, and field days; participants utilizing SerPIE-One Health curricula; and the number of clientele adopting BMPs. The program will also be evaluated on efficacy of the workshops and the educational materials developed. An external evaluation committee, will convene annually to discuss relevant project outcomes. The project's progress will be evaluated yearly, and there will be an annual report that assesses benchmarks, the quality of content deliverables, and the program's capacity to effect change.The progress of SerPIE-One Health will be shared with the management team, the AAMU/TSU CESs and their beneficiary departments and colleges, as well as community and 1890 partners. Project results, impacts and outcomes will be published in USDA-NIFA annual reports, per the agency's guidelines, and CES state and federal reports. SerPIE-One Health promotional materials and internet tools will be shared with extension staff, stakeholders, farmers, animal producers, schools, community leaders and partnering organizations. AAMU and TSU are committed to disseminating project results; thus, results and products will be shared via educational workshops, seminars, conferences, expos, festivals, health fairs, and PPCP awareness campaigns. Products will also be shared through the publication of news articles, fact sheets, brochures, refereed publications, the WRR, and on eXtension, CES and social media websites. Information will also be presented at local, regional and national meetings.

PROGRESS: 2019/06 TO 2020/05
Target Audience:The target audiences reached included urban, rural, and nontraditional audiences, including youth, adults, and the elderly; especially those racial and ethnic minorities who are socially, economically, or educationally disadvantaged. Target audiences also included youth development counselors, K-12 teachers, producers, businesses (i.e., pharmacies, hospitals, medical and animal clinics), community organizations, and community groups. Changes/Problems:The COVID-19 pandemic has caused some delays in implementing the project, specifically as it relates to the minor research components. Nonetheless, efforts are underway to finalize the project. What opportunities for training and professional development has the project provided?As in previous years, the team participated in several professional development opportunities during the FY 2019-2020 program year. Two virtual in-service training sessions were held, including an in-service training by the technology consultant on 360-degree technology and augmented reality (June 26, 2020). Face-to-face and Zoom online sessions were held to discuss specifics of the SerPIE One Health program, its implementation as well as Agent and graduate student training. Team members attended the Annual Alabama Water Resources Symposium and Conference, September 4-5, 2019, in Orange Beach, AL. Team members also participated in the virtual International Conference on Life Sciences, Engineering and Technology (ILSET), July 15-19, 2020, and the 2020 SR-PLN, AEA, ASRED Joint Virtual Meeting, August 24-27, 2020. Team members engaged in numerous online trainings, including the Alabama Rivers Alliance's Wateris Life webinar series. Investigators attended AAMU-CALNs and TSU's CAHNS mandatory Principal Investigator meetings to understand reporting guidelines better. Like previous years, these opportunities were used to seek out research-based solutions to environmental and water quality issues that would enhance the development and delivery of the program. Upcoming professional development opportunities include the AEA 2021 System-wide Extension Conference in Orlando, Florida. How have the results been disseminated to communities of interest?In FY 2019-2020, program results were disseminated and/or shared with communities of interest using radio, television, newsletters, magazines, University bulletins and calendars, and online internet sources (i.e., Facebook, Twitter, ACES website, Blogs, etc.). Program outcomes were presented at local and national conferences, meetings, and symposiums. A poster entitled "Using a One Health Approach to Minimize Pharmaceutical Impacts in the Home and the Environment" was presented at the 2019 Annual Alabama Water Resources Symposium and Conference in Orange Beach, AL (September 4-5, 2019). A poster presentation entitled "The Presence of Pharmaceutical and Personal Care Products (PPCPs), Volatile Organic Compounds (VOCs), Petroleum Compounds and Contaminants of Emerging Concern (CECs) in the Tennessee Watershed "was presented at the Towson University Honors College Celebration of Scholarship and Learning Forum in Towson, Maryland (September 27, 2019). An oral presentation entitled "Minimizing Pharmaceutical Impacts in the Home and the Environment Utilizing a One Health Approach' was accepted to the AEA 2020 System-wide Extension Conference in Orlando, Florida. However, the event was postponed and rescheduled for June 25-29, 2021, due to the COVID-19 pandemic. A scientific article entitled "Detection of Human Pharmaceuticals in the Surface Water of East Fork Stones River" was published in the Journal of Water Resources and Protection. Several PSAs were provided to reach communities of interest for the DEA National Prescription Drug Take-Back Day. Program impacts were highlighted in local newscasts and newspapers, newsletters, and in state and federal annual reports. Drug box dedication ceremonies were shared via newspaper, radio and social media. General educational information related to PPCPs and One Health were also shared via exhibits and demonstrations throughout the State. The team also disseminated an estimated 575 brochures, 420 publications, and 1515 flyers during programming efforts in FY 2019-2020. What do you plan to do during the next reporting period to accomplish the goals?Noting that COVID-19 pandemichas altered traditional modes of program delivery and implementation, virtual platforms will be significantly utilized. The next reporting period will include work aimed at completing SerPIE One Health Components I through VII. There will be continued training for Extension staff and students, strengthening of collaborative partnerships, continued participation in efforts like drug take-back programs, a lock-your-meds campaign, installation of permanent drug drop-off receptacles, and dissemination of SerPIE One Health Program educational information and outcomes. A particular focus will be placed on App development, completing the PIE Prescreening Project, completing the graduate student research work, finalizing the project, and publishing the results.

IMPACT: 2019/06 TO 2020/05
What was accomplished under these goals? In FY 2019-2020, the SerPIE One Health Program was implemented as an Extension Team Project (ETP) via the Alabama Cooperative Extension System (ACES). FourUrban Regional Extension Agents, one Statewide Specialist, one County Extension Coordinator, three Associate Professors, two full Professors, one graduate student, and one undergraduate student representing ten counties in Alabama and one county in Tennessee implemented over 22 activities, reaching an estimated 2880 program participants. Component I:A questionnaire to assess stakeholder perceptions of PPCP, PIE, and 'One Health' issues and their use of pharmaceutical best management practices (BMPs) or lack thereof is underway. It addresses demographics and utilizes a 5-point Likert type scale with statements receiving a weight of 1 (strongly disagree); 2 (disagree); 3(undecided); 4 (agree); and 5 (strongly agree). The results of the questionnaire will be shared in FY 2020-2021. Component II:The Web-based resource repository (WRR) was updated via the ACES website with publications, programs, and educational resources and expanded to include Biteable videos. Team members continued to utilize portable 3-D Enviroscape models, an interactive curriculum, and a drinking water quality video. The video was featured as a virtual drinking water demonstration resource for JT&A, Incorporated during theCOVID-19 pandemic. The video received 120 views, 27 resends, and had a 12.4% click rate. Component III:Partnerships with Spectra Careand Wellstone Behavioral Health have been enhanced and aim to increase PIE awareness among underrepresented populations. Coordinated efforts resulted in the collection of thousands of pounds of unwanted medicationand the establishment of five new permanent drug drop-off sites. The new locations include Decatur, Slocomb, Daleville, and Headland, AL. Several drug box dedication ceremonies were hosted throughout the State. Discussions also took place concerning installing new permanent drug boxes in Mobile and Rogersville, AL. A total of 7 drug take-back programs with ACES staff participation were conducted in FY 2019-2020. AAMU continued its drug take-back program in conjunction with DEA's National Medication Take Back Day, held on October 26, 2019. Other fall drug take-back events were held in conjunction with ACES's Senior Aging InitiativeConference, including events in Huntsville, AL (October 17, 2019) and Florence, AL (September 27, 2019). The DEA drug take-back event for April 25, 2020, was canceled due to the COVID-19 pandemic. One additional drug take-back event was held in conjunction with the 2020 Decatur Shred Day, yielding 378 pounds in unwanted and expired medicine, up 244% from 2019. Overall, the amount of PPCPs stockpiled in homes and fated for the environment was reduced drastically via the seven statewide drug take-back programs and twelve permanent drug drop-off receptacles installed throughout the State. Efforts yielded over 4000 pounds in pharmaceutical waste and, in turn, decreased the accessibility and potential misuse of drugs among adults and teens. This ultimately reduced the number of pharmaceuticals fated for our soil and water supplies. Component IV:Several webinars, demonstrations, exhibits, drug take-back initiatives and workshops were carried out this past year. Two virtual webinars entitled "PPCPs in the Home and Environment" (June 23, 2020) and "Effects of PPCPs on Society and the Environment" (July 25, 2020) were offered through the Environmental Education (EE) Virtual Webinar Series. A Camp Conservation for Teachers Virtual Webinar Series was offered on June 14-24, 2020. It provided environmental education resources and continuing education units (CEUs) for certified teachers. One Health workshops were also held throughout the State, including at the Purple for a Passion Alzheimer's Conference, November 14, 2019in Greenville, AL. Interactive demonstrations and/or exhibits were set up at the Moulton County Health Fair, November 13, 2019in Hartselle, AL; the 32nd Annual Alabama Water Resources Conference, September 4-5, 2019 in Orange Beach, AL, and the 13th Annual Georgia Pacific Water Ways Festival, October 6, 2019in Blakely, GA. Nearly 300 students, teachers, presenters, and volunteers visited Kolomoki Mounds State Park to participate. Interactive lessons were offered to highlight the numerous ways water influences the earth and all living things. Over 275 "Lock Your Meds" pledges were obtained by the team via a campaign with the 1890 Universities. Program outcomes revealed significant increases in knowledge and anticipated positive changes in behavior for the participants. Participants learned the benefits of properly disposing of PPCPs, how pharmaceuticals enter waterways, recommended BMPs, and the human, animal, and environmental health hazards associated with improperly disposing of medications. The majority of the participants surveyed stated that they were able to achieve an environmental expectation of protecting the environment from pharmaceutical drug contamination and a social expectation of providing a drug-free, safer, and securer home for their family. Overall, the reduction in PPCPs resulted in improved social, economic, and environmental conditions for Extension's clientele. Component V:All sampling equipment and personal protective equipment (PPE) was obtained for Phase II of the PIE Prescreening Project, which will occur in fall 2020 as a result of COVID-19. It will involve quantifying PPCPs in aquatic streams and alluvial soils in AL and TN and a visual site assessment at each location. All samples, including quality controls, will be collected based on USEPA and USGS sampling protocols. After collection, the samples will be iced, shipped overnight via courier, and analyzed using HPLC/MS/MS and HRGC/HRMS, next-generation analytical techniques (USEPA, 2009). The experimental analysis will be performed by Weck Laboratories in City of Industry, CA, and include test runs for steroids and hormones (i.e., 17b-estradiol, etc.) and PPCPs (i.e., caffeine, etc.). Component VI:Work is currently underway to publish the findings from SerPIE-ASEMP II. Mentee evaluations revealed significant knowledge gains concerning PPCP issues and increased interest in Extension and Science careers. SerPIE- ASEMP II was held June 3 through July 15, 2019. It consisted of a nationwide search targeting undergraduate STEM majors, with a minimum GPA of 3.0/4.0. Eight students learned first-hand the responsibilities of serving the community-at-large and the importance of protecting human, animal and environmental health.The mentees were engaged in hands-on field, classroom, and laboratory exercises. They participated in workshops, service learning projects, and site visits. They also utilized an ELISA test kit (Abraxis, Inc.) to detect levels of carbamazepine and sulfamethoxazole in the East Fork Stones and Cumberland Rivers of southern Tennessee. The program culminated with an intensive 3-day workshopat the Alabama 4-H Center in Columbiana, AL. Component VII:Work continued towards the graduate project entitled "Detection and Quantification of Pharmaceuticals in Surface Water of Rural and Urban sub-watersheds." Sample collection, processing, and analysis were recently completed. However, the process was greatly impacted by the COVID-19 pandemic, which led to a prolonged and transformative disruption of the student's research. The student's work was also significantly impeded by the power outage last fall resulting from the EF-3 tornado that struck the campus of Tennessee State University. With the reopening of the University of Georgia, the student recently traveled to the University[i.e., collaborating entity] to complete PPCP sample analysis. Significant progress has been made writing up portions of the research work and finalizing other graduate program requirements. The tentative defense date is scheduled for October 2020.

PUBLICATIONS (not previously reported): 2019/06 TO 2020/05
1. Type: Websites Status: Published Year Published: 2020 Citation: https://www.aces.edu/blog/topics/products-programs-urban/serpie-web%E2%80%90bas ed-repository/
2. Type: Other Status: Published Year Published: 2019 Citation: https://www.aces.edu/blog/topics/news/huntsville-gets-new-prescription-drug-dro p-boxes/
3. Type: Websites Status: Published Year Published: 2020 Citation: https://www.aces.edu/event/camp-conservation-for-teachers-a-virtual-workshop-se ries-3/
4. Type: Other Status: Published Year Published: 2019 Citation: Karnita Garner. 2019. Synergistic Efforts to Reduce Pharmaceuticals in the Environment. Alabama Cooperative Extension System. November UNP2064
5. Type: Other Status: Published Year Published: 2019 Citation: Emily Edwards. 2019. Prescription drug take back box dedication. The Southeast Sun. Retrevied Nov 13, 2019. http://www.southeastsun.com/daleville/article b76347e2-0628-11ea-be22-f33ac1611 f0b.html
6. Type: Websites Status: Published Year Published: 2020 Citation: https://www.aces.edu/blog/topics/natural-resources-urban/environmental-educatio n-virtual-webinar-series/
7. Type: Journal Articles Status: Published Year Published: 2020 Citation: Kaur, Ravneet, Anonya Akuley-Amenyenu, Karnita G. Garner, and Sam O. Dennis. âDetection of Human Pharmaceuticals in the Surface Water of East Fork Stones River,â Journal of Water Resource and Protection, no. 12, (2020):240-259. https://www.scirp.org/pdf/jwarp 2020031313272976.pdf.
8. Type: Other Status: Published Year Published: 2020 Citation: Karnita Garner, âIs your drinking water safe,â Alabama Cooperative Extension System, accessed July 21, 2020. https://www.aces.edu/blog/topics/natural-resources-urban/is-your-drinking-water -safe/.
9. Type: Other Status: Published Year Published: 2019 Citation: https://www.headlandalabama.org/departments/public-safety/police/477-headland-p d-drug-take-back-program
10. Type: Other Status: Published Year Published: 2019 Citation: https://allevents.in/headland/headland-prescription-drug-drop-box-dedication/20 0018267621338
11. Type: Other Status: Published Year Published: 2019 Citation: https://www.facebook.com/events/headland-police-department-chief-mark-d-jones/h eadland-prescription-drug-drop-box-dedication/2534167666870309/
12. Type: Other Status: Published Year Published: 2020 Citation: https://www.aces.edu/blog/topics/home-family-urban/water-you-doing-water-usage- and-conservation/
13. Type: Other Status: Published Year Published: 2020 Citation: https://www.aces.edu/blog/topics/news/shred-day-events-important-for-communitie s/
14. Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Allyson Shabel, Karnita Garner, Phillip Carter, Roosevelt Robinson, Jack Lecroy and Paul Okweye. Using a One Health Approach to Minimize Pharmaceutical Impacts in the Home and the Environment. In Proceedings of the Annual Alabama Water Resources Symposium and Conference. September 4-5, 2019. Orange Beach, AL
15. Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Zari McCullers, MacKenzie Hutchinson, Paul Okweye, and Karnita Garner. The Presence of Pharmaceutical and Personal Care Products (PPCPs), Volatile Organic Compounds (VOCs), Petroleum Compounds and Contaminants of Emerging Concern (CECs) in the Tennessee Watershed. In Proceedings of the Towson University Honors College Celebration of Scholarship and Learning Forum. September 7, 2019. Towson, Maryland

PROGRESS: 2017/06/01 TO 2018/05/31
Target Audience:The target audiences reached included urban, rural and nontraditional audiences, including youth, adults and elderly; especially those racial and ethnic minorities who are socially, economically, or educationally disadvantaged. Target audiences also included youth development counselors, farmers and businesses (i.e., pharmacies, hospitals, medical and animal clinics), community organizations and community groups. Changes/Problems:One Co-PI is no longer with Alabama A&M University. Actions have been to taken to replace that person with another qualified individual who has experience working in this area. The new Co-Investigator will assist with the implementation of the Agricultural Science and Extension Mentorship Program and other educational aspects of this project.The M.S. student proposed to receive experiential training is now a PhD candidate as a result of extenuating circumstances related to the award timeline. What opportunities for training and professional development has the project provided?A total of two in-service training sessions (one coupled with a Mobile Delta Coastal Ecosystems Tour on June 20, 2017) and five planning meetings were conducted during the program year. These face-to-face and Zoom online sessions were held to discuss details of the SerPIE One Health program, its implementation, and to train Agents on technology such as augmented reality and 360-degree video as well as program delivery. The team participated in several professional development opportunities; they included attendance at statewide and multistate professional development activities including the National Urban Extension Conference on May 8-11, 2017 in St. Paul, MN; the Alabama A&M University Annual STEM Day on April 13, 2018 in Huntsville, AL; the 2017 Emerging Contaminants in the Aquatic Environment Conference on May 31 -June 1, 2017 inChampaign, IL; the AMRV RC&D General Council Meeting on July 27, 2017 in Trinity, AL; the AMRV RC&D Annual Meetingon October 26, 2017in Guntersville, AL; the Professional Development Sustainability Summit Conference on January 27, 2018 in Mobile, AL. These opportunities were used to seek out research-based solutions to environmental and water quality issues that would enhance the development and delivery of the One-Health SerPIE Program. Investigators also attended AAMU-CALNs and TSU's CAHNS mandatory Principal Investigator meetings to gain a better understanding of reporting guidelines for financial, progress and final NIFA reports. The team has collectively begun participating in a series of Extension Opioid Programming Webinars offered through the Extension Opioid Crisis Response Workgroup. The webinars share Extension substance abuse programming that could be used to address the growing opioid crisis, including program targets, costs and adoption strategies. The webinars are as follows: Community-Based Opioid Awareness Program (May 24, 2018); Life Skills Training Program (May 29, 2018); Generation Rx (May 29, 2018); Mental Health First Aid: Adult and Youth Mental Health First Aid (May 30, 2018); Community Assessment to Promote Behavioral Health Planning and Evaluation (CAPE) (May 30, 2018); Strengthening Families Program 10-14 (June 1, 2018); and PROSPER (Date and Time: TBD). Upcoming professional development opportunities provided as a result of this project include the 2018 Emerging Contaminants in the Aquatic Environment Conference and the 2018 Southern & 1890s Urban Extension Conference. How have the results been disseminated to communities of interest?Results from the SerPIE One Health activities were disseminated and/or shared with communities of interest using radio, television, newsletters, magazines, University bulletins, and internet online sources (i.e., Facebook, Twitter, ACES website, Blogs, etc.). Program outcomes were presented at local and national conferences, meetings, and symposiums. An oral presentation entitled "Assessment of pharmaceuticals and polycyclic aromatic hydrocarbon pollutants in Flint Creek and the Flint River watersheds" was delivered at the 2017 Emerging Contaminants in the Aquatic Environment Conference on May 31-June 1 in Champaign, Illinois. An oral presentation entitled "The SerPIE - One Health Initiative: Enabling Alabama's citizens to safeguard their homes and the environment from pharmaceutical wastes" and a poster presentation entitled "Addressing Contaminants of Emerging Concern (CECs) through the SerPIE-ASEMP for Undergraduates" was presented at the Association of Natural Resources Extension Professionals (ANREP) Conference on May 29 - June 3 in Biloxi, MS. Educational information related to veterinary pharmaceuticals was shared at via a statewide 4-part workshop series entitled "Health Management Workshop for Sheep & Goat, March 3 - May 5, 2018. A radio interview on pharmaceuticals and personal care products (PPCPs) was conducted on with WJAB 90.0 FM on April 9, 2018. Multiples PSAs were provided to reach communities of interest for the DEA National Prescription Drug Take Back Day, including a PSA on April 11, 2018 with WLRH, 89.3 FM. Impacts of the drug take-back programs conducted have been highlighted in local news casts and newspapers, newsletters, and in state and federal annual reports. What do you plan to do during the next reporting period to accomplish the goals?The next reporting period will include the coordination and hosting of a One Health Symposium for Sheep & Goat Production at the Perdido Beach Resort in Orange Beach, AL, August 24-25, 2018. Symposium topics will entail minimization of zoonotic diseases and medicine usage, natural resource conservation best management practices (BMPs), and application of proper techniques for disposing of unwanted, expired veterinary medicines.Work will continue towards completion of SerPIE One Health Components 1 through VII, with special focus on expansion of the PIE Prescreening Project andPhase II and the Agricultural Science and Extension Mentorship Program (ASEMP) II. There will be continued training for Extension staff; development and training on technology components (i.e., augmented reality and 360-degree video); strengthening of collaborative partnerships; continued participation in efforts like drug take-back programs; installation of permanent drug drop-off receptacles, and dissemination of SerPIE One Health Program educational information and outcomes. Upcoming presentations include an oral presentation entitled the "Incidence of pharmaceuticals in surface water of an urbanizing watershed" at the 2018 Emerging Contaminants in the Aquatic Environment Conference on June 5-6, 2018 in Champaign, Illinois; a poster presentation entitled "One Health and Environmental Management in Meat Goat Herds" and an oral presentation entitled "Advancing Efforts Towards Zero Pharmaceutical Waste Utilizing The One Health Approach" at the 2018 Southern & 1890s Urban Extension Conference, August 13-15 in Chattanooga, TN. The team also disseminated an estimated 2240 brochures, 856 publications, and 2565flyers during programming efforts in FY 2017-2018.

IMPACT: 2017/06/01 TO 2018/05/31
What was accomplished under these goals? In FY 2017-2018, the SerPIE One Health Program was implemented as an Extension Team Project (ETP) via ACES. Six UREAs, two Statewide Specialists, two Associate Professors, two Professors, one graduate and one undergraduate student representing eleven counties in Alabama and Tennessee carried out 56 activities with 58 contact reports for a total of 2673 traceable contacts. Component I: A questionnaire to access stakeholder perceptions of PPCP, PIE and 'One Health' issues and their use of BMPs has been designed. It addresses demographics and utilizes a 5-point Likert-type scale with statements receiving a weight of 1 (strongly disagree); 2 (disagree); 3(undecided); 4(agree); and 5 (strongly agree). Results of the questionnaire will be shared in FY 2018-2019. Component II: Team members are utilizing portable 3-D Enviroscape Models along with a hands-on curriculum and two newly developed PPCPs videos. The curriculum and videos demonstratehow PPCPs enter the waste water treatment cycle as well as how they enter surface and groundwater. Efforts are underway to expand the existing curriculum and SerPIE Web-Based Resource Repository (WRR) by adding information from multiple disciplines and elements like infographics andpodcasts. The current SerPIE Extension and Science Video Resource Library is also being updated with new digital media materials. Component III: Efforts have begun to develop a coalition that broadens collaborative linkages in establishing 'One Health' PIE initiatives and maximizes outreach efforts. New partnerships aimed at increasing PIE awareness among underrepresented populations include those with Wellstone Mental Health, the AAMU Health and Counseling Center, and the AAMU and TSU Departments of Public Safety, as well as continued partnerships with law enforcement. Coordinated efforts have resulted in the establishment of four permanent secure PPCP drop-off sites in Alabama that utilize MedReturn courier systems or similar systems. They include Huntsville, Dothan, Geneva and Eufaula, AL; these outcomes were recognized with dedication ceremonies. To date, over 280 poundsof unwanted medicines have been collected via these courier systems;https://www.mainstreetfamilycare.com/drug-take-back-box-placed-eufaula- pd/ A total of ten drug take-back programs with ACES staff participation were conducted in FY 2017 alone. Alabama A&M University also held its first drug take-back program, collecting 40 poundsof pharmaceuticals on April 28, 2018 from 9:00 am to 12 noon. Other partners in the drug take-back initiative included police in Mobile, Morganand Houston counties. Approximately 65 cars dropped off 524 pounds of medication at one of five locations in Huntsville, AL; giving Madison county of total of 1,304 pounds for its April 28th collection. The majority of the medicines collected were prescription drugs, followed by over-the-counter (OTC) medicines. The types of PPCPs collected included tablets, liquids and ointments. Approximately 24,000 pounds have been collected since the first drug take-back event in Madison county. The drug take-backs were advertised using online resources, TV and radio. Strides were also made between TSU investigators and their local police department to collaborate in upcoming Drug Take-Back Initiatives.In summary, the amount of PPCPs stockpiled in homes and fated for the environment was drastically reduced; in turn reducing the accessibility and potential misuse/abuse of drugs among adults and teens and decreasing the amount of pharmaceuticals fated for our water supplies. Overall, the reduction in PPCPs resulted in improved social, economic and environmental conditions for Extension's clientele. Component IV: Fifty-three workshops, demonstrations, exhibits, and drug take-back initiatives were carried out in FY 2017-2018. The events provided training forums for extension personnel and learning forums for at-risk clientele. Program outcomes for the workshops revealed significant increases in knowledge and anticipated positive changes in behavior for the participants. Farmers and small ruminant producers participated in a 4-part workshop series coupled with on-farm demonstrations entitled "Health Management Workshop for Sheep and Goat in Madison, Jackson, Houston, and Talladega counties March 3rd through May 5th of 2018. A total of 56 surveys were recovered represented by: 28 (50%) men, 28 (50%) women; 6 (11%) African-Americans, 49 (87%) Caucasians, 1 Native-American and 1 Asian. Results revealed increased knowledge of the hazards associated with improperly disposing of unwanted veterinary medications among participants. Workshops focusing on impacts of pharmaceuticals were also conducted in Mobile, Decatur,Dothanand Montgomery, AL. SerPIE One Health Interactive demonstrations and/or exhibits were setup at the following events: the 31st Annual Alabama Water Resources Conference, Sept. 7-8, 2017 in Orange Beach, AL; the SAI Conference, September 9, 2017 in Florence, AL; ACES Career Exploration Day for NACEE students, June 14, 2017 in Huntsville, Al; Earth Day at Hays Preserve, April 21, 2018 in Huntsville, AL; the Alabama Rural Water Conference, March 18-21, 2018 in Mobile, AL;Mount Hope Senior Center, November 1, 2017 and the NARCOG Health Fair (November 14, 2017); both in Moulton, AL. Component V: Planning has begun for Phase II of the PIE Prescreening Project which will occur in 2019, and involve quantifying levels of PPCPs in aquatic streams and alluvial soils in AL and TN and visual site assessments. The study area will include 24 AL sites and newTN sites that reflect the geology and hydrology indicative of the areas. After collection, the samples will be iced, shipped overnight via courier, and analyzed using HPLC/MS/MS and HRGC/HRMS. The experimental analysis will be performed by Weck Laboratories in City of Industry, CA and will include test runs for steroids and hormonesand PPCPs. A ProDSS Handheld Sonde with GPS and Manta 2TM multi-probe have been purchased to perform in-situ water measurements. Component VI: The guidelines and selection procedures for the Agricultural Science Extension Mentorship Program (ASEMP) II are being modified and the program will be offered in the summer of 2019. The program is designed to build Extension's multicultural capacity, by orienting underrepresented students towards Science and Extension careers. Advisors of complimentary institutionalized programs like the NSF-REU program are being consulted and utilized in the modification process. The program will consist of a nationwide search with advertisement online and via social media. The program will last eight weeks and offer eight undergraduate students an opportunity to explore Science and Extension professions that focus on concepts, like PIE. The program will culminate with formal presentations, submission of a journal, and a final written report summarizing their experiential learning experience. The mentees will be evaluated and assessed based on desired learning outcomes. Component VII: Multiple advisor/advisee meetings took place in FY 2017-2018 in the Dept. of Agricultural and Environmental Sciences at TSU in order to lay the foundation for a graduate research/extension project; the project has been fully developed. Entitled "Detection and Quantification of Pharmaceuticals in Surface Water of Rural and Urban sub-watersheds" this project offers experiential training for the doctoral graduate student. The proposal was presented and accepted by a five-member graduate panel on April 18, 2018 and submitted to the TSU School of Graduate Studies for approval. The student will travel to the University of Georgia [i.e., collaborating entity] to gain experience in PPCP sample analysis. A timeline has been developed to ensure completion of the project's objectives.

PUBLICATIONS: 2017/06/01 TO 2018/05/31
1. Type: Conference Papers and Presentations Status: Published Year Published: 2018 Citation: Shabel, A., D. Heubach, K. Garner, P. Okweye, P. Carter, R. Robinson, J. LeCroy, S. Dennis, M. Leite-Browning, S. Hopkinson, and R. Browning. 2018. The SerPIE - One Health Initiative: Enabling Alabama?s citizens to safeguard their homes and the environment from pharmaceutical wastes. In Proceedings of the Association of Natural Resources Extension Professionals (ANREP) Conference, May 29 - June 3, Biloxi, MS.
2. Type: Other Status: Published Year Published: 2018 Citation: Garner, K., P. Okweye, L. Kammin, S. Zach and S. Hopkinson. 2018. Utilizing a One Health Approach to Achieve Zero Pharmaceutical Waste. SerPIE One Health Conference on Pharmaceutical and Personal Care Products Conference Proceedings. UNP. 2132.
3. Type: Conference Papers and Presentations Status: Awaiting Publication Year Published: 2018 Citation: K. Ravneet , A. Amenyenu, K. Garner, P. Okweye and S. Dennis. 2018. Incidence of pharmaceuticals in surface water of an urbanizing watershed. In Proceedings of the Emerging Contaminants in the Aquatic Environment Conference, June 5-6, Champaign, Illinois.
4. Type: Conference Papers and Presentations Status: Under Review Year Published: 2018 Citation: Leite-Browning, M. and K. Garner. 2018. One Health and Environmental Management in Meat Goat Herds. In Proceedings of Southern & 1890s Urban Extension Conference, August 13-15, Chattanooga, TN.
5. Type: Conference Papers and Presentations Status: Under Review Year Published: 2018 Citation: K. Garner, P. Okweye, A. Shabel, D. Heubach, P. Carter, R. Robinson, S. Dennis, J. LeCroy, M. Leite-Browning, S. Hopkinson, and R. Browning. 2018. Advancing Efforts Towards Zero Pharmaceutical Waste Utilizing The One Health Approach. In Proceedings of Southern & 1890s Urban Extension Conference, August 13-15, Chattanooga, TN.
6. Type: Conference Papers and Presentations Status: Published Year Published: 2018 Citation: K. Garner, P. Okweye, A. Shabel, D. Heubach, P. Carter, R. Robinson, S. Dennis, J. LeCroy, M. Leite-Browning, S. Hopkinson, and R. Browning. 2018. Addressing Contaminants of Emerging Concern (CECs) through the SerPIE-ASEMP for Undergraduates. 2018. In Proceedings of the Association of Natural Resources Extension Professionals (ANREP) Conference, May 29 - June 3, Biloxi, MS.
7. Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: K. Garner, P. Okweye, A. Shabel, D. Heubach, P. Carter, R. Robinson, S. Dennis, D. Heubach, M. Leite-Browning, S. Hopkinson, and R. Browning. 2017. Advancing PPCP education and outreach through the SerPIE Agricultural Science and Extension Mentorship Program (ASEMP). In Proceedings of the Emerging Contaminants in the Aquatic Environment Conference, May 31-June 1, Champaign, IL.
8. Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: P. Okweye, K. Garner, and S. Dennis. 2017. Assessment of pharmaceuticals and polycyclic aromatic hydrocarbon pollutants in Flint Creek and the Flint River watersheds." In Proceedings of the Emerging Contaminants in the Aquatic Environment Conference, May 31-June 1, Champaign, IL.
9. Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: D. Heubach, K. Garner, P. Okweye, A. Shabel, P. Carter, R. Robinson, S. Dennis, D. Heubach, M. Leite-Browning, S. Hopkinson, and R. Browning. 2017. The SerPIE -One Health Program: Implementing strategies to reduce the presence of pharmaceutical waste in the home and environment." In Proceedings of the Emerging Contaminants in the Aquatic Environment Conference, May 31-June 1, Champaign, IL.
10. Type: Other Status: Published Year Published: 2018 Citation: Public Service Annoucements http://news.aces.edu/blog/2018/02/26/extension-offers-statewide-health-manageme nt-workshops-for-sheep-and-goats/ http://www.aces.edu/urban/documents/ReleaseforDrugTakeBack2018.pdf http://www.aces.edu/urban/documents/ReleaseforOneHealthSymposium2018.pdf Brochures/Digital Brochures http://www.aces.edu/urban/documents/OneHealthSymposiumSheepGoatDigitalBrochure i.pdf http://www.aces.edu/urban/documents/OneHealthSheepGoatSymposium.pdf