Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
June 2, 2009
1:00 p.m. – 4:00 p.m.
Snelling Office Park
Red River Room
1645 Energy Park Drive
St. Paul, Minnesota
Meeting agenda
Minnesota Department of Health
Environmental Health Tracking and Biomonitoring Advisory Panel Meeting
June 2, 2009
1:00 p.m. – 4:00 p.m.
Red River Room at Snelling Office Park
1645 Energy Park Drive, St. Paul, MN
Item type/Anticipated outcome
Time
Agenda item
Presenter(s)
1:00
Welcome and
Introductions
Beth Baker, Chair
1:05
East Metro PFC
Biomonitoring Project:
Preliminary Results
Adrienne Kari
Carin Huset
Tannie Eshenaur
Discussion item.
Staff will provide a brief overview of the PFC
pilot project results and plans for
disseminating the results to the study
community and the general public. Panel
members are invited to provide feedback on
the analyses; to make recommendations for
communicating the findings; and to make
recommendations for further action based on
the pilot study results.
2:05
Biomonitoring Project
updates:
• Minneapolis
Children’s Arsenic
Study
• Lake Superior
Mercury
• Riverside Prenatal
• Laboratory Funding
Opportunity
Various staff
Information sharing.
2:10
Panel members are invited to ask questions or
provide input on any of these items.
Break
i
2:25
2:30
Tracking Project updates: Various staff
• Data Reports
• Communications and
Outreach
• Public Data Portal
• CDC National
Program
Air Quality and Health
Data Linkage Project
Information sharing.
Panel members are invited to ask questions or
provide input on any of these items.
Jean Johnson
Chuck Stroebel
Information sharing.
Panel members are invited to ask questions or
provide input on future ideas for data linkage
projects with EPHT data.
2:45
3:55
Biomonitoring
Strategies: Planning for
a long-term, sustainable
state-based program
Barb Deming
Jean Johnson
Discussion Item
Staff will review planning progress to date.
Barb Deming will lead the panel in follow-up
discussion to elicit panel members responses
to a set of questions designed to further the
development of recommendations for a future
program.
New business
Discussion Item
The chair will invite panel members to
suggest topics for future discussion.
4:00
Adjourn
Mark your calendars – Upcoming meeting dates
Tuesday, September 15, 2009
Tuesday, December 8, 2009
Tuesday, March 9, 2010
Tuesday, June 8, 2010
All meetings will be held from 1-4 pm and will take place at
MDH’s Snelling Office Park location at 1645 Energy Park Drive.
ii
Meeting Materials for June 2, 2009
Environmental Health Tracking & Biomonitoring Advisory Panel
Table of Contents
Agenda........................................................................................................................................... i
Table of contents ...................................................................................................................... iii
Materials related to specific agenda items
East Metro PFC Biomonitoring Study
Section overview: East Metro PFC Biomonitoring Study........................................................1
Participant Recruitment, Eligibility and Response for Oakdale Municipal
Water Community......................................................................................................................3
Participant Recruitment, Eligibility and Response for Lake Elmo/Cottage Grove Private Well
Water Community......................................................................................................................4
East Metro PFC Biomonitoring Study Preliminary Results Tables...........................................5
Biomonitoring Project Updates
Section overview: Biomonitoring Project Updates.................................................................19
Status Update: Minneapolis Children’s Arsenic Study ..........................................................21
Status Update: Mercury Study ................................................................................................22
Status Update: Riverside Prenatal Biomonitoring Study........................................................23
Status Update: Funding Opportunity - State-based Public Health Laboratory
Biomonitoring Program ...........................................................................................................24
Tracking Project Updates
Section overview: Tracking Project Updates...........................................................................25
Status Update: Tracking Data Reports....................................................................................27
Status Update: Tracking Communications Outreach..............................................................28
Status Update: Public Data Portal...........................................................................................29
Status Update: CDC National Program Tracking...................................................................31
Letter: Health Tracking Network and Laboratory Funding.....................................................33
Air Quality
Section overview: Exploring Data Linkages with Air Quality and
Health Outcomes Data .............................................................................................................37
Data Linkage Research Project: Measuring the Impacts of Particulate Matter Reductions by
Environmental Health Outcome Indicators .............................................................................39
Biomonitoring Strategies
Section overview: Biomonitoring Strategies for an Ongoing State-based Program................47
Biomonitoring Strategies Retreat Summary ............................................................................49
iii
General reference materials
Section overview: General reference materials .............................................................................55
NEW: EHTB advisory panel meeting summary (from March 10, 2009) ......................................57
EHTB advisory panel roster (revised) ...........................................................................................63
Biographical sketches of Advisory Panel members (revised) .......................................................65
EHTB steering committee roster ...................................................................................................69
EHTB inter-agency workgroup roster..............................................................................................71
Glossary of terms used in environmental health tracking and biomonitoring ...............................73
Acronyms used in environmental health tracking and biomonitoring...........................................77
EHTB statute (Minn. Statutes 144.995-144.998)....................................................................................... 79
iv
Section overview: East Metro PFC Biomonitoring Study
Included in this section is a draft summary of the preliminary analytical results of the
East Metro PFC Biomonitoring Project. The study design and methods are described in
previous Advisory Panel meeting materials. Serum specimen collection was completed
for 196 participants in early January 2009 and analysis by the MDH Public Health
Laboratory was completed in March 2009. Individual results were mailed out to
participants in February and March.
Following input from the EHTB Advisory Panel on these preliminary results, a final
technical report and a brief community report will be written. Community meetings will
be planned in the Oakdale, Lake Elmo and Cottage Grove area to present study findings
and announced in a press release. The community report will be mailed to study
participants in advance inviting them to join the community meetings.
This section contains the following information:
• Participant recruitment, eligibility, and response results
• Preliminary Results Tables:
A1-2. House Hold Survey Results
B1-2. Demographics and Questionnaire Responses of Study Participants
C1-C8. Biomonitoring Results and Comparison Values
• NHANES distributions for the three most prevalent PFCs.
• References
EHTB Biomonitoring Coordinator, Adrienne Kari, and Public Health Laboratory
Chemist, Carin Huset, will describe their analytical methods and results in a brief
presentation. Tannie Eshenaur will present the communications plan. Panel members are
invited to provide comments to address the following questions:
•
•
•
•
•
•
What are the most important findings?
Are the interpretations and conclusions appropriate?
Are there methodological limitations that should be emphasized?
Are there additional analyses of the data that should be pursued?
What specific methods would you recommend for effectively communicating
these results to the community and to the general public?
Are there any follow-up actions that you would recommend to the community or
to public health officials based on these results?
ACTION NEEDED: At this time, no formal action is needed by the advisory panel.
Panel members are invited to ask questions or provide input on any of these questions
during the designated time on the meeting agenda.
1
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2
Figure 1. Participant Recruitment, Eligibility and Response for
Oakdale Municipal Water Community
Households Identified from
Municipal Water Supply Billing
Records
N = 6655
The following is a flow chart
for the recruitment of 100
adults consuming water from
the Oakdale Municipal water
supply.
Random Sample of
Households from Municipal
Water Billing Records
N = 500
Response to Household
Surveys
N = 235
No Response to Household
Survey
N = 265
Number of individuals
identified through the
household survey
N = 460
Number of eligible
individuals
identified through
household survey
N = 415
Number of ineligible
individuals
identified through
household survey
N = 45
Number of individuals
randomly selected and
invited to participate
N = 154
Number of individuals that
declined to participate
N = 54
Number of individuals that
returned consent materials
N = 100
3
Number of individuals
that completed the PFC
Biomonitoring Project
N = 98
Figure 2: Participant Recruitment, Eligibility and Response for Lake
Elmo/Cottage Grove Private Well Water Community
Eligible Households with Well
Water Sampling Results exceeding
N = 169
No Response to Household
Survey
N = 59
Response to Household
Surveys
N = 110
Number of individuals
identified through the
household survey
N = 230
Number of eligible
individuals
identified through
household survey
N = 186
Number of individuals
randomly selected and
invited to participate
N = 149
Number of ineligible
individuals
identified through
household survey
N = 45
Number of individuals
that agreed to participate
N = 102
Number of individuals that
declined to participate
N = 47
4
Number of individuals
that completed the PFC
Biomonitoring Project
N = 98
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or
reproduce*
East Metro PFC Biomonitoring Study
Preliminary Results Tables
A1. House Hold Survey Results: Eligible Adults
*Each property/household identified either through random selection from the Oakdale
Municipal Water billing records or from the list of wells tested by the Environmental
Health division of the Minnesota Department of Health. The survey requested that
households provide information (name, date of birth, telephone number, length of
residence, gender, and for those on Oakdale Municipal water the number of years lived
in Oakdale) on each adult over the age of 20, who were residents prior to Jan. 1, 2005,
and who currently lived in the home.
A list of individuals was compiled from these returned surveys; the following table
describes basic demographic characteristics of the individuals eligible for the study.
Oakdale
Age
Residence Time in House
Length of Time lived in
Oakdale
Male
Female
Lake Elmo/Cottage Grove
Age
Residence Time in House
Male
N = 415
414
414
390
Mean
53.3
18.03
20.46
Min
20
4
3
Max
87
86
85
Skew
Normal
Log-Normal
Log-Normal
51.11
18.13
20
4
86
60
Normal
Log-Normal
196
215
N = 186
186
181
88
Female
89
Table 1. Demographics of Eligible Adults Indentified From Household Surveys
5
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
A2. Household Survey Results: Current Water Filtration and Treatment Used in Eligible Households
The survey sent to properties/households to determine if eligible individuals were present also asked questions in regards to current
drinking water sources and filtration practices in the home. The question in the survey is shown in the box below.
The following questions are about the current drinking water source used in the home.
1.
What, if any, water filter or treatment device(s) is your household currently using? (please check all that apply)
 none, no filter or treatment device used
 under the sink carbon filter*
 reverse osmosis (RO) system
 pitcher filter (i.e. Brita, Pur, etc.)
 whole house carbon filter*
 refrigerator filter
 kitchen faucet filter
 not sure
 none; use bottled water only
 other, please describe:________________________________________
*Carbon filter may be called a Granular Activated Carbon or GAC filter.
2. Do you know the recommended schedule for changing your water filter?
 Yes
No
If Yes: How often do you change it? _________________________________________________________________________
The following table describes the current water filtration or treatment practices reported in the survey. There were a number of
households that identified multiple filtration/treatment systems used.
Current Filtration/Treatment in Eligible Households
Multiple types used
Drinking water filtration/treatment responses
Bottled Water Only
Reverse Osmosis System
Granulated Activated Carbon Filter (whole House)
None – no filtration Device
6
Oakdale N= 225(%)
32 (14)
Lake Elmo/Cottage Grove N = 95(%)
24 (25)
40(18)
17(8)
3(1)
106(47)
8(8)
16(17)
20(21)
33(35)
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
B1. Demographics of Study Participants
From the eligible individuals identified on the returned household surveys 98 individuals in each
community were randomly selected, agreed to participate and completed the serum collection for the
biomonitoring pilot project.
Oakdale Municipal
Age
Residence Time in House
Length of Time lived in
Oakdale
Male
Female
N = 98
98
98
98
Lake Elmo/Cottage Grove
Age
Residence Time in House
Male
Female
N = 98
98
98
44
54
Combined by Gender
Male
Female
Combined by 3M
Employment
Worker
Non Worker
Mean
53.07
17.83
20.74
Min
25
4
3.5
Max
85
62
62
Skew
Normal
Log-Normal
Log-Normal
53.31
19.83
20
4
86
60
Normal
Log-Normal
44
54
Average
Average Length of
N = 196
Age Residence
88
53.8
19.4
108
53.3
18.6
30
166
59.1
52.5
7
21.3
18.6
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
B2. Questionnaire Responses of Study Participants
The 196 participants were asked a series of short questions about employment, water consumption habits, ethnicity/race, and health.
Questionnaire Variable N = 196
Employment
Have you ever worked at 3M?
Ever worked in PFC Research?
Ever worked in PFC production?
Responses:
Yes
30
3
2
No
166
27
28
Water
What type of water do you typically drink?
Unfiltered Tap
86
Filtered Tap
66
Bottled
43
Other
1
Filtration/Treatment
What type of water filter/treatment is used?
None
67
Whole House Carbon
23
Bottled
17
Sink Carbon
6
Kitchen Faucet
14
RO
17
Non-H White
187
Non-H Black
0
Hispanic
1
Asian American
3
Native American
1
Other
4
Very Good
97
Good
93
Bad
6
Very Bad
0
Ethnicity
How would you describe your ethnicity?
Health
How would you describe your health?
8
Pitcher Filter
14
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C1. PFOA – perfluorooctanoate- East Metro Biomonitoring Results and Comparison Values
Study and Population (Sample size)
Bio
Time period
Geometric Mean
Arithmetic Mean
Median
Range
ng/mL (ppb)
ng/mL (ppb)
ng/mL (ppb)
ng/mL (ppb)
15.4
22.5
16
1.6 – 177
Female (108)
14.4
21.7
15
1.6 - 152
Specimen
MDH E. Metro PFC Biomonitoring Pilot Project (N=196)
Serum
Oct 2008 – Jan
2009
Male (88)
16.6
23.4
17
3.0 - 177
Well Water Community (98)
13.6
21.9
13
1.6 - 177
Municipal Water Supply Community (98)
17.3
22.9
21
2 - 79
224.1
NA
28
0.25 – 22,412
Little Hocking, WV (N = 4,465)
Serum
2005 – 2006
197
Serum
2005 - 2006
NA
Serum
2003 – 2004
3.9 (3.6 – 4.3)
4.3
4.0
0.1 – 77.2
Female 3.5
Female 3.87
Female 3.6
0.1 – 45.9
Male 4.5
Male 4.79
Male 4.6
0.1 – 77.2
PFOA Levels in a Community (0 to >70 years of age)
Surrounding a Chemical Plant. C8 study1
Ohio River Valley (N = 64,251)
83
PFOA Levels in a Community Surrounding a Chemical Plant. C8
study2
US NHANES (N = 2,094)
PFOA was measured in 2,094 individuals (12 to > 60 years of age)
from a random sample of the United States Population in sampling
years 2003 - 20043
Red Cross Blood Donors (N = 600)
Plasma
2006
600 blood samples (20 - 69 years of age) from 6 Red Cross blood
centers (including the Twin Cities) were analyzed for PFCs in
20064
Germany (N; males = 103, females = 153)
Plasma
Oct – Nov 2006
A random sample of females (age 23 to 49) and males (age 18 –
69) from North Rhine – Westphalia Germany.5
Germany (N; Males = 101, females = 164)
Plasma
A random sample of individuals from Arnsberg, Germany, an area
with known PFC water contamination.6
Occupational Group (N=215)
Serum
Sept – Nov
2006
Serum
3.9
3.6
<1.0 – 28.1
Female 3.5
Female 3.1
< 1.0 – 11.9
Male 3.9
Male 4.4
Male 4.0
0.8 – 28.1
Female 3.2
Female 2.8
NA
NA
Male 6.4
Males 5.8
Female 23.4
Female 26.7
NA
Female 5.4 -99.7
Male 25.3
Male 28.5
1130
1780
NA
428
2000
Male 6.1 – 77.5
NA
3M production workers from the Decatur plant voluntarily had
PFC measurments completed during medical surveillance.7
Occupational Group (N = 1024)
3.4
Female 3.0
40 - 12700
2004
A group of Dupont workers volunteered to participate in a study
investigating levels of PFOA and lipid levels.8
9
189
5 – 9550
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C2. PFOA Analyses: Population Distribution Histograms
Combined Sub Groups –
60
25
50
20
40
P 15
e
r
c
e
n
t
10
P
e
r
c 30
e
n
t
20
5
10
0
0
10
30
50
70
90
110
130
150
170
0. 5
1
1. 5
2
2. 5
3
3. 5
4
4. 5
5
l ogPFOA
PFOA l evel
Oakdale – Municipal Water Supply Sub Group
35
30
30
25
25
20
P 20
e
r
c
e
n
t
15
P
e
r
c 15
e
n
t
10
10
5
5
0
0
6
18
30
42
54
66
78
0. 6
1. 2
1. 8
2. 4
PFOA l evel
3
3. 6
4. 2
l ogPFOA
Lake Elmo/Cottage Grove – Well Water Sub Group:
35
50
30
40
25
30
P 20
e
r
c
e
n
t
15
P
e
r
c
e
n
t
20
10
10
5
0
0
0
25
50
75
100
125
150
0. 3
175
0. 9
1. 5
2. 1
2. 7
l ogPFOA
PFOA l evel
10
3. 3
3. 9
4. 5
5. 1
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C3. PFOS – perfluorooctanesulfonate-East Metro Biomonitoring Results and Comparison Values
Study and Population (Sample size)
Bio
Time period
Geometric Mean
Arithmetic Mean
Median
Range
ng/mL (ppb)
ng/mL (ppb)
ng/mL (ppb)
ng/mL (ppb)
35.9
47.7
41
3.2 - 448
Female (108)
30.5
40.6
35
3.2 - 151
Male (88)
43.9
56.4
45.5
9.1 - 448
Well Water Community (98)
32.9
47.4
35
3.2 - 448
Municipal Water Supply Community (98)
39.3
48
43
3.9 - 166
20.7
23.9
29.9
0.3 – 435
Female 18.4
Female 21.6
Female 18.2
Female .3 – 406
Male 23.3
Male 26.1
Male 23.9
Male .3 - 435
14.5
16.9
14.2
<2.5 – 77.9
Female 12.3
Female 14.5
Female 11.9
Female < 2.5 – 77.9
Male 17.1
Male 19.3
Male 16.8
Male <2.5 – 62.4
Oct – Nov
2006
Female 5.5
Female 6.3
Female 5.4
NA
Male 10.1
Male 12.1
Male 10.5
Sept – Nov
2006
Female 5.8
Female 6.3
NA
Male 10.5
Male 11.8
440
800
Specimen
MDH E. Metro PFC Biomonitoring Pilot Project (N=196)
US NHANES (N = 2,094)
Serum
Serum
Oct 2008 –
Jan 2009
2003 - 2004
PFOS was measured in 2,094 individuals (12 to > 60 years of
age) from a random sample of the United States Population in
sampling years 2003 - 20043
Red Cross Blood Donors (N = 600)
Plasma
2006
600 blood samples (20 - 69 years of age) from 6 Red Cross
centers (including the Twin Cities) were analyzed for PFCs in
20064
Germany (N; males = 204, females = 317)
Plasma
A random sample of females (age 23 to 49) and males (age 18
– 69) from North Rhine – Westphalia Germany.5
Germany (N; Males = 101, females = 164)
Plasma
A random sample of individuals from Arnsberg, Germany, an
area with known PFC water contamination.6
Occupational Group (N=215)
Serum
Females 1.7 – 16.7
Males 2.7 – 36.2
2000
3M production workers from the Decatur plant voluntarily had
PFC measurements completed during medical surveillance.7
11
NA
10 - 7040
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C4. PFOS Data Analyses: Population Distribution Histograms
Combine SubGroups:
70
35
60
30
50
25
P
e 40
r
c
e
n
t 30
P
e 20
r
c
e
n
t 15
20
10
10
5
0
0
25
75
125
175
225
275
325
375
425
1. 2
1. 8
2. 4
3
PFOS l evel
3. 6
4. 2
4. 8
5. 4
6
l ogPFOS
Oakdale – Municipal Water Supply Sub Group:
35
45
40
30
35
25
30
P 20
e
r
c
e
n
t
15
P
25
e
r
c
e
n
t 20
15
10
10
5
5
0
0
12. 5
37. 5
62. 5
87. 5
112. 5
137. 5
162. 5
1. 5
2. 1
2. 7
3. 3
3. 9
4. 5
5. 1
4. 4
5. 2
6
l ogPFOS
PFOS l evel
Lake Elmo/Cottage Grove – Well Water Sub Group:
80
35
70
30
60
25
50
P 20
e
r
c
e
n
t
15
P
e
r
c 40
e
n
t
30
10
20
5
10
0
0
30
90
150
210
270
330
390
450
1. 2
PFOS l evel
2
2. 8
3. 6
l ogPFOS
12
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C5. PFHxS – perfluoroheaxanesulfonate- East Metro Biomonitoring Results and Comparison Values
Study and Population (Sample size)
Bio
Time period
Geometric Mean
Arithmetic Mean
Median
Range
ng/mL (ppb)
ng/mL (ppb)
ng/mL (ppb)
ng/mL (ppb)
8.4
14.8
8.9
0.32 – 316
Female (108)
7.0
13.1
7.4
0.32 – 316
Male (88)
10.6
16.8
10.5
1.7 - 270
Well Water Community (98)
8.3
17.1
7.5
0.37 - 316
Municipal Water Supply Community (98)
8.6
12.4
9.8
0.32 - 72
1.9
2.9
1.9
0.2 - 82
Female 1.7
Female 2.8
Female 2.9
Female 0.2 – 64.1
Male 2.2
Male 3.1
Male 3.3
Male 0.2 - 82
1.5
2.2
1.5
<0.5 – 28.1
Female 1.2
Female 1.6
Female 1.2
Female 0.7 – 1.8
Male 1.9
Male 2.9
Male 1.8
Male 1.2 – 2.8
Sept – Nov
2006
Female 1.1
Female 1.2
NA
Females <0.1 – 1.1
Male 2.5
Male 2.7
2002 - 2004
NA
182
Specimen
MDH E. Metro PFC Biomonitoring Pilot Project (N=196)
US NHANES (N = 2,094)
Serum
Serum
Oct 2008 –
Jan 2009
2003 - 2004
PFHxS was measured in 2,094 individuals (12 to > 60 years of
age) from a random sample of the United States Population in
sampling years 2003 - 20043
Red Cross Blood Donors (N = 600)
Plasma
2006
600 blood samples (20 -69 years of age) from 6 Red Cross
centers (including the Twin Cities)were analyzed for PFCs in
20064
Germany (N; Males = 101, females = 164)
Plasma
A random sample of individuals from Arnsberg, Germany, an
area with known PFC water contamination.6
Occupational Group (N=26)
Serum
3M production workers, 3 from the 3M Cottage Grove
chemical division, voluntarily had PFC measurments
completed to determine the half life of certain PFCs.9
13
Males 0.7 – 2.5
117
10 - 791
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C6. PFHxS Analyses: Population Distribution Histograms
Combined SubGroups:
45
100
40
80
35
30
60
P
e
r
c
e
n
t
P
e 25
r
c
e
n 20
t
40
15
10
20
5
0
0
15
45
75
105
135
165
195
225
255
285
- 0. 8
315
0
0. 8
1. 6
2. 4
3. 2
4
4. 8
5. 6
l ogPFHxS
PFHxS l evel
Oakdale – Municipal Water Supply Sub Group
45
50
40
40
35
30
30
P
25
e
r
c
e
n
t 20
P
e
r
c
e
n
t
20
15
10
10
5
0
0
0
10
20
30
40
50
60
- 0. 8
70
0
0. 8
1. 6
2. 4
3. 2
4
3. 5
4. 5
5. 5
l ogPFHxS
PFHxS l evel
Lake Elmo/Cottage Grove – Well Water Sub Group
40
100
35
80
30
25
60
P
e
r
c 20
e
n
t
P
e
r
c
e
n
t
40
15
10
20
5
0
0
0
50
100
150
200
250
- 0. 5
300
0. 5
1. 5
2. 5
l ogPFHxS
PFHxS l evel
14
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
C7. PFBA – Perfluorobutyrate- East Metro Biomonitoring Results and Comparison Values
Study and Population (sample size)
MDH E. Metro PFC Biomonitoring Pilot
Project (N=196)
Bio
Specimen
Time
Period
Serum
Oct 2008
–
Jan 2009
Female (108)
Male (88)
Well Water Community (98)
Municipal Water Supply Community (98)
Maximum
Value
50 percentile
75 percentile
95 percentile
99 percentile
Minimum
Value
< LOD*
.135
.68
5.6
< LOD*
8.5
<LOD*
<LOD*
.14
.12
.68
.42
5.6
.53
<LOD*
<LOD*
8.5
<LOD*
<LOD*
.11
.15
1.0
.52
5.6
8.5
<LOD*
<LOD*
5.6
th
th
th
th
1.1
8.5
Occupational Group (N = 28)
Serum
2006
8.0
NA
NA
NA
<0.5
56.7
PFBA and PFBS were measured in employees
of the Cordova electronic materials factory.10
*LOD is the limit of detection
C8. PFBS – Perfluorobutanesulfonate- East Metro Biomonitoring Results and Comparison Values
Study and Population (sample size)
MDH E. Metro PFC Biomonitoring Pilot
Project (N=196)
Bio
Specimen
Serum
Time
Period
Oct 2008
–
Jan 2009
Female (108)
Male (88)
Well Water Community (98)
Municipal Water Supply Community (98)
Occupational Group (N = 28)
Serum
2006
50th percentile
75th percentile
95th percentile
99th percentile
Minimum
Value
Maximum
Value
<LOD*
<LOD*
<LOD*
.16
<LOD*
.18
<LOD*
<LOD*
<LOD*
<LOD*
<LOD*
<LOD*
.15
.18
<LOD*
<LOD*
.15
.18
<LOD*
<LOD*
<LOD*
<LOD*
<LOD*
<LOD*
.18
.15
<LOD*
<LOD*
.18
.15
7.3
NA
NA
NA
0.5
128.0
PFBA and PFBS were measured in employees
of the Cordova electronic materials factory.10
*LOD is the limit of detection
Perfluorohexanoic acid (PFHxA) and perfluoro-n-pentanoic acid (PFPeA) were also analyzed for in all 196 serum samples collected from
the two east metro study groups. All measurements for the two chemicals were below the limit of detection for all 196 participants.
15
*DRAFT – Preliminary Data Analysis for Advisory Panel review. Please do not distribute, cite, or reproduce*
NHANES Distributions (PFCs are in ppb):
70
PFOA (perfluorooctanoate)
60
50
P
e
r
c
e
n
t
40
30
20
10
0
0
4
8
12
16
20
24
28
32
36
40
44
48
52
56
60
64
68
72
76
Per f l uor ooct anoi c aci d
70
PFOS (perfluorooctanesulfonate)
60
50
P
e
r
c
e
n
t
40
30
20
10
0
0
25
50
75
100
125
150
175
200
225
250
275
300
325
350
375
400
425
Per f l uor ooct ane sul f oni c aci d
80
70
PFHxS (perfluorohaxanesulfonate)
60
50
P
e
r
c
e
n
t
40
30
20
10
0
2
6
10
14
18
22
26
30
34
38
42
46
50
54
Per f l uor ohexane sul f oni c aci d
16
58
62
66
70
74
78
82
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Steenland K FT, Savitz D. Status Report: Factors Associated with PFOA Levels in a community
surrounding a chemical plant. 2008.
Steenland K JC, MacNeil J, Lally C, Ducatman A, Vieira V, and Fletcher T. Predictors of PFOA
Levels in a Community Surrounding a Chemical Plant. Environ Health Perspect. In Press ed. Volume
In Press, 2009.
Calafat AM, Wong LY, Kuklenyik Z, Reidy JA, Needham LL. Polyfluoroalkyl chemicals in the U.S.
population: data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004
and comparisons with NHANES 1999-2000. Environ Health Perspect. 2007 Nov;115(11):1596-602.
Olsen GW, Mair DC, Church TR, et al. Decline in perfluorooctanesulfonate and other
polyfluoroalkyl chemicals in American Red Cross adult blood donors, 2000-2006. Environ Sci
Technol. 2008 Jul 1;42(13):4989-95.
Wilhelm M, Angerer J, Fromme H, Holzer J. Contribution to the evaluation of reference values for
PFOA and PFOS in plasma of children and adults from Germany. Int J Hyg Environ Health. 2007
Dec 24.
Holzer J, Midasch O, Rauchfuss K, et al. Biomonitoring of perfluorinated compounds in children and
adults exposed to perfluorooctanoate-contaminated drinking water. Environ Health Perspect. 2008
May;116(5):651-7.
Olsen GW, Burris JM, Burlew MM, Mandel JH. Epidemiologic assessment of worker serum
perfluorooctanesulfonate (PFOS) and perfluorooctanoate (PFOA) concentrations and medical
surveillance examinations. J Occup Environ Med. 2003 Mar;45(3):260-70.
Sakr CJ, Kreckmann KH, Green JW, Gillies PJ, Reynolds JL, Leonard RC. Cross-sectional study of
lipids and liver enzymes related to a serum biomarker of exposure (ammonium perfluorooctanoate or
APFO) as part of a general health survey in a cohort of occupationally exposed workers. J Occup
Environ Med. 2007 Oct;49(10):1086-96.
Olsen GW, Burris JM, Ehresman DJ, et al. Half-life of serum elimination of
perfluorooctanesulfonate,perfluorohexanesulfonate, and perfluorooctanoate in retired fluorochemical
production workers. Environ Health Perspect. 2007 Sep;115(9):1298-305.
Olsen GW, Buehrer, B.D., Cox, R.L., Nunnally, M.C., and Ramm, K. H. Descriptive Analysis of
Perfluorobutyrate (PFBA) and Perfluorobutanesulfonate (PFBS) in Sera Collected in 2006 from 3M
Cordova Electronic Materials Factory Employees. St. Paul: 3M, 2007 July 30, 2007. Report No.:
Epidemiology, 220-6W-08. 1 - 15 p.
17
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18
Section overview: Biomonitoring Project updates
Given the limited time available for advisory panel meetings, updates on some items will be
provided to the panel as information items only. This information is intended to keep panel
members apprised of progress being made in program areas that are not a featured part of the
current meeting’s agenda and/or to alert panel members to items that will need to be discussed in
greater depth at a future meeting.
Included in this section of the meeting packet are written status updates on the following items:
•
Minneapolis Children’s Arsenic Study
•
Lake Superior Mercury Biomonitoring Study
•
Riverside Prenatal Biomonitoring Study
•
Funding Opportunities for Future Biomonitoring
ACTION NEEDED: At this time, no formal action is needed by the advisory panel. Panel
members are invited to ask questions or provide input on any of these topics during the
designated time on the meeting agenda.
19
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20
Status Update: Minneapolis Children’s Arsenic Study
(The Arsenic Pilot Biomonitoring Project)
The complete technical report for the Minneapolis Children’s Arsenic Study has been finalized
and is now available at: http://www.health.state.mn.us/divs/eh/tracking/arsenicfinalrept.pdf.
A community meeting was held April 27, 2009 at the Corcoran Community Center in South
Minneapolis. Study findings were presented to the community with time for questions and
feedback from the community for future use of the study results and for future biomonitoring
projects. The meeting was well attended by approximately 10-15 community members. Dr.
Nancy Baker and medical student, Emily Moody, attended to provide results on the Smiley’s
Clinic arsenic study as well as information on accessing medical care for arsenic-related
questions and concerns. In addition, representatives from the City of Minneapolis, EPA, MPCA,
and MDA were in attendance. Community representatives from the Phillips neighborhood
environmental organization requested, and MDH staff agreed, for staff to attend and present at
one of their community events in the near future.
A poster for the project has been accepted for presentation at the National Environmental Health
Association’s Annual Educational Conference and Exhibition and will be presented at the end of
June by project coordinator, Adrienne Kari.
21
Status Update: Mercury Project
As of May 1, 2009 written informed consent has been received for 347 participants; 32 of these
consents were received through local public health. The first batch of blood spots has been received
from Wisconsin. Mercury analysis of blood spots is expected to start in June.
The MDH Public Health Laboratory is continuing to optimize the method for analyzing newborn
blood spots for mercury. Tests are ongoing to validate the use of automated punchers, instead of the
hand punchers originally specified in the study design, in the newborn screening laboratories in
Minnesota and Wisconsin. To date, experiments show no mercury carry-over between blood spots
and blank filter paper and that punches obtained from the automated puncher in the Minnesota
newborn screening lab are statistically similar to those obtained using the hand punchers originally
designated for this project.
In March, Dr. Betsy Edhlund participated in a training session with Dr. Brian Wels of the University
of Iowa Hygienic Laboratory covering blood spot analysis techniques. She is incorporating some of
these techniques into the MDH method. The most significant change will be the adoption of a 96well plate as the sample holder in the autosampler. The use of 96-well plates instead of larger
centrifuge tubes for the samples allows for a smaller volume, 300 μL versus 1 mL. The main
advantage of the smaller volume is the need for only 2, instead of 4, blood spot punches. Because
some newborn screening cards have only a limited amount of residual blood, this allows for the
enrollment of more infants into the study. In addition, using a 96-well plate allows for an in-line
filtering step, which greatly reduces the possibility of clogging the instrument with filter paper
fibers.
There are still several studies that must be completed before analysis of samples from Lake Superior
basin newborns can begin. These include analyzing blank punches from the automated puncher in
the Wisconsin newborn screening lab to determine comparability to the Minnesota puncher and the
designated hand punchers. Also, the new products associated with using 96-well plates and filtering
the samples need to be tested for background mercury levels.
22
Status Update: Riverside Prenatal Biomonitoring
Dr Carin Huset, research scientist in the MDH Public Health Laboratory, has begun work
on the analysis of environmental phenols, including bisphenol A, benzophenone,
triclosan, methyl paraben, ethyl paraben, propyl paraben, and butyl paraben in urine. To
date, she has obtained standards, established instrument conditions, and has begun to
analyze controls and mock specimens. The method utilizes online solid phase extraction
and includes a deconjugation step to allow for the analysis of conjugated and
unconjugated species. Dr. Huset continues to work on internal validation of the analytical
method which was initially developed and published by CDC.
The complete study protocol and materials were developed by Adrienne Kari,
Biomonitoring Coordinator, for the collection of a urine sample from 90 pregnant women
who are currently enrolled in the Riverside Birth Study (RBS) in collaboration with study
investigators at the University of Minnesota. IRB approval was received from the
University of Minnesota for the ancillary project. The MDH IRB determined that the
project is exempt given that MDH will have no direct contact with participants and no
personal identifiers are received by MDH. RBS staff at the University of Minnesota have
enrolled over 100 women in their study. All recruitment materials and specimen
collection kits have been provided to the University study staff. The initial set of
recruitment letters will be mailed to eligible RBS participants (who have not already
given birth) in May.
23
Status Update: Funding Opportunity - State-based
Public Health Laboratory Biomonitoring Program
In February 2009, CDC released a Request for Applications (RFA) for “state-based
public health laboratory biomonitoring programs”. The application deadline was in April
2009, and awards should be announced on August 31, 2009. CDC anticipates one - three
awards. The purpose of the funding is to increase the capability and capacity of state
public health laboratories to conduct biomonitoring and thus assess human exposure to
environmental chemicals within their jurisdictions. Recipients cannot use funds for
research or clinical care. Funds can only be expended for reasonable program purposes,
including laboratory instrumentation and supplies, field operations necessary to obtain
biomonitoring samples, and essential related activities for training on the analytical
methods, analysis, and personnel.
An application, “Biomonitoring the Driftless Area of Iowa, Minnesota, and Wisconsin”,
was submitted jointly by these three state public health labs. The proposal is to measure
specific chemicals in blood and urine specimens collected from 300 residents of the
Driftless Area, which covers northeast Iowa, southeast Minnesota, and southwest
Wisconsin. From a public health standpoint, the Driftless Area (with Karst topography) is
of special interest because of the potential for polluted surface water to penetrate into the
groundwater. The biomonitoring project is to survey residents; most use groundwater,
and many use private drinking water wells.
If funds are awarded, the state public health laboratories in Iowa, Minnesota, and
Wisconsin will use their analytical expertise in a wide array of biomonitoring methods.
Sample collection will be aided through a partnership with the Survey of the Health of
Wisconsin (SHOW), which is a NHANES-type program that has mobile exam centers.
Data sharing, analysis, and interpretation will use the infrastructure built by the
Wisconsin Environmental Public Health Tracking Program. The project will rely on the
biomonitoring experience gained through the state-funded Minnesota Environmental
Health Tracking and Biomonitoring Program and several sentinel agricultural studies in
Iowa that relate environmental exposure to health effects. A key aspect of the proposed
project will be partnerships between the state public health laboratories and advisory
panels in each state. These will draw upon the expertise of citizens, local officials,
medical and scientific professionals, and public health practitioners.
24
Section overview: Tracking Project Updates
Given the limited time available for advisory panel meetings, updates on some items will be
provided to the panel as information items only. This information is intended to keep panel
members apprised of progress being made in program areas that are not a featured part of the
current meeting’s agenda and/or to alert panel members to items that will need to be discussed in
greater depth at a future meeting.
Included in this section of the meeting packet are written status updates on the following items:
•
Tracking Data Reports
•
Communications and Outreach
•
Public Portal Progress
•
CDC National Program Network and Funding
•
Letter of Support for National Program Funding
ACTION NEEDED: At this time, no formal action is needed by the advisory panel. Panel
members are invited to ask questions or provide input on any of these topics during the
designated time on the meeting agenda.
25
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26
Status Update: Tracking Data Reports
After soliciting comments from the advisory panel, work group, and indicator development team,
the indicator profile template presented at the March panel meeting has been revised. Tracking
staff have decided to break the tracking surveillance report into smaller indicator-specific
reports, include graphs and/or tables for all nationally consistent data and measures, and have set
the reading level at twelfth grade. Tracking staff have been in communication with the Oregon
Department of Human Services’ EPHT program, and are sharing resources for building a more
“reader friendly” tracking report format.
Tracking staff are currently working on reports for the hospitalization indicators, birth outcomes
indicators, cancer indicators, and childhood lead poisoning indicators. Air quality, water quality,
carbon monoxide poisoning, and birth defects reports will follow later this summer. When
complete, each indicator report will be published to the updated MN EPHT website. A brief
“Frequently Asked Questions” factsheet without data for each indicator is also planned for the
website.
27
Status Update: Tracking Communications Outreach
Our Communications Coordinator for Minnesota’s Environmental Public Health Tracking program (MN
EPHT, formerly known as MEHTS), Mary Jeanne Levitt, continues developing and implementing a
communications plan to create public awareness about what MN EPHT is and what MN EPHT can do to
improve our capacity to understand, respond to and prevent chronic disease in Minnesota. Our long term
goal is to establish public demand/support for MN EPHT.
Our public awareness campaign includes creating a name that the public can easily identify, MN EPHT,
along with a logo specific to MN EPHT (please see below); establishing relationships with community
organizations, identifying events, conferences, and workshops where MN EPHT staff can educate the
public about MN EPHT; creating a new format for the MN EPHT web compliant with MDH rules;
creating a MN EPHT fact sheet and flyer, preparing materials for the Minnesota State Fair, and exploring
conference opportunities, such as the ISES 2009 Conference in November.
The front page of the April issue of Minnesota Physician (MP) magazine included an article about MN
EPHT written by Michonne Bertrand, MN EPHT staff. This publication is distributed to the 14,000
physicians registered in Minnesota. We are purchasing the pdf file for inclusion on our MN EPHT
website, as well purchasing reprints of the article for distribution where MN EPHT staff are presenting.
The editor of MP, Donna Ahrens, has suggested modifying the MH EPHT article for their consumer
oriented publication, Minnesota Health Care News, which is distributed statewide. We are moving
forward on this second publication opportunity.
28
Status Update: Public Data Portal
Tracking program staff are continuing to work with the MDH Information Systems &
Technology Management (ISTM) division staff to evaluate the Indicator-Based Information
System for Public Health (IBIS-PH, or just IBIS) for use in establishing a Minnesota web portal.
Web portals are powerful tools for the dissemination of tracking data to the public. ISTM are
providing project management, systems architecture, development, and other IT consultation to
EHTB as needed.
Based on recent meetings to discuss shortcomings of the IBIS software and significant changes
to purpose and funding, the IBIS Project staff in ISTM requested clarification to direction,
purpose, process, and outcomes. The portal demonstration and an expanded IBIS Project were
given clarification at a meeting of the EHTB Steering Committee on April 23, 2009.
For the portal demonstration, work continues on loading into IBIS-View the 7 indicators and
messages from 2 Tracking content areas, drinking water and hospitalizations. Jerry Alholm,
ISTM, is the point of contact, working with program content staff (Pam Shubat, Deanna Scher,
and Jeannette Sample). ISTM staff will document current configurations and system
discoveries/discrepancies for future reference. The demonstration portal implementation will be
limited to the current internal MDH test environment and will not be accessible outside MDH for
review or comment. Two small ($5,000) annual plan agreements with outside vendors have been
established for technical support.
Next steps will focus on work presenting cost estimates, implementation options, and total cost
of ownership for a fully implemented MN-IBIS system at MDH. To initiate MN-IBIS
implementation, a sponsor would propose a new project (with scope, funding, and staffing
decisions). MDH will need to establish a governance process for this project.
No additional indicators will be loaded and no work will be done on SAS/IBIS-Query or
mapping modules, customization or resolution of shortcomings of system functionality at this
time. Minnesota will participate in a multi-state IBIS consortium upon decision and commitment
to fund the IBIS project as a production service.
29
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30
Status Update: CDC National Program Tracking
Dr. Michael McGeehin, Director of the National Center for Environmental Health at CDC,
informed state officials in April that the CDC received approximately $7.3 million for tracking,
and will fund five new states through a grant announcement to begin in 2009. In addition, the
money will be used to supplement currently-funded states by increasing their budgets 8-10
percent.
Dr. McGeehin also reported that the CDC is looking for ways to tie biomonitoring programs to
state and national tracking programs. The Council of State and Territorial Epidemiologists
(CSTE) Environmental Epidemiology leadership may partner with CDC in guiding this effort.
Currently, the CDC funds 16 states and 1 local health department (New York City) to build and
implement state-based Environmental Public Health Tracking (EPHT) networks. All programs
have now implemented web-based portals for dissemination of Tracking data and information.
A complete list of their web addresses is provided below. Advisory Panel members are invited
to visit these sites to learn more about activities in other states.
State Environmental Public Database Portals
California
• www.ehib.org/project.jsp?project_key=EHSS01
Connecticut
• www.ct.gov/dph/cwp/view.asp?a=3140&q=386922&dphNav_GID=1826&dphPNa
vCtr=|#47432
Florida
• www.floridacharts.com/HealthTrackFL/default.aspx
Maine
• www.maine.gov/dhhs/eohp/epht/index.htm
Maryland
• http://eh.dhmh.md.gov/tracking/
Massachusetts
• www.mass.gov/?pageID=eohhs2subtopic&L=5&L0=Home&L1=Consumer&L2=C
ommunity+Health+and+Safety&L3=Environmental+Health&L4=Environmental+P
ublic+Health+Tracking&sid=Eeohhs2
31
State Environmental Public Database Portals (continued)
Missouri
• www.dhss.mo.gov/EPHT/
New Hampshire
• www.nh.gov/epht
New Jersey
• www.nj.gov/health/epht
New Mexico
• http://nmtracking.unm.edu/
New York
• http://nyhealth.gov/statistics/environmental/public_health_tracking/
New York City
• www.nyc.gov/html/doh/html/home/home.shtml
Oregon
• www.oregon.gov/DHS/ph/epht/index.shtml
Pennsylvania
• www.dsf.health.state.pa.us/health/cwp/view.asp?a=171&Q=251317
Utah
• http://ibis.health.utah.gov/home
Washington
• https://fortress.wa.gov/doh/wtn/WTNPortal/
Wisconsin
•
http://dhs.wisconsin.gov/epht/index.htm
32
33
34
35
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36
Section overview: Exploring Data Linkages with Air Quality and
Health Outcomes Data
In this section, MDH staff present a brief overview of an EPA funded research project
being conducted in collaboration with the MPCA and the Rochester Epidemiology
Project at Olmsted Medical Center. This project serves as a model for new collaborations
in environmental public health research by joining the efforts of state, academic and
medical scientists together in solving the challenges of working with the available health
outcome and exposure data.
MDH and MPCA epidemiologists and research scientists, together with investigators at
Olmsted Medical Center in Rochester, are currently working on developing methods for
measuring the impacts of local and regional air pollution reduction strategies on
cardiovascular and respiratory disease indicators. This work is being conducted with
separate research funding from the U.S. EPA and is focused on the Twin Cities sevencounty metropolitan area and Olmsted County. However, the methodology that is being
utilized to study the statistical relationships or “links” between health and air quality data
may be directly applicable to linkage projects that may be conducted in other areas and
possibly be done on a statewide basis for MN EPHT in the future. Other states, including
New York, Michigan, and California, as well as several academic partners, including the
University of Minnesota, are pursuing similar approaches.
Action Item:
This item is presented for informational purposes. Members are invited to ask
questions, and provide comment on any of the information presented.
No formal vote or decision is anticipated.
37
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38
Data Linkage Research Project: Measuring the Impacts of
Particulate Matter Reductions by Environmental Health
Outcome Indicators
Supported by EPA Science to Achieve Results (STAR) research funding (R833627010)
Investigators: Jean Johnson, Barbara Yawn, Greg Pratt, Paula Lindgren, Chuck
Stroebel, Margaret McCourtney, Kari Palmer, Naomi Shinoda, Allan Williams,
Wendy Brunner, Peter Wollan
The purpose of this three-year project is to develop and evaluate a set of Environmental
Health outcome indicators to measure the public health impacts of particulate matter
(PM) reduction policies over a ten-year study period, from 2000-2009.
A wide range of national and local air pollution reduction strategies currently being
implemented are expected to reduce population exposures to PM in the study areas of
Twin Cities Seven-County Metropolitan Area and Olmsted County. These strategies
include, but are not limited to, the following:
• Minnesota Emissions Reduction Project (MERP)
• Project Green Fleet (retrofitting buses and other diesel vehicles),
• The Metropolitan Council’s “Go Green” Initiative
• Congestion Mitigation and Air Quality (CMAQ) Improvement Program, and
• National initiatives for ultra low sulfur diesel fuels, heavy duty diesel rule, and the
clean air interstate rule (CAIR).
Work Progress and Accomplishments
Work in year one of the project has focused primarily on collecting and describing the
available environmental (particulate matter and ozone) data and health outcome data for
years 2000-2006 necessary for indicator development. Data from this time period will
provide baseline indicator information for evaluating impacts of PM reductions
implemented from 2006 through 2009.
1. Indicator Measures of Population Exposure to PM
Project investigators, Greg Pratt and Kari Palmer, with the Minnesota Pollution Control
Agency (MPCA) have provided to the Minnesota Department of Health (MDH) the
ozone, PM2.5 (FRM 24 -hour averages and BAM continuous) and PM10 ambient air
monitoring data for 2000-2006 covering the two study areas. The data is collected by
MPCA and supplied to EPA where it is maintained in the EPA AQS database system. In
39
addition to extracting the data from AQS, MPCA investigators have provided guidance
on the interpretation of the data, including issues such as formatting, missing and below
detection data, spatial applicability, data collection frequency, and comparisons among
measurement parameters.
Limitations identified with the use of PM monitoring data sets for use in epidemiological
analyses are well described in the literature. For the years 2000-July 2002, BAM
continuous monitoring data are not available in the Twin Cities Metro. FRM data are
limited by the lack of daily measurements for these early years. We have examined the
variability in PM concentrations measured across FRM monitors in the Twin Cities
Metro for 2000-2006 and found concentrations to be relatively homogenous such that
further spatial interpolation techniques may not significantly improve zip code level
estimates of population exposure. For assigning exposure levels to zip code areas with
this data set we plan to examine differences in the effect estimates using a nearest
monitor approach versus using a calculation of the daily average PM concentration across
all monitors for the Twin Cities Metro area.
Emissions modeling data (described below) were explored to further refine and improve
the exposure parameter. Project scientist, Margaret McCourtney, at the MPCA used a
modeling system to simulate contiguous PM2.5 concentrations over the study area that is
not possible using monitoring data. For this study, we are using an air quality modeling
system composed of the following:
• Comprehensive Air Quality Model with Extensions (CAMx) version 4.51;
• Pennsylvania State University/National Center for Atmospheric Research
Mesoscale Model (MM5) version 3.7 (for the meteorological model); and
• Emissions Modeling System (EMS-2003) and Consolidated Community
Emissions Processing Tool (CONCEPT).
The model year was 2005. The model domain consists of a 36km grid covering the
United States and Canada east of a line dissecting the United States at the western-most
tip of Texas. A nested 12-km domain includes Minnesota and adjacent areas. A program
was developed and used to "window" out a smaller domain from the available large 12km meteorological data domain. In addition, a 4km flexi-nested grid (used for better
placement of point sources) covers the southeast portion of Minnesota, containing the
Twin Cities Metro area and Rochester. The 4-km gridded model results were spatially
interpolated using ArcGIS to zip code and provided to MDH.
We evaluated model performance against observed species values from STN and
IMPROVE sites located within the study area. In summary, time series show that daily
undulations of model data follow monitored data quite well. Fred Dimmick of EPAORD released to Minnesota a non-publicly available alpha version of their Hierarchical
Bayesian (HB) model with GUI interface to test for use in this study. The HB model
combines the numerical model output with observed PM2.5 concentrations from 24-hour
FRM sites. This model prepares data ready for import to the case-crossover analysis with
health outcome data.
40
2. Indicator Measures of Health Outcomes
Olmsted County Rochester Epidemiology Project (REP) asthma data:
The data for Olmsted County has been collected and provided to MDH by Co-PI Dr.
Barbara Yawn and REP biostatistician Peter Wollan, for asthma exacerbations for the
period 2000--2007. The data comes from the Rochester Epidemiology Project (REP), a
system to link all health care received within Olmsted County, MN to individual residents
of Olmsted County. For this study, we identified all visits for all Olmsted County
residents for which asthma (493.xx) was the first ICD-9 code for outpatient visits and the
first or second code for emergency department and hospitalizations for the period 20002007. In addition, we counted all episodes of clusters of 3 or more outpatient visits that
occurred within any 14 day period and for which 493.xx as the first diagnostic code. In
previous work we determined that such clusters of asthma visits had a 97% likelihood of
being for an asthma exacerbation.
To increase the sensitivity of this measure for this study, we plan to identify episodes of
care during which oral steroid bursts were prescribed and 493.xx was the diagnostic code
for the visit. This, however, is a new use of the electronic drug prescription module and
will require addition time and work in this next year of the study.
Progress on obtaining geo-codes for each of the individuals in Olmsted County with
evidence of one or more asthma exacerbations has been slower than anticipated due
primary to the need to submit the renewal for the REP grant. That was completed and
submitted in December and so we hope to have the geo-codes soon. This will allow for a
more refined spatial analysis of the health outcome data in Olmsted County.
Twin Cities Metro Area Health Outcome Data:
Health outcome data for years 2000-2006 were collected and described by MDH
investigators. We have completed time series plots for all asthma hospitalizations,
asthma ED visits, chronic lower respiratory disease hospitalizations, total respiratory
hospitalizations, cardiovascular disease hospitalizations and cardiopulmonary disease
mortality and all cause mortality. For each outcome the dataset includes gender, age,
county and zip code of residence, and date of the event.
Missing or invalid zip codes were identified in mortality datasets (based on death
certificates) in less than 1% of records. We resolved this problem by obtaining street
address information for each death record with a missing or invalid zip code and used
Arcview to assign zip codes, though a small percentage (less than 0.5% of events) could
not be corrected. Next steps will be to assess a method for assigning Lat/long
coordinates to health events derived from the zip code.
State Ambulance Reporting (STAR) data has also been collected. Evaluation and
validation of these data by MDH investigators in the next year of the project is planned.
Validation of outcome codes is proposed by conducting a linkage of STAR data with
hospital ED data.
41
3. Indicator Measures of Association
Case Crossover methods:
Analytical software (C-CAT) for associating PM exposure data with health outcome data
using a case-crossover study design was developed by the EPA and CDC as part of the
Public Health Air Surveillance Evaluation (PHASE) project. Project investigators Naomi
Shinoda and Paula Lindgren at MDH have conducted a preliminary test of the software
using all available 2002-2006 hospitalization and mortality health outcome data and
ambient PM2.5 (Twin Cities Metro area 24 hour average). Further refinement of the
method is needed. Important questions in the model to be resolved include the selection
of the referent time period and appropriate lags.
Time Series Methods:
Project biostatistician Paula Lindgren tested methods for conducting a Bayesian analysis
of Twin Cities Metro Area asthma emergency department visits for 2006 using 2006 air
quality data. Time series analyses with a spatial component were run to assess the effect
of the prior day’s PM value on asthma ED visits. A spatial model without the temporal
component was also run. PM 2.5 daily maximum value was used. Daily counts of asthma
ED visits were entered as the dependent variable. Other covariates included day of the
week, weekly flu activity, ozone data (April-September) and socioeconomic variables
from the 2000 census. A hierarchical modeling approach was used. WinBUGS and R
were used to implement these models. Plans are underway to further refine this
analytical method before applying it to the complete data sets.
Plans for 2009 and 2010
In 2009, we will continue to focus our efforts on completing data collection and will add
available 2007 exposure and health outcome data. We will obtain additional data from
the REP for COPD exacerbations and acute myocardial infarctions that are comparable to
that collected for asthma in 2009. In addition we hope to obtain data from the pollen
monitor located on one of the Mayo Clinic buildings.
Exposure to traffic will be tested as a variable for explaining observed health outcomes.
Annual average traffic count data (segregated into total and heavy duty diesel
components) obtained from the Minnesota Department of Transportation is used to
calculate average daily vehicle miles traveled (VMT) within each zip code. This metric
will be assigned to the health outcomes for each zip code in the Twin Cities Metro area.
The health outcomes data in the Rochester community is more highly resolved spatially
and allows calculation of more refined metrics for traffic exposure. Metrics that will be
tested include:
1. VMT (total and heavy duty diesel components) within 500 and 1000 meters of the
residential location of the health outcome data point;
2. Traffic density (calculated by a kernel density approach) within varying radii of
the health outcome data point;
3. Maximum VMT of any roadway within a given radius of the health outcome data
point (various radii will be tested);
42
4. Other metrics identified by literature review and discussion with traffic data
experts.
We will continue to develop and refine methods for case-crossover and time series
analyses for measure of association and calculate the population attributable fraction
using baseline (2000-2006) data. We plan to compare the effect of using BAM
continuous and FRM monitoring data versus available Bayesian modeled exposure data
for the year 2005 on the relative risk estimate.
43
Proposed Environmental Health Outcome-Based Indicators:
A. Outcome-based Indicators Of Population Exposure (Table 1)
Table 1. Summary of Indicators of Population Exposure
Indicators
PM10,
Measures
Concentration in ambient air
Units
ug/m3
Metro Data
2000-current
Olmsted Data
2000-current
PM2.5, 24-hour
average
PM2.5, continuous
Concentration in ambient air
ug/m3
2000-Current
2000-Current
Concentration in ambient air
ug/m3
2003-Current
2003-Current
PM2.5, speciation
Concentration of components of
PM2.5 (sulfates, nitrates, carbon)
in ambient air
ug/m3
1/7/2001current, 1 in 3
day sampling
9/22/2001current, 1 in 6
day sampling
44
Figure 2. Locations of Criteria Pollutant Monitors
45
Table 2. Summary of Indicators of Population Health
Health Condition
Morbidity:
ICD-9-CM
Mortality:
ICD-10
Data Source
Time
Period
Expected
Annual
Events
MSP Metro
Expected
Annual
Events
Olmsted
Asthma Inpatient
Hospitalizations
ICD-9 Code:
493
Hospital Discharge
Data (inpatient)
20002009
2,590
100
Asthma ED Visits
ICD9-Code
493
Hospital Discharge
Data (outpatient)
20002009
9,810
340
Chronic Lower
Respiratory
Disease (CLRD)
Hospitalizations
ICD9490-496
Hospital Discharge
Data (inpatient)
20002009
5,460
200
Total Respiratory
Disease
Hospitalizations
ICD9464,466,480487,490-496
Hospital Discharge
Data (inpatient)
20002009
15,520
460
Cardiovascular
Disease
Hospitalizations
ICD9-Code:
390-448
Hospital Discharge
Data (inpatient)
20002009
34,630
780
Cardiopulmonary
EMS Events
TBD
MN State
EMS Reporting
20042009
12,974
732
Cardiopulmonary
Disease Mortality
I00-I78, J40J47, J10-J18,
J69
Death Certificates
20002009
6,250
290
All-Cause
Mortality
All, excluding
V01-Y98
Death Certificates
20002009
15,230
730
Childhood Asthma
Clinic Visits
REP
20002009
Not
applicable
4,780
(ages 5-18)
Oral Steroid Rxs
REP
20052009
Not
applicable
950
*Mortality based on 2004 data; hospitalizations and EMS based on 2005 data.
46
Section overview: Biomonitoring Strategies for an Ongoing
State-based Program
The EHTB statute requires the program to make recommendations to the state legislature about
the development of an ongoing biomonitoring program in Minnesota. To guide a strategic
planning process for arriving at these recommendations, MDH enlisted the assistance of a
consultant from Management, Analysis and Development at the State Department of
Administration. EHTB workgroup, steering committee and advisory panel members, along with
program staff, have been active participants in this process
To date, we have accomplished the articulation of a vision and purposes for a state biomonitoring
program. The purposes are intended to describe why a state biomonitoring program exists,
whereas the vision seeks to describe more broadly what will be different in Minnesota as a result
of a state biomonitoring program.
A second planning retreat was held on May 1, 2009 to build on this progress with the
development of recommendations for strategies that would help the program accomplish its
stated purposes. Members of the EHTB workgroup, steering committee and advisory panel were
invited to attend. A meeting summary of the discussion that occurred during the retreat is
included here.
Meeting attendees were advised to not be discouraged by the current state budget realities. Our
legislative leaders, in their interview, advised us to “Ask legislators for their support of the
establishment of a program. If it cannot be established this year due to budget constraints,
prepare to lobby for it in the next budget year.” In addition, the CDC continues to support state
efforts through building laboratory capacity and has recognized a role for Environmental Public
Health Tracking programs in guiding state biomonitoring activities. With continued planning,
Minnesota will be well positioned to apply for funding opportunities in the future.
For the June 2nd meeting, the advisory panel will again be asked to consider various strategies
put forth at the retreat, and to build on these ideas. Advisory panel members individually are key
program stakeholders and, as a group, the advisory panel is a vital source of guidance to both
MDH and the legislature. The advisory panel is asked to provide critical input on
recommendations for a strategic plan for an ongoing state biomonitoring program in Minnesota.
Jean Johnson will present an updated statement of program purposes and integration with EPHT.
Barb Deming from Management, Analysis and Development will lead a discussion during the
meeting.
See next page for ACTION NEEDED:
47
ACTION NEEDED:
In preparation for this meeting, panel members are asked to carefully consider the following
questions:
o What is surprising or noteworthy to you about the May retreat summary? What
additional comments or insights do you have about a state biomonitoring program
after reading through the summary?
o In your own desired vision for the future, what strategies do you think would be most
effective at accomplishing our stated purposes for an ongoing state biomonitoring
program in Minnesota? Is your vision reflected in the summary notes? If not, what is
missing?
o Legislators have stated that “we would want the Science Advisory Panel to figure out
how targeted to be”. If the program were to select or target a certain population for
biomonitoring, and not a state-wide general population survey, what population do
you think is most important to include in an ongoing program?
o Do we need to monitor the general population of the state as a baseline, or will the
federal NHANES data for the US population provide an adequate baseline from which
to make comparisons for more targeted population surveys in the state?
o Which strategies will help us to integrate biomonitoring within an Environmental
Public Health Tracking program? Is that goal important?
o What lessons have we learned from the pilot projects to date that help to inform these
strategies? Are there strategies that have worked well that should continue to be
implemented in an ongoing program?
No formal vote is anticipated for this agenda item.
48
Biomonitoring Strategies Retreat Summary
May 1, 2009
In attendance MN EHTB Steering Committee, Advisory Panel, and Workgroup members: John Adgate , Beth
Baker, Alan Bender, Carin Huset, Jean Johnson, Rita Messing, Louise Liao, Mary Manning,
Deb McGovern, Jill Heins Nesvold, Geary Olsen, Greg Pratt, Pam Shubat , Dan Stoddard, Allan
Williams, Lisa Yost, Joe Zachmann
Facilitator: Barb Deming
Notes: Andrea Baeder and Adrienne Kari
Support Staff: Leslie Schreier
Review and context The group reviewed information about the current situation, including a brief discussion of the
November 2008 summary of stakeholder interviews, the biomonitoring vision and purposes,
pilot status, legislative update, and grant application status.
The stated goal of this retreat is build on the vision and purposes; to continue to develop
recommendations for the Commissioner and Legislators for a strategic plan for an ongoing
biomonitoring program in Minnesota.
Definitions In preparation for development of strategies, the participants discussed the meaning of several
key terms. Highlights from the discussion included:
• Monitor = Systematic, ongoing observation
•
Environment = Broader than Minnesota soil, air and water, includes products, homes, and
foods
•
Track = Observe change, trends over time
•
Exposure vs. Hazard = (CDC EPHT tracking definitions)
o Exposure = a measure of chemicals in the body;
o Hazard = a measure of chemicals in the environment
•
Health Risk = does not exist without hazard and exposure
•
Surveillance (CDC definition) = the ongoing, systematic collection, analysis, and
interpretation of outcome-specific data, closely integrated with the timely dissemination
of these data to those responsible for preventing and controlling disease or injury
•
Non-research (CDC) = Intent is to prevent or control disease or injury and improve health
or improve public health programs or services
49
•
Research (CDC) = Intent is to contribute to generalizable knowledge
•
Body burden/ Dose = Tissues, biological levels, internal exposures
•
Community (MN Legislation) = geographically or non-geographically based populations
Small group strategy brainstorm results Participants broke into four groups, each focusing on one of the four core purposes. The groups
responded to the question, “What strategies/approaches/activities would help to accomplish this
core purpose and bring about the vision?” Responses from each group were summarized and
presented to the full group for discussion.
Core Purpose Group #1: Monitor the distribution of exposure to designated chemicals in
the environment among the general population and communities within the population and
identify exposure disparities.
Participants included: Rita Messing, Greg Pratt, Carin Huset, Deb McGovern, John Adgate,
Lisa Yost
ƒ Why?
o Short term strategy: Keep the program alive, continue partnerships, and apply
for grants to sustain program
o Long term strategy: Proactive, visionary, and having a sustained approach.
Develop long-term sustainable program.
o Share results: publish, present
ƒ
What? Chemicals and populations
o Focus on designated chemicals with perceived risk and known risk
o Identify needs and perceived needs and pursue grant opportunities
o With limited funds start with subpopulations. Identify populations using
NHANES data, tracking surveillance data, environmental media, and then link
back to chemicals.
o Partner with medical community to use medical data
o Project (population/chemical)
ƒ
Funding
Who? Other States, U of MN, medical community
o Get stakeholders involved early on – answer questions
o Leverage equal partnerships
o Risk (actual and perceived)
Stakeholder
50
Core Purpose Group #2: Monitor the distribution of exposure to designated chemicals in
the environment among targeted communities that are likely to be exposed to assess the
need for community-level public health interventions.
Participants included: Pam Shubat, Mary Manning, Beth Baker, Adrienne Kari, Andrea Baeder
ƒ Create a Community Advisory Committee that would provide guidance to MDH on
chemical and community selection. May need to be contracted out. Chosen over
CBPR (community based participatory research).
ƒ
NHANES or other databases would inform chemical selection.
ƒ
Work with communities to have control populations.
ƒ
Assess horizontal and vertical exposure data needs when completing studies.
ƒ
Build Bio-banking into program for future and continued research.
Core Purpose Group #3: Track trends in population or community exposures to designated
chemicals over time.
Participants included: Alan Bender, Geary Olson, Al Williams
ƒ Make a decision to track based on level of exposure, level of hazard, and other factors
ƒ
Study Design is important
1. Agent
2. Sampling Model – Longitudinal, cross sectional, grab sample, etc
•
Need political support, commitment and money to implement
•
During design process work with partners and identify available resources
•
May lead to a decision to stop biomonitoring. More information may be obtained by
tracking environmental levels than by doing biomonitoring.
Core Purpose Group #4: Evaluate the effectiveness of statewide and community-level
interventions and policies that are implemented to reduce exposure to designated chemicals
over time.
Participants included: Jill Heins Nesvold, Louise Liao, Jean Johnson
• Evaluation: Lends itself to long-term infrastructure
o Shows public health benefit, reach, why program should be funded, and value
of program
51
•
Success stories with national programs (examples: lead and cotinine) give permission
and credibility to continue. Important to tie results with policy.
•
Evaluation process:
1. Process starts with stakeholders to develop evaluation questions
2. Inventory policies and interventions aimed at exposure reduction . . . and
improved health
3. Develop evaluation plan at same time designing program
4. Measure changes/trends in exposure in the body
5. Assess change in body burden (PK models) with research partners
6. With partners conduct risk evaluation and measure health impacts
ƒ
Link to tracking data
Discussion about proposed strategies •
Core purposes 1, 2 and 3 could be collapsed into one statement.
Example statement: Monitor and track the distribution of exposure to designated
chemicals in the environment among the general population and communities
within the population, in order to:
ƒ Identify exposure disparities
•
ƒ
Assess the need for community-level public health interventions
ƒ
Evaluate the effectiveness of interventions in reducing exposures
ƒ
Assess the need for continued biomonitoring of a chemical
ƒ
Decide whether to continue biomonitoring in that setting.
Community advisory board concept includes:
o Freestanding, statewide, long-term/big-picture
ƒ
Could have one or two rotating seats on board
o Potential to piggyback on an existing structure
o Consider risks and benefits of various approaches:
ƒ
political, local (project specific) vs. statewide
52
ƒ
combine models
ƒ
interests: industry, neighborhood, advocates
ƒ
representatives of community interests
•
Purpose statement #3 lacks a purpose clause, such as, “ . . . in order to determine the need
for an intervention.” Other potential purposes include: to monitor the effect/mitigation,
evaluate an intervention, or determine the need for an intervention.
•
Commit to “doing it right.” Scientific peer review or better.
•
Cross-cutting strategies (from more than one group) include:
o Use pre-existing data.
o Stakeholder involvement – managing tension between “evidence-based” and
stakeholder involvement
o Short-term and long-term approaches? Factors include:
ƒ
Funding and infrastructure issues
ƒ
Issues of “the agent.”
Next steps •
Continue writing the plan document. Add strategies to the vision and purpose.
•
Create and confirm a single core-purpose statement
•
Short term: How to sustain the capacity we have now?
•
Continue to develop Long term strategy
•
SAP meeting in June: follow up on this work.
53
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54
Section overview: General reference materials
One new document is included in this meeting packet as items that may be of interest to panel
members:
•
EHTB advisory panel meeting summary (from March 10, 2009)
•
More reference materials will be available at the meeting.
In addition, the following items are included in each meeting packet as reference materials:
•
EHTB advisory panel roster (revised)
•
Biographical sketches of advisory panel members (revised)
•
EHTB steering committee roster (revised)
•
EHTB interagency workgroup roster
•
Glossary of terms used in environmental health tracking and biomonitoring
•
Acronyms used in environmental health tracking and biomonitoring
•
EHTB statute (Minn. Statutes 144.995-144.998)
55
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56
Summary of the
Minnesota Department of Health (MDH)
Environmental Health Tracking and Biomonitoring Advisory Panel Meeting
March 10, 2009
1:00 p.m.-4:00 p.m.
Advisory Panel Members – Present
Beth Baker (chair)
John Adgate
Bruce Alexander
Alan Bender
Debra McGovern
Geary Olson
Susan Palchick
Gregory Pratt
Samuel Yamin
Lisa Yost
Advisory Panel Members – Regrets
Jill Heins Nesvold
Cecilia Martinez
Daniel Stoddard
Welcome and Introductions
Beth Baker, chairperson, convened the meeting, welcomed all participants and invited the panel members and
other participants to introduce themselves. She thanked Bruce Alexander for chairing the previous Advisory
Panel meeting held in December 2008. Beth Baker asked for any changes to the minutes from the previous
minutes and there were none.
Legislative and Funding Update
John Stine, Assistant Commissioner, MDH presented a brief legislative update. Norm Crouch retired in midFebruary, and John Stine has been appointed as Assistant Commissioner of Health. A progress report on
biomonitoring and environmental public health tracking was submitted to the legislature in January; John
thanked the Advisory Panel for their input on the report. MDH was invited to present information on the report
to the Minnesota House Public Health and Housing Subcommittee for Finance and Policy. John Stine and Jean
Johnson, EHTB Program Director, appeared before the subcommittee to speak about the program and give an
overview of the report submitted to the legislature, including an update on the four biomonitoring pilot projects.
The Governor’s budget for this year includes ongoing funding for biomonitoring and environmental health
tracking in accordance with what the original legislation set up: $500,000 per year; which is one-half of the
initial funding. The original program funding was one million dollars per year from the environmental and
natural resources fund: $100,000 for MPCA staff costs and $900,000 transferred from PCA to MDH. With
members who have asked about the reduction, MDH has responded that MDH will continue the environmental
health tracking program and very minimally continue biomonitoring projects.
MDH is pursuing federal grants/funding possibilities for both biomonitoring and environmental health tracking.
An EPA grant currently supports the mercury biomonitoring project; CDC and NIH recently issued solicitations
that could sponsor biomonitoring projects. Because Minnesota took the lead in funding an environmental health
tracking program without CDC funds, this action, hopefully, positions MDH well for federal funds.
John Stine noted that in the report to the legislature the role of the advisory panel was identified as a point for
discussion. MDH staff would appreciate input on how the Advisory Panel members’ think their role can be
more effective: Could the panel meet more often to get into more depth about the content of the biomonitoring
and tracking program activities? More time to hear the panel members’ perspectives on the issues would be
57
helpful. MDH staff will ask the panel to consider this as MDH moves forward on the strategic plan. MDH is
planning a one-day retreat in late April or early May focused on the future of the program.
In regards to funding, John noted MDH staff has had conversations with legislators about the constitutional
amendment, “Clean Water, Land, and Legacy”, as a possible source for additional funding for biomonitoring.
The Constitutional Amendment applies directly to water resources and drinking water is specifically named in
the constitutional amendment. From the constitutionally dedicated funds, 33% are available for water resources
and of that, 5% is to be spent for drinking water protection.
John asked for questions and comments from the Advisory Panel.
Deb McGovern thanked the staff for the report and asked if the upcoming retreat should be held after the
legislative session so the advisory panel knows how much money the legislature has allocated to the program.
John responded that the advisory panel’s input would be helpful in identifying the implications of a program
funded at various levels and it might be wise to have that conversation before the legislators are done meeting,
as they will ask that question at some point.
Al Bender added that a lot of the negotiations happen towards the end of the legislative session in which MDH
has input; the fact that there is $500,000 now does not mean that it will stay there, it can get moved around in
the negotiation phase and having the advisory panel’s input would help.
Deb McGovern commented that finding more time for Panel meetings would be hard, and it would be better to
make more efficient use of our time for important issues.
Beth Baker asked John Stine if there were other comments from legislators when the report was presented. John
responded that the legislators are interested in lessons learned and how will the results be communicated to the
communities that were involved in the pilot projects.
Samuel Yamin commented that of the four biomonitoring pilot projects, the PFCs project is most aligned with
the Clean Water Funds. He asked John whether MDH wants input now from the scientific panel to take into
discussion with the legislature, would that be of value, rather than the scientific panel waiting to see what
comes from the legislature. Lisa Yost agreed with the sentiment to be proactive during this legislative session.
Beth Baker suggested that future biomonitoring could examine exposures to pharmaceuticals in drinking water.
John asked what risks are associated with drinking water contaminants, and how we would prioritize those
risks. We are establishing our health risk limits for groundwater, but we don’t always have the greatest
exposure information; would we benefit from waiting for biomonitoring to answer that question?
Bruce Alexander asked whether it is the ultimate goal to have this program be designed to address the
occasional problem or it is ongoing monitoring or is it a hybrid of the two. What is the most effective use of
MDH’s resources? John responded that we need to report to the legislature on the value of the program into the
future. We don’t think it should be driven by the hot button issue of the day, but how much should it balance
community-based issues and statewide issues, that is relevant to discuss.
John offered to collect the Advisory panel’s feedback through an email questionnaire and will characterize
responses at the retreat. It was suggested to make the retreat a half day; several dates were suggested. Jean
Johnson will send out date suggestions for a half-day retreat.
58
Minneapolis Children’s Arsenic Study:
Adrienne Kari, EHTB Biomonitoring Coordinator, provided a brief overview of the study design for the
Minneapolis Children’s Arsenic Study. As described previously, the project area was expanded beyond the
initial pool of properties with arsenic levels of >20 ppm in the soil to also include households with arsenic
levels of <20 ppm in the soil. Parents completed a short questionnaire at the time of the urine collection. She
described the recruitment and the characteristics of the 65 children in the study.
Betsy Edhlund, Research Scientist in the MDH Public Health Laboratory, presented the urinary arsenic results
in the 65 study participants. She noted that the technology has only become available recently for detecting
arsenic at physiological levels. In fact, CDC’s first analysis of NHANES specimens corresponded to a subset of
the 2003-2004 NHANES enrollment, and CDC reported its first total and speciated arsenic findings in 2008.
Betsy found that the total arsenic level in 23 of the 65 children was >15 μg/g creatinine. The 3 highest arsenic
values were 58.9, 156, and 191 μg/g creatinine. As prescribed in the study design, she measured the arsenic
species in the urine from these 23 children. All had measurable amounts of inorganic-related arsenic,
predominantly in the form of dimethylarsenic acid (DMA). Several specimens also had measurable amounts of
arsenobetaine, a relatively nontoxic form associated with the diet. The 3 specimens with the highest total arsenic
values had only average amounts of inorganic-related arsenic species, and they had very high amounts of
arsenobetaine.
Adrienne presented her aggregate analysis of the study data. The distribution of total arsenic levels among the
65 children was skewed and so the results were log-transformed for further calculations. She compared the
geometric means for total arsenic and dimethylarsenic acid (DMA) in (a) the 65 Minneapolis children with (b)
the 290 children in the 2003-04 NHANES study. The geometric means are non-overlapping. The difference
could be attributable to differences in the designs of the two studies, e.g. seasonality of collection, spot urine vs.
first morning voids, age range of children, and ratio of urban/rural residences. For the 65 Minneapolis children,
no correlations between soil arsenic levels and urinary arsenic levels were found. The effect of sibling status
was analyzed; again, correlations between soil arsenic levels and urinary arsenic levels were not found.
Regarding the four individuals with elevated total arsenic levels, Adrienne reported that the questionnaire
submitted by the parent of one of these children indicated that the child had consumed fish shortly before the
collection. Adhering to the study design, Adrienne sent recommendations to the parents of the four children
with the highest total arsenic values to visit a primary care provider to determine possible exposure routes and
prevent future exposure. None of these four children lived on the properties with the highest soil arsenic
concentrations.
Beth Baker remarked that the apparent driver for the high arsenic values is the organic arsenic (in particular,
arsenobetaine), which is relatively non-toxic. A more meaningful comparison with the NHANES data set might
be to compare the concentrations of the organic species rather than the inorganic-related species.
John Adgate, Bruce Alexander, Beth Baker, and Lisa Yost advised the program staff to search for a better
comparison study. Rather than comparing to the NHANES data set, the Minneapolis data set should be
compared to a study that also collected first morning voids from young children. Samuel Yamin recommended
that the panel should consider how this study should be pursued further. The EHTB program might investigate
other exposure routes. Greg Pratt wondered if other members in this target community might also have arsenic
levels of >50 or >100 μg/g creatinine that should be further investigated.
Lisa Yost cautioned the program staff to focus its message on whether the levels found in this study have
clinical significance. Rather than comparing to the NHANES data set, a more meaningful comparison might be
to populations that have arsenic levels of clinical significance. Beth Baker noted that arsenic levels around
59
500-750 μg/g creatinine or higher correspond to significant acute poisonings, and levels above 50 μg/g
creatinine are generally acknowledged to represent clinical significance. Beth recommended that conclusions
based on the relatively non-toxic arsenobetaine levels could be misleading. The panel recommended looking at
other papers/studies for interpreting results because of methodological and population differences with
NHANES.
In response to questions about communicating results to parents, Adrienne reported that staff sent letters
regarding total arsenic results for each individual in October 2008. For the parents of the four children with
values near or above 50 μg/g creatinine, staff recommended follow-up with a health care provider for a repeat
test per study protocol. In January 2009, staff mailed letters to the parents of the 23 children for which
inorganic arsenic species were measured. The children’s individual results were compared to the newly reported
NHANES data. With each letter, MDH included a checklist for sources of arsenic exposure and a fact sheet on
how to reduce arsenic exposure. Spanish and Somali translations of these documents were sent, as appropriate.
Adrienne noted that she received three inquiries regarding the results letters. One of the parents who received a
recommendation for follow-up asked MDH to help connect the family to a health care provider, and Adrienne
coordinated a visit to Smiley’s Clinic. Another parent noted that her child was taking a vitamin supplement
(emergen-c) to compensate for dietary restrictions; she wondered if she should take steps to decrease her child’s
(low-range) arsenic level. The third call was from a physician, seeking clarification about the results letter.
Tannie Eshenaur, Program Planner and Risk Communication Specialist with the MDH Environmental Health
Division, described the plans to communicate the results with the South Minneapolis community. A news
release is planned within the next few weeks, and it will include an announcement about an upcoming
community meeting. Prior notice will be provided to groups that have been involved in the study, including
local government officials, elected representatives, clinics, and community groups.
Tannie reported that the US Environmental Protection Agency (EPA) had completed its remediation of all
neighborhood yards containing arsenic levels >95 ppm in the soil. In summer 2009, EPA will begin to
remediate yards containing soil arsenic levels between 20 ppm and 95 ppm.
In response to questions about the public health messages, Tannie described key messages that would be
conveyed to the community. Various forms of arsenic contribute to exposures and health outcomes. Urban soils
and urban environments could contribute a variety of contaminants (beyond arsenic), and we should take care to
decrease all avoidable exposures. The messages would convey that community members have some control
over their environment, exposures, and health.
In wrapping up this topic, Adrienne remarked that the primary “lesson learned” in conducting the Minneapolis
Children’s Arsenic Study was that recruitment was more challenging than anticipated. She described the
comprehensive recruitment plan, which included an extensive door-to-door endeavor, post cards via the US
mail, Spanish and Somali translators, additional field staff, and an expanded recruitment effort. To reach the
target of 100 participants that are representative of this community, the EHTB program would have needed to
invest significantly more time into engaging the community in the study than was possible for the pilot.
Deb McGovern asked whether there would be more work on the arsenic results report before the public release
and what recommendations would be made. Jean responded that while there were plans for a press release and
community meeting to follow the Panel meeting in the next few weeks, that release would depend on time
needed to address comments from the panel in the final analysis and report. A suggestion was made that
recommendations for follow-up should be made with input from the community after the results are presented.
60
Biomonitoring Project Updates
Beth asked whether Panel members had any comments or questions about the project updates provided in the
meeting materials. Jean reported that participation in the East Metro PFC biomonitoring project was good with
196 participants providing blood specimens. Individual results have been mailed to participants and aggregate
data analysis is soon to get underway. The Riverside Prenatal Biomonitoring Study is ready to start but waiting
for MDH IRB response.
Jean also reported that staff, working with consultant, Barb Deming, has revised the Statement of Vision and
Purposes to address comments and recommendations from the last Advisory Panel meeting identifying the core
purposes for an ongoing state biomonitoring program. Jean will send an electronic copy to Advisory Panel
members and request that they submit comments to her by email. Comments will be discussed at the
Biomonitoring Strategic Planning retreat.
Environmental Public Health Tracking (EPHT) Data Report
Jean introduced the topic by reviewing the nine content areas that the CDC national EPHT program is currently
tracking and gave an update from the recent national conference, CDC Tracks 2009, held in Washington DC in
February. Jean, along with EHTB staff Jeannette Sample and Naomi Shinoda, and Advisory Panel member
Susan Palchick, were able to attend. Jean reminded the panel that our program remains consistent with the
national program in collecting, analyzing, and disseminating indicators in the nine content areas: air quality,
water quality, blood lead, carbon monoxide poisonings, selected cancers, birth defects, birth outcomes, heart
disease and chronic respiratory disease (hospitalizations).
Jean also reported on a couple of new content areas that Minnesota is interested in developing with partners in
other states. These include measures of the public health impacts of climate change. Indicators of heat-related
morbidity and mortality, and population vulnerability are being tested. Another content area that is emerging is
pesticide-associated illnesses. Several states are interested in pursuing this area, which some states have
monitored for years as an occupational illness, primarily among farm workers and pesticide applicators, with
funding from the NIOSH SENSOR program.
Jean reported that recent efforts of the EHTB program staff have focused on multiple methods for dissemination
of data to the public. Three approaches that are being worked on simultaneously are: 1) a Tracking data report
to be distributed via the web and available in hard copy; 2) a public Tracking data portal for direct, online
access to aggregate data; and 3) a communications and outreach plan (website, publications, presentations,
displays, etc.).
Jeannette Sample, EHTB Epidemiologist, gave an update on progress with the Tracking Data Report. Jeannette
has been leading our Indicator Development Team in generating the report. She described the process by which
she has adapted the indicator templates that are being used on CDC-funded state tracking portals for use in a
surveillance data report as a way of communicating our measures of hazard, exposure, and disease trends to the
public. The template is a way to standardize the content and messages being displayed in each of the nine
content areas. The report will also have an introductory chapter and a technical information section at the end.
The challenge has been to structure the report in way that makes it useful to many different audiences. A
tentative publication date is the end of May.
Jeannette showed examples of the indicator template for two content areas: cancers (lung and mesothelioma)
and birth outcomes. John Soler, Epidemiologist with the Minnesota Cancer Surveillance System joined her in
describing the cancer indicator data. Alan Bender asked how the list of specific cancers to be tracked was
chosen, and why malignant melanoma was not included. Jeannette responded that the list was selected by the
CDC Tracking program’s cancer content workgroup using a set of criteria. Al suggested that the CDC’s
definition of “environment” may be limited to only chemical risk factors, and that other environmental factors
should be considered. John Soler agreed that people can use the term “environment” and mean different things,
61
it is often not well defined, and we could consider including melanoma on the list for tracking. Alan pointed out
that melanoma has far more documented evidence of a link to an environmental risk factor than some of the
other cancers listed by the CDC.
After Jeannette showed the data templates for birth outcomes, Bruce Alexander commented that there are
socioecomomic factors that influence fertility rates and those should be factored in. Rates may reflect
demographic changes with immigration patterns. Lisa Yost commented that, for the general public, there
needed to be more definition of terms. Most people would not be familiar with the ‘national objectives”, ie
Healthy People objectives.
Geary Olson commented that while the report of statewide trends might be of interest to some, he thought that
there would be more interest in seeing the data broken out by region, giving the example that farming
communities in the southeast may be different from populations in the cities, or in the northeast. The
mesothelioma excess in the northeast goes away when you only look at the statewide numbers, diluting that
statistic. Jeannette responded that the national program calls for the reporting of county level statistics on the
state and national data portals, but this is difficult to do on this report with so much content. Also, smaller
geographical areas lead to smaller numbers and result in some data suppression to protect privacy. Geary asked
whether there is something between county and state level that allows you to stay within a defined environment
but with large enough populations.
Alan commented that MDH has used regions defined by the Center for Health Statistics that have been very
useful. Jeannette confirmed that it is the goal of the state portals to provide the data at some smaller level. Utah
offers data by county and by local health district. States have flexibility to break the data down they way they
want. John Adgate commented that this is important for legislators because there will be constituencies for
particular regions but not for statewide data in the same sense. It would be important for the program to gain
support from those constituencies.
Jeannette thanked the panel members for their comments.
Tracking Project Updates
Keith Kearney, Project Director for the Information Systems and Technology Management Division at MDH,
reported on progress with the demonstration portal project. While tracking program staff are developing the
data content and templates, ISTM staff are looking at the IBIS data content management system and
technology. They are finding that IBIS is not operating “out of the box” as well as anticipated. The goal is to
get seven indicators in two content areas loaded on to the portal. Indicators will be static, and the interactive
query portion will take longer.
Alan asked how the data are stored and queried in IBIS. Keith responded that data will be stored in SAS data
sets. The query system uses a pull down menu and you can select all or a subset of the data for display.
Mary Jeanne Levitt, Communications Coordinator, briefly described plans for outreach to communities about
the Tracking program.
Jean reminded Panel members that the next meeting date was changed to June 2, 2009.
The meeting was adjourned by Beth Baker.
62
Environmental Health Tracking and Biomonitoring
Advisory Panel
Jill Heins Nesvold, MS
American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota 55103
651-223-9578
[email protected]
Nongovernmental organization representative
John L. Adgate, PhD
University of Minnesota School of Public Health
Environmental Health Sciences Division
MMC 807 Mayo
420 Delaware Street SE
Minneapolis, Minnesota 55455
612-624-2601
[email protected]
University of Minnesota representative
Cecilia Martinez, PhD
Center for Energy and Environmental Policy
University of Delaware
Newark, Delaware 19716
302-831-8405
Bruce H. Alexander, PhD
University of Minnesota School of Public Health
Environmental Health Sciences Division
MMC 807 Mayo
420 Delaware Street SE
Minneapolis, Minnesota 55455
612-625-7934
[email protected]
Minnesota House of Representatives appointee
Local office:
Inver Grove Heights, Minnesota
651-470-5945
[email protected]
[email protected]
Nongovernmental organization representative
Beth Baker, MD, MPH
Specialists in Occupational and Environmental
Medicine
Fort Road Medical Building
360 Sherman Street, Suite 470
St. Paul, MN 55102
952-270-5335
[email protected]
At-large representative
Debra L. McGovern
Essar Steel Minnesota, LLC
Government & Public Affairs
555 West 27th Street
Hibbing, MN 55746
218-312-1442
[email protected]
Statewide business organization representative
Alan Bender, DVM, PhD
Minnesota Department of Health
Health Promotion and Chronic Disease Division
85 East 7th Place
PO Box 64882
Saint Paul, MN 55164-0882
651-201-5882
[email protected]
MDH appointee
Geary Olsen, DVM, PhD
3M Medical Department
Corporate Occupational Medicine
MS 220-6W-08
St. Paul, Minnesota 55144-1000
651-737-8569
[email protected]
Statewide business organization representative
63
Susan Palchick, PhD, MPH
Hennepin County Human Services and Public
Health Department
Public Health Protection
1011 South 1st Street, Suite 215
Hopkins, Minnesota 55343
612-543-5205
[email protected]
At-large representative
Samuel Yamin, MPH
Minnesota Center for Environmental
Advocacy
26 E. Exchange St., Ste. 206
St. Paul, MN 55101
(651) 223-5969
[email protected]
Minnesota Senate appointee
Lisa Yost, MPH, DABT
Exponent, Inc.
15375 SE 30th Pl, Ste 250
Bellevue, Washington 98007
Gregory Pratt, PhD
Minnesota Pollution Control Agency
Environmental Analysis and Outcomes Division
520 Lafayette Road
St. Paul, MN 55155-4194
651-757-2655
[email protected]
MPCA appointee
Local office
St. Paul, Minnesota
651-225-1592
[email protected]
At-large representative
Daniel Stoddard, MS, PG
Minnesota Department of Agriculture
Pesticide and Fertilizer Management Division
625 Robert Street North
St. Paul, Minnesota 55155-2538
651-201-6291
[email protected]
MDA appointee
Rev. March 12, 2009
Please submit corrections to [email protected]
Established October 4, 2007
64
Biographical sketches of advisory panel members
John L. Adgate is an Associate Professor in the Division of Environmental Health Sciences at
the University of Minnesota School of Public Health. His research focuses on improving exposure
assessment in epidemiologic studies by documenting the magnitude and variability of human exposure to
air pollutants, pesticides, metals, and allergens using various measurement and modeling techniques,
including biomonitoring. He has written numerous articles and book chapters on exposure assessment,
risk analysis, and children’s environmental health. He has also served on multiple U.S. EPA Science
Advisory Panels exploring technical and policy issues related to residential exposure to pesticides, metals,
and implementation of the Food Quality Protection Act of 1996, and was a member of the Institute of
Medicine’s Committee on Research Ethics in Housing Related Health Hazard Research in Children.
Bruce H. Alexander is an Associate Professor in the Division of Environmental Health Sciences
at the University of Minnesota School of Public Health. Dr. Alexander is an environmental and
occupational epidemiologist with expertise in cancer, reproductive health, respiratory disease,
injury, exposure assessment, and use of biological markers in public health applications.
Beth Baker is Medical Director of Employee Health at Regions Hospital and a staff physician at the
HealthPartners. She is President of Medical and Toxicology Consulting Services, Ltd. Dr. Baker is an
Assistant Professor in the Medical School and Adjunct Assistant Professor in the School of Public Health at
the University of Minnesota. She is board certified in internal medicine, occupational medicine and medical
toxicology. Dr. Baker is a member of the Board of Trustees for the Minnesota Medical Association and is
on the Board of Directors of the American College of Occupational and Environmental Medicine.
Alan Bender is the Section Chief of Chronic Disease and Environmental Epidemiology at the
Minnesota Department of Health. He holds a Doctor of Veterinary Medicine degree from the
University of Minnesota and a PhD in Epidemiology from Ohio State University. His work has focused
on developing statewide surveillance systems, including cancer and occupational health, and exploring
the links between occupational and environmental exposures and chronic disease and mortality.
Jill Heins Nesvold serves as the Director of the Respiratory Health Division for the American Lung
Association of Minnesota, North Dakota, and South Dakota. Her responsibilities include program
oversight and evaluation related to asthma, chronic obstructive lung disease (COPD), lung cancer, and
influenza. Jill holds a masters degree in health management and a short-course masters of business
administrative. Jill is extensively published in a variety of public health areas.
Cecilia Martinez has a B.S. degree from Stanford University and a Ph.D from the University of Delaware.
She is an Adjunct Faculty at the Center for Energy and Environmental Policy where she leads projects on
environmental mapping and community health. Her research interests include environmental policy,
indigenous rights and the environment, and sustainable development. Dr. Martinez has numerous publications
including Environmental Justice: Discourses in International Political Economy with John Byrne and Leigh
Glover. Her interests include policy research on sustainable energy and environmental policy.
65
Debra McGovern has more than 30 years of environmental experience. She has 15 years of
experience in Minnesota governmental regulation and 15 years of experience in heavy process
industry, and is well versed in Minnesota’s regulatory requirements. Ms. McGovern has created and
implemented numerous environmental programs and is active in many organizations. Ms. McGovern is
the former Environmental Policy Committee Chairperson for the Minnesota Chamber of Commerce,
and currently serves on the Board of Directors for the Minnesota Environmental Initiative (MEI).
Geary Olsen is a staff scientist in the Medical Department of the 3M Company. He obtained a
Doctor of Veterinary Medicine (DVM) degree from the University of Illinois and a Master of
Public Health (MPH) in veterinary public health and PhD in epidemiology from the University
of Minnesota. For 22 years he has been engaged in a variety of occupational and environmental
epidemiology research studies while employed at Dow Chemical and, since 1995, at 3M. His
primary research activities at 3M have involved the epidemiology, biomonitoring (occupational
and general population), and pharmacokinetics of perfluorochemicals. Recently, he completed a
3-year appointment on the Board of Scientific Counselors for the U.S. Centers for Disease
Control and Prevention (CDC) ATSDR/NCEH.
Susan Palchick is the Administrative Manager for Epidemiology, Environmental Health,
Assessment and Public Health Emergency Preparedness at Hennepin County Human Services
and Public Health Department. She has been with Hennepin County for 11 years and also serves
as the Environmental Health Director for Hennepin County. Prior to coming to Hennepin
County, Susan was the program manager for the Metropolitan Mosquito Control District
(MMCD) for 10 years. Susan is on the National Association of County and City Health Officials
(NACCHO) environmental health essential services committee. She is the principal investigator for an
Advanced Practice Center (APC) grant from NACCHO which focuses on environmental health
emergency preparedness. Susan received her Ph.D. in Medical Entomology from the University of
California-Davis; Master of Public Health in Epidemiology from the University of California-Berkeley;
M.S. in Entomology from University of Wisconsin-Madison; and B.S. (with honors) in Agricultural
Journalism-Natural Science from the University of Wisconsin-Madison.
Greg Pratt is a research scientist at the Minnesota Pollution Control Agency. He holds a Ph.D.
from the University of Minnesota in Plant Physiology where he worked on the effects of air
pollution on vegetation. Since 1984 he has worked for the MPCA on a wide variety of issues
including acid deposition, stratospheric ozone depletion, climate change, atmospheric fate and
dispersion of air pollution, monitoring and occurrence of air pollution, statewide modeling of air
pollution risks, and personal exposure to air pollution. He is presently cooperating with the
Minnesota Department of Health on a research project on the Development of Environmental
Health Outcome Indicators: Air Quality Improvements and Community Health Impacts.
Daniel Stoddard is the Assistant Director for Environmental Programs for the Pesticide and
Fertilizer Management Division at the Minnesota Department of Agriculture (MDA). He holds a master’s
degree in Management of Technology which focuses on the management of multi-disciplinary technical
organizations and projects, and he is a licensed Professional Geologist. He currently administers the
MDA’s non-point source programs for pesticides and inorganic fertilizer. These include: monitoring
surface water and groundwater for pesticides; monitoring pesticide use; registering pesticide products;
developing and promoting voluntary best management practices; developing regulatory options; and,
responding to local contamination problems. He previously worked in or managed a variety of other
66
environmental and regulatory programs at the MDA and the Minnesota Pollution Control Agency, and as
an environmental consultant.
Samuel Yamin is the Public Health Scientist for the Minnesota Center for Environmental
Advocacy. Before joining MCEA, Samuel worked as a toxicologist for the New Hampshire
Bureau of Environmental and Occupational Health, and prior to that as an environmental
epidemiologist for the Delaware Division of Public Health. While working for those agencies, his
responsibilities included exposure assessment, risk analysis and hazard communication for pollutants in
water, air, soils and indoor environments. Samuel has also worked extensively on the subject of
environmental carcinogens and the potential impacts on public health. Samuel’s experience in
hazardous materials management and environmental regulatory programs also includes two years of
work with the Environmental Health and Safety Department at Ionics, Inc., a Massachusetts-based
manufacturer of drinking water purification technology. Samuel holds a Master of Public Health in
Environmental Health Sciences from Tufts University School of Medicine and a Bachelor of Science
in Environmental Health and Safety from Oregon State University.
Lisa Yost is a Managing Scientist at Exponent Inc., a national consulting firm, in their Health
Sciences Group and she is based in Saint Paul, Minnesota. Ms. Yost completed her training at the
University of Michigan School of Public Health and is a board-certified toxicologist with
expertise in evaluating human health risks associated with substances in soil, water, and the food
chain. She has conducted or supervised risk assessments under CERCLA, RCRA, or state-led
regulatory contexts involving a wide range of chemicals and exposure situations. Her particular
areas of specialization include exposure and risk assessment, risk communication, and the
toxicology of chemicals such as PCDDs and PCDFs, PCBs, pentachlorophenol (PCP),
trichloroethylene (TCE), mercury, and arsenic. Ms. Yost is a recognized expert in risk assessment
and has collaborated in original research on exposure issues including background
dietary intake of inorganic arsenic. She is currently assisting in a number of projects including a
complex multi-pathway risk assessment for PDDD/Fs that will integrate extensive biomonitoring
data collected by the University of Michigan. Ms. Yost is also an Adjunct Instructor at the
University of Minnesota, School of Public Health.
Rev. May 13 2009
Please submit additions and corrections to [email protected]
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68
Environmental Health Tracking and Biomonitoring
Steering Committee
John Linc Stine (chair)
Assistant Commissioner
Minnesota Department of Health
PO Box 64975
St Paul, Minnesota 55164-0975
651-201-5063
[email protected]
Mary Manning, RD, MBA
Division Director
Health Promotion and Chronic Disease
Division
Minnesota Department of Health
PO Box 64882
St. Paul, Minnesota 55164-0882
651-201-3601
[email protected]
Joanne Bartkus, PhD
Division Director
Public Health Laboratory Division
Minnesota Department of Health
PO Box 64899
St Paul, Minnesota 55164-0899
651-201-5256
[email protected]
Rev. May 13, 2009
Linda Bruemmer,
Division Director
Environmental Health Division
Minnesota Department of Health
PO Box 64975
St. Paul, Minnesota 55164-0975
[email protected]
69
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70
EHTB inter-agency workgroup roster
Frank Kohlasch, JD
Environmental Data Management Unit
Environmental Analysis & Outcomes
Division
Minnesota Pollution Control Agency
520 Lafayette Road N
St. Paul, Minnesota 55155-4194
651-205-4581
[email protected]
Jerry Alholm
Information Systems & Technology Management
Minnesota Department of Health
PO Box 64975
St. Paul, Minnesota 55164-0975
651-201-4973
[email protected]
Michonne Bertrand, MPH
Chronic Disease & Environmental
Epidemiology
Health Promotion and Chronic Disease
Division
Minnesota Department of Health
PO Box 64882
St. Paul, Minnesota 55164-0882
651-201-3661
[email protected]
Louise Liao, PhD
Environmental Laboratory
Public Health Laboratory Division
Minnesota Department of Health
PO Box 64899
St Paul, Minnesota 55164-0899
651-201-5303
[email protected]
Carin Huset, PhD
Environmental Laboratory
Public Health Laboratory Division
Minnesota Department of Health
PO Box 64899
St Paul, Minnesota 55164-0899
651-201-5329
[email protected]
Rita Messing, PhD
Site Assessment & Consultation
Environmental Health Division
Minnesota Department of Health
PO Box 64975
St Paul, Minnesota 55164-0899
651-201-4916
[email protected]
Jean Johnson, PhD
Chronic Disease & Environmental
Epidemiology
Health Promotion and Chronic Disease
Division
Minnesota Department of Health
PO Box 64882
St. Paul, Minnesota 55164-0882
651-201-5902
[email protected]
Pam Shubat, PhD
Health Risk Assessment
Environmental Health Division
Minnesota Department of Health
PO Box 64975
St Paul, Minnesota 55164-0899
651-201-4925
[email protected]
71
John Soler, MPH
Chronic Disease & Environmental
Epidemiology
Health Promotion and Chronic Disease
Division
Minnesota Department of Health
PO Box 64882
St. Paul, Minnesota 55164-0882
651-201-5481
[email protected]
Allan Williams, MPH, PhD
Chronic Disease & Environmental
Epidemiology
Health Promotion and Chronic Disease
Division
Minnesota Department of Health
PO Box 64882
St. Paul, Minnesota 55164-0882
651-201-5905
[email protected]
Erik Zabel, PhD
Environmental Impact Analysis
Environmental Health Division
Minnesota Department of Health
PO Box 64975
St Paul, Minnesota 55164-0899
651-201-4931
[email protected]
Joe Zachmann, PhD
Pesticide & Fertilizer Management Division
Minnesota Department of Agriculture
625 Robert Street North
St. Paul, Minnesota 55155-2538
651-201-6588
[email protected]
Rev. November 14, 2008
72
Glossary of terms used in environmental health tracking and
biomonitoring
Biomarker: According to the National Research Council (NRC), a biomarker is an indicator of a
change or an event in a human biological system. The NRC defines three types of biomarkers in
environmental health, those that indicate exposure, effect, and susceptibility.
Biomarker of exposure: An exogenous substance, its metabolites, or the product of an
interaction between the substance and some target molecule or cell that can be measured
in an organism.
Biomarker of effect: A measurable change (biological, physiological, etc.) within the
body that may indicate an actual or potential health impairment or disease.
Biomarker of susceptibility: An indicator that an organism is especially sensitive to
exposure to a specific external substance.
Biomonitoring: As defined by Minnesota Statute 144.995, biomonitoring is the process by which
chemicals and their metabolites are identified and measured within a biospecimen. Biomonitoring data
are collected by analyzing blood, urine, milk or other tissue samples in the laboratory. These samples
can provide physical evidence of current or past exposure to a particular chemical.
Biospecimen: As defined by Minnesota Statute 144.995, biospecimen means a sample of human
fluid, serum, or tissue that is reasonably available as a medium to measure the presence and
concentration of chemicals or their metabolites in a human body.
Community: As defined by Minnesota Statute 144.995, community means geographically or
nongeographically based populations that may participate in the biomonitoring program. A nongeographical
community includes, but is not limited to, populations that may share a common chemical exposure
through similar occupations; populations experiencing a common health outcome that may be linked to
chemical exposures; populations that may experience similar chemical exposures because of comparable
consumption, lifestyle, product use; and subpopulations that share ethnicity, age, or gender.
Designated chemicals: As defined by Minnesota Statute 144.995, designated chemicals are those
chemicals that are known to, or strongly suspected of, adversely impacting human health or
development, based upon scientific, peer-reviewed animal, human, or in vitro studies, and baseline
human exposure data. They consist of chemical families or metabolites that are included in the federal
Centers for Disease Control and Prevention studies that are known collectively as the National Reports
on Human Exposure to Environmental Chemicals Program and any substances specified by the
commissioner after receiving recommendations from the advisory panel in accordance with the criteria
specified in statute for the selection of specific chemicals to study.
Environmental data: Concentrations of chemicals or other substances in the land, water, or air. Also,
information about events or facilities that release chemicals or other substances into the land, water, or air.
73
Environmental epidemiology: According to the National Research Council, environmental
epidemiology is the study of the effect on human health of physical, biologic, and chemical factors in
the external environment. By examining specific populations or communities exposed to different
ambient environments, environmental epidemiology seeks to clarify the relation between physical,
biologic, and chemical factors and human health.
Environmental hazard: As defined by Minnesota Statute 144.995, an environmental hazard is a
chemical or other substance for which scientific, peer-reviewed studies of humans, animals, or cells
have demonstrated that the chemical is known or reasonably anticipated to adversely impact human
health. People can be exposed to physical, chemical, or biological agents from various environmental
sources through air, water, soil, and food. For EPHT, environmental hazards include biological toxins,
but do not include infectious agents (e.g. E. coli in drinking water is not included).
Environmental health indicators: Environmental health indicators or environmental public health
indicators are descriptive summary measures that identify and communicate information about a
population’s health status with respect to environmental factors. Within the environmental public health
indicators framework, indicators are categorized as hazard indicators, exposure indicators, health effect
indicators, and intervention indicators. See www.cste.org/OH/SEHIC.asp and
www.cdc.gov/nceh/indicators/introduction.htm for more information.
Environmental justice: The fair treatment and meaningful involvement of all people regardless of
race, national origin, color or income when developing, implementing and enforcing environmental
laws, regulations and policies. Fair treatment means that no group of people, including a racial, ethnic,
or socioeconomic group, should bear more than its share of negative environmental impacts.
Environmental health tracking: As defined in Minnesota Statute 144.995, environmental health
tracking is the collection, integration, integration, analysis, and dissemination of data on human
exposures to chemicals in the environment and on diseases potentially caused or aggravated by those
chemicals. Environmental health tracking is synonymous with environmental public health tracking.
Environmental public health surveillance: Environmental public health surveillance is public
health surveillance of health effects integrated with surveillance of environmental exposures and hazards.
Environmental Public Health Tracking Network: The National Environmental Public Health
Tracking Network is a Web-based, secure network of standardized health and environmental data. The
Tracking Network draws data and information from state and local tracking networks as well as
national-level and other data systems. It will provide the means to identify, access, and organize hazard,
exposure, and health data from these various sources and to examine and analyze those data on the
basis of their spatial and temporal characteristics. The network is being developed by the Centers for
Disease Control and Prevention (CDC) in collaboration with a wide range of stakeholders. See
www.cdc.gov/nceh/tracking/network.htm for more information.
Environmental Public Health Tracking Program: The Congressionally-mandated national
initiative that will establish a network that will enable the ongoing collection, integration, analysis, and
interpretation of data about the following factors: (1) environmental hazards, (2) exposure to
environmental hazards, and (3) health effects potentially related to exposure to environmental hazards.
Visit www.cdc.gov/nceh/tracking/ for more information.
74
Epidemiology: The study of the distribution and determinants of health-related states or events in
specified populations, and the application of this study to the control of health problems.
Exposure: Contact with a contaminant (by breathing, ingestion, or touching) in such a way that the
contaminant may get in or on the body and harmful effects may occur.
Exposure indicator: According to the Council of State and Territorial Epidemiologists (CSTE), an
exposure indicator is a biological marker in tissue or fluid that identifies the presence of a substance or
combination of substances that may potentially harm the individual.
Geographic Information Systems (GIS): Software technology that enables the integration of
multiple sources of data and displaying data in time and space.
Hazard: A factor that may adversely affect health.
Hazard indicator: A condition or activity that identifies the potential for exposure to a contaminant or
hazardous condition.
Health effects: Chronic or acute health conditions that affect the well-being of an individual or
community.
Health effect indicator: The disease or health problem itself, such as asthma attacks or birth defects,
that affect the well-being of an individual or community. Health effects are measured in terms of illness
and death and may be chronic or acute health conditions.
Incidence: The number of new events (e.g., new cases of a disease in a defined population) within a
specified period of time.
Institutional Review Board: An Institutional Review Board (IRB) is a specially constituted review
body established or designated by an entity to protect the welfare of human subjects recruited to
participate in biomedical or behavioral research. IRBs check to see that research projects are well
designed, legal, ethical, do not involve unnecessary risks, and include safeguards for participants.
Intervention: Taking actions in public health so as to reduce adverse health effects, regulatory, and
prevention strategies.
Intervention indicator: Programs or official policies that minimize or prevent an environmental
hazard, exposure or health effect.
National Health and Nutrition Examination Survey (NHANES): A continuous survey,
conducted by CDC, of the health and nutritional status of adults and children in the United States. The
survey is unique in that it combines interviews and physical examinations. Since 1970, children in the
survey were biomonitored for lead poisoning, and since 1999, an increasing number of environmental
contaminants has been included in the survey. Visit www.cdc.gov/exposurereport/report.htm for more
information.
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National Human Exposure Assessment Survey (NHEXAS): An EPA survey designed to
evaluate comprehensive human exposure to multiple chemicals on a community and regional scale.
The study was carried out in EPA Region V, of which Minnesota is a part. Individual households from
four Minnesota Counties were included in the survey. Visit www.epa.gov/heasd/edrb/nhexas.htm for
more information.
Persistent chemicals: Chemical substances that persist in the environment, bioaccumulate through
the food web, and pose a risk of causing adverse effects to human health and the environment.
Population-based approach: A population-based approach uses a defined population or
community as the organizing principle for targeting the broad distribution of diseases and health
determinants. A population-based approach attempts to measure or shape a community’s overall health
status profile, seeking to affect the determinants of disease within an entire community rather than
simply those of single individuals.
Prevalence: The number of events (e.g., instances of a given health effect or other condition) in
a given population at a designated time.
Public health surveillance: The ongoing, systematic collection, analysis, and interpretation of
outcome-specific data used to plan, implement, and evaluate public health practice.
Standard: Something that serves as a basis for comparison. A technical specification or written
report drawn up by experts based on the consolidated results of scientific study, technology, and
experience; aimed at optimum benefits; and approved by a recognized and representative body.
Revised October 10, 2007
Please submit additions and changes to [email protected]
76
Acronyms used in environmental health tracking and
biomonitoring
ACGIH
American Conference of Governmental Industrial Hygienists
ATSDR
Agency for Toxic Substances and Disease Registry, DHHS
CDC
Centers for Disease Control and Prevention, DHHS
CERCLA
Comprehensive Environmental Response; Compensation and Liability Act
(Superfund)
CSTE
Council of State and Territorial Epidemiologists
DHHS
US Department of Health and Human Services, including the US Public Health
Service, which includes the CDC, ATSDR, NIH and other agencies
EPA
US Environmental Protection Agency
EHTB
Environmental Health Tracking and Biomonitoring (the name of Minnesota
Statutes 144.995-144.998 and the program established therein)
EPHI
Environmental Public Health Indicators
ICD
International Classification of Diseases
IRB
Institutional Review Board
MARS
Minnesota Arsenic Study, conducted by MDH in 1998-1999
MDA
Minnesota Department of Agriculture
MDH
Minnesota Department of Health
MEHTS
Minnesota Environmental Health Tracking System
MNPHIN
Minnesota Public Health Information Network, MDH
MPCA
Minnesota Pollution Control Agency
NCEH
National Center for Environmental Health, CDC
NCHS
National Center for Health Statistics
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NGO
Non-governmental organization
NHANES
National Health and Nutrition Examination Survey, National Center for Health
Statistics (NCHS) in the CDC
NHEXAS
National Human Exposure Assessment Survey, EPA
NIOSH
National Institute for Occupational Safety and Health, CDC
NIEHS
National Institute of Environmental Health Sciences, NIH
NIH
National Institutes of Health, DHHS
NLM
National Library of Medicine, NIH
NPL
National Priorities List (Superfund)
NTP
National Toxicology Program, NIEHS, NIH
PFBA
Perfluorobutanoic acid
PFC
Perfluorochemicals, including PFBA, PFOA and PFOS
PFOA
Perfluorooctanoic acid
PFOS
Perfluorooctane sulfonate
PHL
Public Health Laboratory, MDH
PHIN
Public Health Information Network, CDC
POP
Persistent organic pollutant
SEHIC
State Environmental Health Indicators Collaborative
Revised October 10, 2007
Please submit additions and changes to [email protected]
78
EHTB statute: Minn. Statutes 144.995-144.998
Minnesota: Environmental Health Tracking and Biomonitoring
$1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount, $900,000 each year is
for transfer to the Minnesota Department of Health. The base appropriation for this program for fiscal year 2010 and
later is $500,000.
(i) "Environmental hazard" means a chemical or
other substance for which scientific, peer-reviewed
studies of humans, animals, or cells have
demonstrated that the chemical is known or
reasonably anticipated to adversely impact human
health.
(j) "Environmental health tracking" means
collection, integration, analysis, and dissemination of
data on human exposures to chemicals in the
environment and on diseases potentially caused or
aggravated by those chemicals.
144.995 DEFINITIONS; ENVIRONMENTAL
HEALTH TRACKING AND
BIOMONITORING.
(a) For purposes of sections 144.995 to 144.998,
the terms in this section have the meanings given.
(b) "Advisory panel" means the Environmental
Health Tracking and Biomonitoring Advisory Panel
established under section 144.998.
(c) "Biomonitoring" means the process by which
chemicals and their metabolites are identified and
measured within a biospecimen.
(d) "Biospecimen" means a sample of human fluid,
serum, or tissue that is reasonably available as a
medium to measure the presence and concentration of
chemicals or their metabolites in a human body.
(e) "Commissioner" means the commissioner of the
Department of Health.
(f) "Community" means geographically or
nongeographically based populations that may
participate in the biomonitoring program. A
"nongeographical community" includes, but is not
limited to, populations that may share a common
chemical exposure through similar occupations,
populations experiencing a common health outcome
that may be linked to chemical exposures,
populations that may experience similar chemical
exposures because of comparable consumption,
lifestyle, product use, and subpopulations that share
ethnicity, age, or gender.
(g) "Department" means the Department of Health.
(h) "Designated chemicals" means those chemicals
that are known to, or strongly suspected of, adversely
impacting human health or development, based upon
scientific, peer-reviewed animal, human, or in vitro
studies, and baseline human exposure data, and
consists of chemical families or metabolites that are
included in the federal Centers for Disease Control
and Prevention studies that are known collectively as
the National Reports on Human Exposure to
Environmental Chemicals Program and any
substances specified by the commissioner after
receiving recommendations under section 144.998,
subdivision 3, clause (6).
144.996 ENVIRONMENTAL HEALTH
TRACKING; BIOMONITORING.
Subdivision 1. Environmental health tracking. In
cooperation with the commissioner of the Pollution
Control Agency, the commissioner shall establish an
environmental health tracking program to:
(1) coordinate data collection with the Pollution
Control Agency, Department of Agriculture,
University of Minnesota, and any other relevant state
agency and work to promote the sharing of and
access to health and environmental databases to
develop an environmental health tracking system for
Minnesota, consistent with applicable data practices
laws;
(2) facilitate the dissemination of aggregate public
health tracking data to the public and researchers in
accessible format;
(3) develop a strategic plan that includes a mission
statement, the identification of core priorities for
research and epidemiologic surveillance, and the
identification of internal and external stakeholders,
and a work plan describing future program
development and addressing issues having to do with
compatibility with the Centers for Disease Control
and Prevention's National Environmental Public
Health Tracking Program;
(4) develop written data sharing agreements as
needed with the Pollution Control Agency,
Department of Agriculture, and other relevant state
agencies and organizations, and develop additional
procedures as needed to protect individual privacy;
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(5) organize, analyze, and interpret available data,
in order to:
(i) characterize statewide and localized trends and
geographic patterns of population-based measures of
chronic diseases including, but not limited to, cancer,
respiratory diseases, reproductive problems, birth
defects, neurologic diseases, and developmental
disorders;
(ii) characterize statewide and localized trends and
geographic patterns in the occurrence of
environmental hazards and exposures;
(iii) assess the feasibility of integrating disease rate
data with indicators of exposure to the selected
environmental hazards such as biomonitoring data,
and other health and environmental data;
(iv) incorporate newly collected and existing
health tracking and biomonitoring data into efforts to
identify communities with elevated rates of chronic
disease, higher likelihood of exposure to
environmental hazards, or both;
(v) analyze occurrence of environmental hazards,
exposures, and diseases with relation to
socioeconomic status, race, and ethnicity;
(vi) develop and implement targeted plans to
conduct more intensive health tracking and
biomonitoring among communities; and
(vii) work with the Pollution Control Agency, the
Department of Agriculture, and other relevant state
agency personnel and organizations to develop,
implement, and evaluate preventive measures to
reduce elevated rates of diseases and exposures
identified through activities performed under sections
144.995 to 144.998; and
(6) submit a biennial report to the chairs and
ranking members of the committees with jurisdiction
over environment and health by January 15,
beginning January 15, 2009, on the status of
environmental health tracking activities and related
research programs, with recommendations for a
comprehensive environmental public health tracking
program.
Subd. 2. Biomonitoring. The commissioner shall:
(1) conduct biomonitoring of communities on a
voluntary basis by collecting and analyzing
biospecimens, as appropriate, to assess environmental
exposures to designated chemicals;
(2) conduct biomonitoring of pregnant women and
minors on a voluntary basis, when scientifically
appropriate;
(3) communicate findings to the public, and plan
ensuing stages of biomonitoring and disease tracking
work to further develop and refine the integrated
analysis;
(4) share analytical results with the advisory panel
and work with the panel to interpret results,
communicate findings to the public, and plan ensuing
stages of biomonitoring work; and
(5) submit a biennial report to the chairs and
ranking members of the committees with jurisdiction
over environment and health by January 15,
beginning January 15, 2009, on the status of the
biomonitoring program and any recommendations for
improvement.
Subd. 3. Health data. Data collected under the
biomonitoring program are health data under section
13.3805.
144.997 BIOMONITORING PILOT
PROGRAM.
Subdivision 1. Pilot program. With advice from
the advisory panel, and after the program guidelines
in subdivision 4 are developed, the commissioner
shall implement a biomonitoring pilot program. The
program shall collect one biospecimen from each of
the voluntary participants. The biospecimen selected
must be the biospecimen that most accurately
represents body concentration of the chemical of
interest. Each biospecimen from the voluntary
participants must be analyzed for one type or class of
related chemicals. The commissioner shall determine
the chemical or class of chemicals to which
community members were most likely exposed. The
program shall collect and assess biospecimens in
accordance with the following:
(1) 30 voluntary participants from each of three
communities that the commissioner identifies as
likely to have been exposed to a designated chemical;
(2) 100 voluntary participants from each of two
communities:
(i) that the commissioner identifies as likely to
have been exposed to arsenic; and
(ii) that the commissioner identifies as likely to
have been exposed to mercury; and
(3) 100 voluntary participants from each of two
communities that the commissioner identifies as
likely to have been exposed to perfluorinated
chemicals, including perfluorobutanoic acid.
Subd. 2. Base program. (a) By January 15, 2008,
the commissioner shall submit a report on the results
of the biomonitoring pilot program to the chairs and
ranking members of the committees with jurisdiction
over health and environment.
(b) Following the conclusion of the pilot program,
the commissioner shall:
(1) work with the advisory panel to assess the
usefulness of continuing biomonitoring among
members of communities assessed during the pilot
program and to identify other communities and other
designated chemicals to be assessed via
biomonitoring;
(2) work with the advisory panel to assess the pilot
program, including but not limited to the validity and
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accuracy of the analytical measurements and
adequacy of the guidelines and protocols;
(3) communicate the results of the pilot program to
the public; and
(4) after consideration of the findings and
recommendations in clauses (1) and (2), and within
the appropriations available, develop and implement
a base program.
Subd. 3. Participation. (a) Participation in the
biomonitoring program by providing biospecimens is
voluntary and requires written, informed consent.
Minors may participate in the program if a written
consent is signed by the minor's parent or legal
guardian. The written consent must include the
information required to be provided under this
subdivision to all voluntary participants.
(b) All participants shall be evaluated for the
presence of the designated chemical of interest as a
component of the biomonitoring process. Participants
shall be provided with information and fact sheets
about the program's activities and its findings.
Individual participants shall, if requested, receive
their complete results. Any results provided to
participants shall be subject to the Department of
Health Institutional Review Board protocols and
guidelines. When either physiological or chemical
data obtained from a participant indicate a significant
known health risk, program staff experienced in
communicating biomonitoring results shall consult
with the individual and recommend follow-up steps,
as appropriate. Program administrators shall receive
training in administering the program in an ethical,
culturally sensitive, participatory, and communitybased manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that address
the science and practice of biomonitoring to be
utilized and procedures for changing those protocols
to incorporate new and more accurate or efficient
technologies as they become available. The
commissioner and the advisory panel shall be guided
by protocols and guidelines developed by the Centers
for Disease Control and Prevention and the National
Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up counseling
and support; and communicating findings to
participants, communities, and the general public.
The informed consent used for the program must
meet the informed consent protocols developed by
the National Institutes of Health;
(3) educational and outreach materials that are
culturally appropriate for dissemination to program
participants and communities. Priority shall be given
to the development of materials specifically designed
to ensure that parents are informed about all of the
benefits of breastfeeding so that the program does not
result in an unjustified fear of toxins in breast milk,
which might inadvertently lead parents to avoid
breastfeeding. The materials shall communicate
relevant scientific findings; data on the accumulation
of pollutants to community health; and the required
responses by local, state, and other governmental
entities in regulating toxicant exposures;
(4) a training program that is culturally sensitive
specifically for health care providers, health
educators, and other program administrators;
(5) a designation process for state and private
laboratories that are qualified to analyze
biospecimens and report the findings; and
(6) a method for informing affected communities
and local governments representing those
communities concerning biomonitoring activities and
for receiving comments from citizens concerning
those activities.
(b) The commissioner may enter into contractual
agreements with health clinics, community-based
organizations, or experts in a particular field to
perform any of the activities described under this
section.
144.998 ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
ADVISORY PANEL.
Subdivision 1. Creation. The commissioner shall
establish the Environmental Health Tracking and
Biomonitoring Advisory Panel. The commissioner
shall appoint, from the panel's membership, a chair.
The panel shall meet as often as it deems necessary
but, at a minimum, on a quarterly basis. Members of
the panel shall serve without compensation but shall
be reimbursed for travel and other necessary
expenses incurred through performance of their
duties. Members appointed by the commissioner are
appointed for a three-year term and may be
reappointed. Legislative appointees serve at the
pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner shall
appoint eight members, none of whom may be
lobbyists registered under chapter 10A, who have
backgrounds or training in designing, implementing,
and interpreting health tracking and biomonitoring
studies or in related fields of science, including
epidemiology, biostatistics, environmental health,
laboratory sciences, occupational health, industrial
hygiene, toxicology, and public health, including:
(1) at least two scientists representative of each of
the following:
(i) nongovernmental organizations with a focus on
environmental health, environmental justice,
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children's health, or on specific chronic diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a representative of
the University of Minnesota.
(b) Two citizen panel members meeting the
scientific qualifications in paragraph (a) shall be
appointed, one by the speaker of the house and one
by the senate majority leader.
(c) In addition, one representative each shall be
appointed by the commissioners of the Pollution
Control Agency and the Department of Agriculture,
and by the commissioner of health to represent the
department's Health Promotion and Chronic Disease
Division.
Subd. 3. Duties. The advisory panel shall make
recommendations to the commissioner and the
legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based on
sound science and practice, and that will advance the
state of public health in Minnesota;
(3) specific chronic diseases to study under the
environmental health tracking system;
(4) specific environmental hazard exposures to
study under the environmental health tracking
system, with the agreement of at least nine of the
advisory panel members;
(5) specific communities and geographic areas on
which to focus environmental health tracking and
biomonitoring efforts;
(6) specific chemicals to study under the
biomonitoring program, with the agreement of at
least nine of the advisory panel members; in making
these recommendations, the panel may consider the
following criteria:
(i) the degree of potential exposure to the public or
specific subgroups, including, but not limited to,
occupational;
(ii) the likelihood of a chemical being a carcinogen
or toxicant based on peer-reviewed health data, the
chemical structure, or the toxicology of chemically
related compounds;
(iii) the limits of laboratory detection for the
chemical, including the ability to detect the chemical
at low enough levels that could be expected in the
general population;
(iv) exposure or potential exposure to the public or
specific subgroups;
(v) the known or suspected health effects resulting
from the same level of exposure based on peerreviewed scientific studies;
(vi) the need to assess the efficacy of public health
actions to reduce exposure to a chemical;
(vii) the availability of a biomonitoring analytical
method with adequate accuracy, precision,
sensitivity, specificity, and speed;
(viii) the availability of adequate biospecimen
samples; or
(ix) other criteria that the panel may agree to; and
(7) other aspects of the design, implementation,
and evaluation of the environmental health tracking
and biomonitoring system, including, but not limited
to:
(i) identifying possible community partners and
sources of additional public or private funding;
(ii) developing outreach and educational methods
and materials; and
(iii) disseminating environmental health tracking
and biomonitoring findings to the public.
Subd. 4. Liability. No member of the panel shall
be held civilly or criminally liable for an act or
omission by that person if the act or omission was in
good faith and within the scope of the member's
responsibilities under sections 144.995 to 144.998.
INFORMATION SHARING.
On or before August 1, 2007, the commissioner of
health, the Pollution Control Agency, and the
University of Minnesota are requested to jointly
develop and sign a memorandum of understanding
declaring their intent to share new and existing
environmental hazard, exposure, and health outcome
data, within applicable data privacy laws, and to
cooperate and communicate effectively to ensure
sufficient clarity and understanding of the data by
divisions and offices within both departments. The
signed memorandum of understanding shall be
reported to the chairs and ranking members of the
senate and house of representatives committees
having jurisdiction over judiciary, environment, and
health and human services.
Effective date: July 1, 2007
This document contains Minnesota Statutes, sections
144.995 to 144.998, as these sections were adopted in
Minnesota Session Laws 2007, chapter 57, article 1,
sections 143 to 146. The appropriation related to
these statutes is in chapter 57, article 1, section 3,
subdivision 4. The paragraph about information
sharing is in chapter 57, article 1, section 169. The
following is a link to chapter 57:
http://ros.leg.mn/bin/getpub.php?type=law&year=20
07&sn=0&num=57
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