Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
September 15, 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
September 15, 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, introductions,
and finalize the June 9
meeting summary
Beth Baker, Chair
1:05
Federal EPHT grant
• Grant work plan and
implications for the
state tracking
program
• National EPHT
network update and
portal demonstration
• Minnesota portal
plans and priorities
Jean Johnson, MN
EHTB Program
Director
Data sharing and rerelease plans: Issues and
challenges
• Water Quality
• Hospitalization
• Cancer
• Birth Defects
• Lead poisoning
Various staff
2:00
2:30
CDC staff
Information sharing.
Panel members are invited to ask questions
and provide input on these items.
Wendy Nelson, Chief
Information Officer,
Information Systems
& Technology
Management
Division
Discussion item.
Panel members are invited to provide
suggestions for addressing the challenges
associated with sharing and re-releasing
tracking data.
Break
i
2:45
2:55
Tracking updates:
Various staff
• Data reports
• Communications and
outreach
• New content areas:
Climate change and
pesticides
• Climate change
capacity-building grant
East Metro PFC
Biomonitoring Study
Information sharing.
Panel members are invited to ask questions or
provide input on any of these items.
Adrienne Kari,
Biomonitoring
Coordinator
Tannie Eshenaur,
Health Risk
Communications
3:15
3:35
Biomonitoring updates:
• Lake Superior
mercury
biomonitoring study
• Riverside prenatal
biomonitoring study
• Summary of grant
application to NIEHS
Various staff
Biomonitoring program:
Next steps
John Linc Stine,
Assistant
Commissioner &
EHTB Steering
Committee Chair
Discussion item.
Panel members are invited to provide
feedback and to recommend further action or
education based on the community response.
Information sharing.
Panel members are invited to ask questions or
provide input on any of these items.
Discussion Item
Panel members are invited to provide input on
establishing priorities and positioning the
program for future opportunities.
Michonne Bertrand,
EHTB Program
Coordinator
Jean Johnson
3:55
New business
Beth Baker
Discussion Item
The chair will invite panel members to
suggest topics for future discussion.
4:00
Adjourn
Next meeting:
Tuesday, December 8, 2009, 1-4 p.m. Red River Room, Snelling Office Park
ii
Meeting Materials for September 15, 2009
Environmental Health Tracking & Biomonitoring Advisory Panel
Table of Contents
Agenda........................................................................................................................................... i
Table of contents ...................................................................................................................... iii
Materials related to specific agenda items
Federal EPHT grant
Section overview: Federal EPHT grant ....................................................................................1
CDC Environmental Public Health Tracking Program grantees (2009) ...................................3
MN Environmental Public Health Tracking Network Implementation Grant Application:
Abstract (August 2009)..............................................................................................................5
CDC promotional materials .....................................................................................................11
Tracking data sharing and re-release plans
Section overview: Tracking data sharing and re-release plans...............................................17
Water quality data ....................................................................................................................19
Cancer data...............................................................................................................................20
Birth defects data .....................................................................................................................22
Lead poisoning data .................................................................................................................23
Tracking updates
Section overview: Tracking updates........................................................................................25
Status Update: Tracking data reports......................................................................................27
Status Update: Tracking communications and outreach.........................................................28
Update: New national EPHT content areas ............................................................................29
Update: Climate change capacity-building grant.....................................................................30
East metro PFC biomonitoring study
Section overview: East metro PFC biomonitoring study.........................................................31
Status update: East metro PFC biomonitoring study ...............................................................33
East Metro PFC Biomonitoring Study: Community feedback ................................................34
East Metro PFC Biomonitoring Study: Meeting evaluation results ........................................41
Biomonitoring updates
Section overview: Biomonitoring updates...............................................................................45
Status update: Lake Superior mercury biomonitoring study ...................................................47
Status update: Riverside prenatal biomonitoring study ...........................................................49
Update: Partnerships for Environmental Public Health Grant Proposal..................................50
Biomonitoring program next steps
Section overview: Biomonitoring program next steps.............................................................53
iii
Excerpt form EHTB statute .....................................................................................................55
Biomonitoring strategic plan (draft) ........................................................................................57
Other materials
Section overview: Other materials.................................................................................................61
REVISED: New PFC citations (added since December 9, 2008) ..................................................63
Local, national and global biomonitoring and tracking news…....................................................75
Draft EHTB advisory panel meeting summary (from June 2, 2009).............................................79
iv
Section Overview Federal EPHT Grant
Minnesota has been awarded a federal grant to be part of the national Environmental Public
Health Tracking Network. Minnesota joins the 17 states and cities that were previously funded as
part of the network and five other new states who have just received funding. (For more
information, see the map of grantees included on the following page.)
The grant, which is for a five-year period, is an implementation grant, which means that
Minnesota is expected to have a state portal up and running within the first year of funding.
This section of the meeting materials includes a copy of the abstract from the grant application
that Minnesota submitted, which includes the project timeline, a list of evaluation measures and a
list of staff. Jean Johnson, program director, and Wendy Nelson, MDH Chief Information
Officer, will provide further information at the advisory panel meeting on grant deliverables and
the implications of receiving the grant for the tracking program.
Also included in this section are some materials that were used during the recent launch of the
national EPHT portal, including a press release, overview fact sheet and list of tracking data
sources. Several staff members from the CDC – who will be in Minnesota as part of a grantee
site visit – will provide further information on the national EPHT program and a demonstration
of the national portal, which can be found at www.cdc.gov/ephtracking.
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.
1
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2
CDC Environmental Public Health Tracking Program
grantees (2009)
3
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4
MN Environmental Public Health Tracking Network
Implementation Grant Application: Abstract (August 2009)
Background
Public health tracking systems are critical in preventing and controlling disease in populations.
Having accurate and timely tracking data permits public health authorities to determine disease
impact and trends, identify populations and geographic areas most affected, and develop and
assess the effectiveness of policy and environmental public health interventions. The availability
of these types of data in a standardized tracking network will enable researchers, public health
authorities, healthcare practitioners, and the public to understand the possible associations
between the environment and public health outcomes, and use that information in support of
actions that improve the health of communities.
A key characteristic of environmental public health tracking is the emphasis on data integration
across health, human exposure, and hazard information systems. The National Environmental
Public Health Tracking Network (Tracking Network) is the first national effort to provide the
United States with standardized data from multiple health, exposure, and hazard information
systems that includes linkage of these data as part of regular tracking activities.
The Minnesota Legislature, in 2007, passed a state law establishing the Minnesota
Environmental Public Health Tracking (MN EPHT) and Biomonitoring Programs at the
Minnesota Department of Health (MDH). In the first two years of this program MN EPHT has
assessed the available data systems, supported collaborations with program partners, and
analyzed and reported on tracking measures consistent with national data and measures in the
CDC Tracking Network. MN EPHT has actively participated in national workgroups and
contributed to network development. MN EPHT has evaluated information technology needs
and selected the Indicator Based Information System for Public Health (IBIS-PH) for
implementing the MN EPHT public and secure data portals.
This application is submitted by the MN EPHT program at MDH in response to funding
opportunity CDC-RFA-EH09-907. MN EPHT is requesting funding to enter into the Tracking
Network at the implementation phase the project. MN EPHT is ready to enter the program at this
phase because of the substantial planning, progress and capability exhibited by MN EPHT. MN
EPHT looks forward to collaborating with CDC and other appropriate partners to build statewide
networks, to adopt already developed standards and specifications for the implementation of
these networks, and to participate in the development of future standards and specifications.
Goals of MN EPHT
As an awardee, MN EPHT plans to carry out the proposed activities for accomplishing 4 primary
goals identified in the strategic plan developed by MN EPHT staff and the Advisory Panel and
Steering Committee. MN EPHT will join the work of CDC to further develop the Tracking
Network by developing a strong environmental public health tracking system for Minnesota;
ensure environmental public health tracking data are accessible and used; build awareness,
knowledge and skills among potential data users related to environmental public health tracking
in order to inform actions to improve public health; and build collaborations that enhance the
5
environmental public health tracking network for monitoring the public health impacts of
environmental hazards and exposures in Minnesota communities.
Proposed Activities Include
Within 3 months of the award, MN EPHT will formalize and update data sharing agreements and
re-release plans with data stewards; establish procedures for expediting response to requests for
access to restricted datasets (primarily county level data) from MN EPHT that are maintained on
the CDC Tracking Network’s Secure Portal.
Within 6 months of the award, MN EPHT will update and transfer nationally-consistent data and
measures (NCDMs) not currently available to the CDC from national data sources and their
associated metadata to the national Tracking data repository, to include hospitalizations data for
asthma, MI, and carbon monoxide poisonings, as well as all drinking water NCDMs.
Within 12 months of the award, MN EPHT will complete the deployment of MN EPHT’s secure
and public tracking portals; track and make available NCDMs in all content areas on both the
local and national networks; compile metadata on data using the tracking metadata standard and
tools; and make the metadata available on the state tracking network as well as on the national
metadata registry.
MN EPHT will develop and adopt a three-phase outreach and network promotion strategy
consistent with national guidelines; conduct an audience needs assessment and provide training
opportunities for at least 3 identified audiences, including the local public health department
workforce, to promote the network, and to build knowledge and skills of data users.
MN EPHT will continue to build strong collaborations with stakeholders and academic partners
to guide program priorities and future development of new NCDMs or MN-specific tracking data
and measures with the goal of incorporating these data into a tracking network for the
jurisdiction, and will share lessons learned with state and national network partners.
6
MN EPHT Proposal: Goals and Objectives Timeline
Year 1
Year 2
Year 3
Year 4
Year 5
Quarters
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
1. Develop a strong MN EPHT system
A. Maintain and strengthen current structure
of staff and partners.
B. Formalize data sharing agreements and
data re-release plans with MN data stewards.
C. Update NCDMs on hospitalizations, CO
poisonings, and drinking water quality.
D. Compile metadata and make available on
national metadata registry.
E. Participate in conference calls and
workshops to develop and improve NCDMs.
F. Evaluate MN EPHT system attributes.
G. Identify system strengths and weaknesses
and document recommendations.
2. Ensure MN EPHT data are accessible and
used
A. Customize and promote IBIS software to
production and install security module.
B. Submit NCDMs and metadata on
hospitalizations, CO poisonings, and
drinking water quality to CDC.
C. Promote NCDMs and metadata on
hospitalizations, CO poisonings, and
drinking water quality to MN public portal.
D. Install secure portal and query interface
for public portal of MN IBIS.
E. Submit remaining NCDMs and metadata
to CDC and MN public and secure portal.
F. Implement mapping and GIS into MN
IBIS.
G. Select and implement new measures for
inclusion into MN IBIS.
H. Migrate existing vital statistics portal
functions into MN IBIS.
I. Explore capabilities of MN IBIS for
presentation of MEDSS.
J. Review MN IBIS for potential technical
upgrades.
7
3. Build awareness, knowledge and skills
among potential MN EPHT data users
A. Create a three-phase communications and
outreach plan.
B. Update existing program messages to
reflect the broader scope of MN EPHT as a
national EPHT network partner.
C. Define key messages and audiences for
MN network and program.
D. Complete needs assessment of local
public health on portal use.
E. Conduct outreach and trainings for local
public health on portal use.
F. Design, conduct and evaluate training and
outreach for additional audiences.
G. Conduct presentations on MN EPHT to
advance tracking knowledge.
4. Build collaborations to enhance MN EPHT
A. Conduct stakeholder group meetings to
identify data gaps and information needs.
B. Identify data sources and methods for
developing new MN-specific data and
measures.
C. Develop and implement a plan for
promoting partnerships between state and
academic scientists to conduct data linkages
using MN EPHT data.
D. Pilot test new MN EPHT measures for
inclusion into national network.
8
MN EPHT Proposal: Measures of Effectiveness for Performance Goals
Goal 1: Data Content and Quality
Advisory Panel will meet ≥4 times a year and MN’s Technical Team will meet ≥12 times a year.
NCDMs will be updated through 2007 and accompanying metadata will be created within 12
months of implementation.
MN’s Technical Team will actively participate in workgroup conference calls and contribute at
Tracking Network workshops and annual meetings to advance tracking goals and objectives.
Each NCDM and overall system attributes will be evaluated in accordance with surveillance
evaluation guidelines and criteria.
System strengths and limitations will be documented, and recommendations for system
improvements will be reported to CDC and state program officials.
Goal 2: Information Technology
MN IBIS implementation will leverage established MN Tracking/PHIN services.
MN IBIS technical infrastructure will be consistent with the technical architecture adopted by the
Department of Health and the State of MN.
MDH will design and build MN IBIS with appropriate web design for accessibility.
Project management documents will be filed and updated according to implementation schedule.
Portals will be updated with NCDMs and MN-specific data and measures according to schedules
agreed upon with data stewards.
MN’s IBIS implementation will follow established PHIN standards and specifications.
Goal 3: Communications
Messages will be developed to accompany each NCDM on MN’s portal.
A needs assessment will identify specific needs and methods for communication and training
about EPHT data for local public health (LPH).
A 3-phase communications and outreach plan will be developed to meet needs of key audiences
for MN EPHT data and messages consistent with CDC guidance.
Training programs, publications and tutorials will be designed, conducted and evaluated to
address needs of LPH and ≥2 additional key audiences/users of MN EPHT data and messages.
MN EPHT data and concepts will be presented at professional conferences, seminars or
academic institutions each year.
Goal 4: Collaborations
At least 2 meetings with each of 3 stakeholder groups will be held by the end of PY3.
MN EPHT’s strategic plan will be updated in PY3 to incorporate new tracking data sources,
tools, priorities and needs for refinement of existing NCDMs and development of new measures.
New measures will be piloted and integrated into MN EPHT in accordance with priorities and
needs of program stakeholders.
New partnerships will be established with academic scientists to conduct data linkage or new
method development projects using EPHT data and resources.
9
MN EPHT Proposal: MN EPHT Interagency Technical Team Members
National Workgroups
Program Marketing and
Outreach (PMO)
Portal Analysis,
Visualization and
Reports (PAVR)
Standards and Network
Development (SND)
National Content
Areas
Air Quality
Water Quality
MN EPHT Staff
Michonne Bertrand, MDH/CDEE
MN EPHT Staff
Data Steward Contact
MN Data System
Kari Palmer, MPCA
Deanna Scher, MDH/EH
Cassie McMahon, MPCA
Randy Ellingboe, MDH/EH
Blood Lead
Jeannette Sample, MDH/CDEE
Erik Zabel, MDH/EH
Hospitalizations
Jeannette Sample, MDH/CDEE
Tom Major, MDH/HP
Cancer
Jeannette Sample, MDH/CDEE
John Soler, MDH/CDEE
Birth Defects
Jeannette Sample, MDH/CDEE
Myron Falken, MDH/EH
Birth Outcomes
Carbon Monoxide
Poisonings
Jeannette Sample, MDH/CDEE
Adrienne Kari, MDH/CDEE
Judy Palermo, MDH/CHS
Jon Roesler, MDH/CHP
MN Content Areas
(Developmental)
Climate Change
MN EPHT Staff
Data Steward Contact
Air Quality System
MN Drinking Water
Information System
Blood Lead
Surveillance System
MN Hospital
Discharge Database
(MNHDD)
MN Cancer
Surveillance System
Birth Defects
Surveillance System
Vital Statistics
Injury MNHDD and
Mortality
MN Poison Center
MN Data System
Jeannette Sample, MDH/CDEE
Wendy Brunner, MDH/CDEE
Pesticide Poisonings
Adrienne Kari, MDH/CDEE
Deborah Anderson, HRPC
Pesticide Hazards
Deanna Scher, MDH/EH
Joe Zachmann, MDA
Asbestos-related
Respiratory Disease
Air Toxics/Risks
Allan Williams, MDH/CDEE
John Soler, MDH/CDEE
Kari Palmer, MPCA
Greg Pratt, MPCA
Paula Lindgren, MDH/CDEE
Jerry Alholm, MDH/ISTM
Department and Division Acronyms
MDH/CDEE: Chronic Disease and Environmental Epidemiology
MDH/EH: Environmental Health
MDH/ISTM: Information Systems & Technology Management
MDH/HP: Health Policy
MDH/CHS: Center for Health Statistics
MDH/CHP: Center for Health Promotion
MPCA: MN Pollution Control Agency
MDA: MN Department of Agriculture
HRPC: Hennepin Regional Poison Center at Hennepin County Medical Center
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Hospitalizations
Vital Statistics
Pollen monitoring
Hospitalizations
Vital Statistics
MN Poison Center
Pesticide Use, Sales
HSEES
MN Cancer
Surveillance System
MNRiskS and Natl.
Air Toxics (NATA)
Press Release __________________________________________________________________________________________
For Immediate Release
Tuesday July 7, 2009
Contact:
CDC Division of Media Relations
(404) 639-3286
CDC Launches New Environmental Public Health Tracking Network
Revolutionary Environmental Health Tracking Tool designed to help improve and protect our nation’s health
The Centers for Disease Control and Prevention announced today the launch of the Web-based Environmental Public
Health Tracking Network, a surveillance tool that scientists, health professionals, and – for the first time – members of the
public can use to track environmental exposures and chronic health conditions.
“The ability to examine many data sets together for the first time has already resulted in faster responses to environmental
health issues. We believe the Tracking Network holds the potential to shed new light on some of our biggest
environmental health questions,” said Howard Frumkin, M.D., M.P.H., DrPh., director, of CDC’s National Center for
Environmental Health.
The web-based tool unites vital environmental information from across the country, including air and water pollutants
and information for some chronic conditions, including asthma, cancer, childhood lead poisoning and heart disease into
one resource.
While scientists know exposures such as air particle pollution and lead contribute to illnesses, many environmental and
health connections remain unproven since detailed health and environmental data existed in separate silos until now.
“The Tracking Network is the foundation we need to make better environmental health decisions and help prevent
chronic illnesses, such as asthma, cancer, and heart disease,”
said Michael McGeehin, Ph.D., director, Division of Environmental Hazard and Health Effects of CDC’s National Center
for Environmental Health.
CDC funds projects in California, Connecticut, Florida, Maine, Maryland, Massachusetts, Missouri, New Hampshire,
New Jersey, New Mexico, New York, Oregon, Pennsylvania, Utah, Washington, Wisconsin, and New York City.
To date, their projects have led to 73 public health actions to control potential illnesses from environmental exposures.
For example, the Utah Department of Health received a call from a citizen concerned about cases of cancer in his
neighborhood. In the past, a similar call would have prompted a study that would have taken up to a year to complete,
11
with most of that time spent waiting for data. In less than a day, the Utah Tracking Program was able to let this resident
know that the likelihood of cancer in his area was no greater than in the state as a whole.
Massachusetts ranks third in the United States for prevalence of asthma. When Massachusetts Tracking staff conducted
asthma surveillance and indoor quality assessments in schools, a significant association between mold/moisture and the
prevalence of asthma was found. Based on tracking data, Massachusetts staff are working with school officials to correct
mold/moisture problems and to enact policy changes for reducing mold and moisture in schools.
In March 2009, CDC received additional funding from Congress to expand environmental public health tracking to five
more locations. Awards will be made and announced later this summer. Over time, CDC hopes to expand the Tracking
Network across all 50 states, and track additional environmental hazards and health conditions to build a more complete
picture of environmental public health.
CDC’s Tracking Network is the result of collaboration with 17 local and state health departments; federal partners,
including the National Aeronautics and Space Administration, the National Cancer Institute, the U.S. Environmental
Protection Agency and the U.S. Geological Survey; and organizations including the American Public Health Association,
Association of State and Territorial Health Officials, Council of State and Territorial Epidemiologists, National
Association of County and City Health Officials, National Environmental Health Association, National Association of
Health Data Organizations and the National Association for Public Health Statistics and Information Systems.
For more information please visit the Tracking Network at www.cdc.gov/ephtracking. Watch the YouTube video at
http://www.youtube.com/user/CDCStreamingHealth.
###
U.S. Department of Health and Human Services
12
CDC’s National Environmental Public Health Tracking Network
Keeping Track, Promoting Health
Closing the Gap
For decades, the United States has faced a fundamental
gap in knowing how environmental contaminants
affect people’s health. The Centers for Disease Control
and Prevention (CDC) is working to close this gap by
improving surveillance through the Environmental
Public Health Tracking Network (Tracking Network).
The Tracking Network is a dynamic Web-based tool that
tracks and reports environmental hazards and the
health problems that may be related to them. The
Tracking Network is unique because, for the first time,
we are able to see environmental data and public health
data together in one place. This allows scientists, health
professionals, policymakers, and members of the public
to see where these hazards and health problems are
occurring and how they are changing over time.
Scientists will be better able to assess the connections
between the environment and its effect on health.
Public health professionals now can easily assess
unusual trends and events to determine which
communities may be at risk.
Parents can learn about conditions such as asthma or
the presence of contaminants in the air in counties
where they live and take action to protect their children.
Elected officials can see their community’s air quality
trends to determine if actions taken to reduce pollution
levels are working.
Using New and Existing Data
Understanding how the environment affects people’s
health requires many different types of data from many
different sources. To lay the foundation for the national
Tracking Network, CDC is funding health departments
in 16 states and 1 city to build local tracking networks.
These partners send data from their local tracking
systems to the national Tracking Network to help CDC
and other researchers monitor and identify trends in
environmental public health data. For example, the
Tracking Network can show standardized asthma
hospital admission rates in the 16 participating states,
which is the first step in identifying local area trends
Key Features
•
•
•
Standardized environment and health data
across contributing states
Information by location
Easy to read maps, charts, and tables
Health conditions on the Tracking Network:
•
Asthma
•
Birth defects (Coming soon)
•
Cancer
•
Carbon monoxide poisoning
•
Childhood lead poisoning
•
Heart attacks
•
Reproductive and birth outcomes
(Coming soon)
Environmental data on the Tracking Network:
•
Air quality related to ozone and particulate
matter (PM2.5)
•
Community water
•
Well water
that may differ from known national level trends in
asthma hospitalizations. Each state is also able to use
their local tracking network to monitor environmental
public health issues that are important in their communities. In addition to these health departments, CDC is
partnering with four other federal agencies to provide
data and expertise for development of the Tracking
Network; the Environmental Protection Agency, the U.S.
Geological Survey, the National Cancer Institute, and
the National Aeronautics and Space Administration.
The Future of Tracking
The Tracking Network will continue to grow as CDC
increases the types of data available and adds new
functionality. Plans also include supporting more states,
cities, and counties to contribute data to the Network.
This expansion will allow more people from around the
country to see vital public health and environment
information about their communities.
Visit CDC’s Tracking Network today: www.cdc.gov/ephtracking
June 2009
Tracking In Action
CDC and its partners have made great strides in building an information network to guide health protection
decisions. Since 2005, environmental public health tracking has led to 73 public health actions to prevent or
control potential health effects from environmental exposures. These actions are focused on local concerns such
as pesticide poisoning and factory emissions, and national issues such as cancer. The stories below are just a few
examples of the kinds of actions that are happening in all of our funded health departments.
Maine:
Carbon monoxide poisoning has
been an ongoing public health
concern since a major outbreak of
poisonings happened after a 1998
ice storm that left half of Maine's
population without power for days
or weeks. The Maine Tracking
program can now track data on the number of carbon monoxide poisonings each year, and the percent of Maine homes
with a carbon monoxide alarm. These data have been used to
influence state policy and as a result carbon monoxide poisoning is now a reportable condition in Maine. There is also a new
law requiring carbon monoxide alarms in rental property, new
homes, and existing homes when there is a transfer of ownership. In addition to policy change, the Maine Tracking
program developed radio and television public service
announcements that are used during major weather events in
the state to help people prevent carbon monoxide poisoning.
New York City:
In 2008, the New York City Tracking
Program took action to better
understand
and
characterize
short-term health effects and
injuries associated with the use of
total release foggers, more
commonly known as bug bombs.
Year after year, reports had appeared in the media about fires
and explosions triggered by bug bombs, yet little information
existed about how severe or widespread the health problems
were, related to these devices. After reviewing available
national and local data, the NYC tracking program partnered
with the National Institute for Occupational Safety and Health,
other state health departments, and the NYC Poison Control
Center to publish findings on reported bug bomb incidents.
Findings included data for a range of injuries and illness, from
severe irritation of the eyes and throat, to nausea and shortness of breath. In NYC, many events involved the deployment
of bug bombs in large multi-unit apartment buildings, and
injuries were often caused because neighboring tenants were
not notified. The NYC Tracking Program had previously documented that bug bombs and pesticide sprays are more likely
to be used in low-income neighborhoods, rather than safer
alternatives such as bait stations, gels, and other integrated
pest management strategies. This information led the health
department, in partnership with the NY State Department of
Environmental Conservation, to pursue the restriction of bug
bomb use by the public, making the devices only available for
purchase and use by licensed pest control professionals. NYC
has also encouraged the EPA to restrict use of total release
foggers nationwide.
Utah:
The Utah Department of Health
received a call from a citizen
concerned about cases of cancer in
his neighborhood. In the past, a
similar call would have prompted a
study that would have taken up to a
year to complete, with most of that
time spent waiting for data. In less than a day, the Utah Tracking Program was able to let this resident know that the
likelihood of cancer in his area was no greater than in the state
as a whole. To make this conclusion, the Utah Tracking staff
used an analytic tool developed with tracking funds to
conduct two independent investigations, related to space and
time, of the rates of cancer centered on the citizen’s residential
location. This is a substantial improvement in the time and
cost required for cancer investigations in the past and in the
services Utah’s Tracking Program is able to provide to their
citizens.
Wisconsin:
The Wisconsin Department of Health Services received questions about the level of trichloroethylene (TCE) emissions from
a Wisconsin industrial facility. The Wisconsin Tracking Program
produced data on exposure from that industrial facility. This
prompted the facility’s owner to voluntarily agree to changes
to eliminate TCE emissions altogether. While the facility was in
compliance with all applicable emission permit requirements,
the Wisconsin Tracking program’s data was compelling
enough to encourage the owner to make improvements. This
project reduced community TCE exposure. It now serves as a
model for how air pollutant data can identify high-risk
communities, and can translate into reduced exposure to air
toxics.
Tracking Network state & city partners
California
Connecticut
Florida
Maine
Maryland
Massachusetts
Missouri
New Hampshire
New Jersey
New Mexico
New York State
New York City
Oregon
Pennsylvania
Utah
Washington
Wisconsin
National Environmental Public Health Tracking
Network Data Sources
The National Environmental Public Health Tracking Network is a system of integrated health, exposure,
and hazard data from a variety of national, state, and city sources.
Data from State and City Sources
CDC provides funds for 17 state and local health departments to develop local tracking networks that
contribute to the National Tracking Network. These health departments supply the data below.
Health
Department
Asthma
Hospitalizations
Carbon
Monoxide
Hospitalizations
Carbon
Monoxide
Emergency
Visits
Heart Attack
Hospitalizations
Community
Drinking Water
Supply
California
Connecticut
Florida
Maine
Maryland
Massachusetts
Missouri
New Hampshire
New Jersey
New Mexico
New York City
New York State
Oregon
Pennsylvania
Utah
Washington
Wisconsin
www.cdc.gov/ephtracking
15
CS203082-A
June 2009
National Environmental Public Health Tracking Network Data Sources
Data from National Sources
Federal agencies provide data to the National Tracking Network for the content areas shown below. Though these data are from
national sources, each agency provides data for only the shaded states.
Air Quality Monitoring
Well Water Monitoring
PM2.5 and Ozone
Source: U.S. Environmental Protection Agency
Source: U.S. Geological Survey
WA
WA
MT
ME
ND
OR
VT
NH
MN
ID
WI
SD
NV
IA
CO
MO
VA
KY
OK
NM
AR
ID
NV
CO
MO
OK
NM
AR
SC
MS
FL
GA
AL
LA
TX
AK
DC
NC
TN
AZ
GA
AL
VA
KY
RI
NJ
DE
MD
OH
IN
WV
KS
CT
PA
IL
UT
CA
DC
IA
NE
MA
NY
MI
WY
LA
TX
WI
SD
RI
SC
MS
VT
NH
NC
TN
AZ
ME
ND
MN
NJ
DE
MD
OH
IN
WV
KS
CT
PA
IL
UT
CA
MA
NY
MI
WY
NE
MT
OR
FL
AK
HI
HI
Rate of New Cancer Cases
Source: National Cancer Institute
WA
MT
ME
ND
OR
VT
NH
MN
ID
WI
SD
IA
NE
NV
UT
CA
MO
VA
KY
OK
NM
AR
SC
AL
MS
TX
DC
NC
TN
AZ
RI
NJ
DE
MD
OH
IN
WV
KS
CT
PA
IL
CO
MA
NY
MI
WY
GA
LA
FL
AK
HI
Age of Housing
Childhood Lead Poisoning
Testing and Results for Lead Poisoning
Source: CDC
Indicator for Lead-Based Paint in Homes
Source: U.S. Census Bureau and CDC
WA
WA
MT
ME
ND
OR
VT
NH
MN
ID
WI
SD
IA
NE
NV
UT
CA
PA
IL
CO
OH
IN
WV
KS
MO
VA
KY
OK
NM
AR
DC
AL
ID
WI
SD
RI
IA
NE
NV
UT
CA
PA
IL
CO
OH
IN
WV
KS
MO
VA
KY
NC
TN
AZ
OK
NM
AR
GA
SC
MS
TX
LA
HI
HI
16
www.cdc.gov/ephtracking
AL
GA
LA
FL
AK
MA
NY
MI
WY
FL
AK
VT
NH
MN
SC
MS
TX
CT
NJ
DE
MD
ME
ND
NC
TN
AZ
MA
NY
MI
WY
MT
OR
CT
NJ
DE
MD
DC
RI
Section overview: Tracking data sharing and re-release
plans
One of the requirements of the CDC EPHT grant is that a formal memorandum of understanding
(MOU) must be developed with each data steward from which the MN EPHT program receives
data. Because tracking data consist of information gathered by other programs and agencies,
often for other uses, careful attention must be made to ensuring that the data released by the
tracking program remain in compliance with relevant statutes and that data stewards’ concerns
about sharing the data are addressed. This is especially important as it relates to releasing
information through a web-based portal.
MN EPHT staff have been working with data stewards to identify their concerns related to the
sharing and re-release of data, as well as their concerns related to the messages that accompany
the data.
This section contains summaries on the issues and challenges associated with several content
areas:




Water quality data
Cancer data
Birth defects data
Lead poisoning data
Information on hospitalization data will be provided at the September 15 meeting. Several data
stewards will be present at the meeting to discuss the issues and challenges associated with their
data. Advisory panel members are invited to provide suggestions for addressing the challenges
associated with the re-release and sharing of the data.
ACTION NEEDED: At this time, no formal action is needed by the advisory panel. However,
advisory panel members are invited to provide suggestions for addressing the challenges
associated with the re-release and sharing of the data.
17
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Water quality data
Legal authority
Under the federal Safe Drinking Water Act (SDWA), EPA sets standards for drinking water
quality and oversees the states, localities, and water suppliers who implement those standards.
According to SDWA, it is the responsibility of each water system to collect SDWA compliance
samples. In Minnesota, the MDH Drinking Water Protection (DWP) Section collects a service
connection fee to collect required samples. The authority of MDH to take action on a SDWA
violation is part of its primacy agreement with EPA.
Limitations to data sharing and re-release
All results in the Minnesota Drinking Water Information System (MNDWIS) data base are
considered public information, with some exceptions. Since lead and copper are measured at
household taps, lead and copper locational data (i.e., the homeowner’s address) are considered
private data. Lead and copper data can be published as public data when aggregated such that
individual homes cannot be identified. Information that is being used as part of an enforcement
investigation is also considered private data until after the enforcement action is complete.
Issues/barriers
If MNDWIS data are compiled and presented in a way that DWP doesn’t normally present the
data, it may be more difficult for DWP to explain what the data mean. To insure the accuracy of
data and content, DWP would like to be part of any review process prior to publication of EPHT
data. This should be included in any memorandum of understanding between the programs.
19
Cancer data
The following is meant to outline legal constraints on Minnesota Cancer Surveillance System
(MCSS) data release as well as scientific considerations relative to data use by the
Environmental Health Tracking Programs.
Legal authority
The MCSS is Minnesota’s statewide, population-based cancer registry. It was mandated by the
state legislature in 1987 to collect information on all newly diagnosed cancers among Minnesota
residents. The enacting legislation (Minnesota Statutes 144.671-144.69) establishing MCSS
states the purpose of the system, classifies the data as private, describes how the data may be
used, under what conditions data may be released to researchers and penalties for inappropriate
disclosure of private data. Specifics of the above are contained in rules 4606.3300-4606.3309.
Limitations to data sharing and re-release
Broadly speaking, MCSS data can be released only in such a way that no individual in the data
can be identified. The standard (Minn. Stat. 144.6581) is that if a trained epidemiologist with
knowledge of available databases could identify an individual, then these data cannot be
released. Because race is a variable included in the MCSS dataset along with age and year of
diagnosis, and because some geographic locations even at the county level contain very few
individuals of a particular race and age, this limits the information that can be transmitted in a
line listing of cases. For all intents and purposes, only aggregated data has been released with the
exception of some line listings at a statewide level (no county specific information) for example
to the National Program of Cancer Registries (CDC). We have often offered to provide
aggregated data at a county level to CDC, but that offer has not been accepted.
As described in the above statutes and rules, MCSS may release identifying information to
researchers in certain situations. A researcher may obtain private information after submitting an
application which is evaluated by a scientific peer review committee for social and scientific
merit. Upon approval of the application by the commissioner, a contract is established by which
the researcher is held to the same standards for protection of privacy as MCSS, and stipulates
(per Minn. Stat. 144.69) that, unless the subject of the data has already given approval, the
attending physician or surgeon must give consent before any patient can be contacted. The costs
of that process are borne by the researcher. The purpose of these restrictions is to provide a
means by which each subject of the data has knowledge of who has access to his/her data.
Issues/barriers
Data from MCSS has been requested by the Environmental Health Tracking Program for use on
a national portal. It has always been a goal of MCSS that its data be used by researchers to help
determine the etiology of cancers and to support effective prevention strategies. MCSS has
supported dozens of research efforts over the years. With the recent availability of appropriate
software, MCSS has been working to provide better access to the data by the public. Having
20
Minnesota cancer data on an internet portal with a user friendly, point and click interface is
desirable. However, scientific and communication considerations lead us to recommend that all,
or at least most, cancer sites be available for viewing, not just the thirteen sites chosen by
environmental health tracking. The fact that particular sites have been chosen leads to the
impression that there is adequate scientific evidence to think that these cancers are caused by
polluting sources in our environment. One example where this is not the case is breast cancer
which has been and continues to be the focus of numerous studies hypothesizing endocrine
disruptors as a cause of breast cancer. Though interesting studies continue, to date, the results of
these studies are inadequate to suggest even an association between polluting factors and breast
cancers. Two cancer types in particular are not included on the portal, melanoma and
mesothelioma. These are caused by UV radiation and asbestos respectively, both of which are
strong, well-established environmental risk factors. Because of its legislative mandate to use the
collected data to “accurately target .. resources” and “promote high quality research” (emphasis
added), MCSS advocates that all cancer sites be included so as to avoid the inevitable and
difficult decision of which cancer sites “merit” inclusion on a web site emphasizing the
environment (however that is defined). Consistent with its legislative mandate to “inform health
professionals and the public about risks…”, MCSS also advocates that any web site with MCSS
data should be an educational tool about cancer, its causes and prevention. We therefore have an
interest in the message conveyed by any portal with MCSS data. At present there are a number
of problems in the messages on the national portal although we realize that this is a work in
progress and will likely be improved as they receive comments.
21
Birth defects data
Legal authority
The Birth Defects Information System (BDIS) is authorized by Minnesota Statutes 144.2215
through 144.2219, which were passed in 2004. The system began data collection in 2005. Parents
of children included in the system may choose to “opt-out” of the system, which means that the
child’s personal information (name, date of birth, address, medical record numbers, guardian
information) are removed. The county of residence and all birth defect information are retained.
Birth defects information is considered private data, which falls under state statute 13.02. The
data may be shared with other state agency or local agencies for the purposes stated in 144.2215
provided the other agencies agree to maintain the private classification of data.
Limitations to data sharing and re-release
Data that does not contain identifying information may be shared with research entities if
approved by the commissioner and IRB. If research entities want data that includes identifying
information, MDH must obtain informed consent from the parents of the children before giving
the data out. MDH is in the process of setting up a scientific review panel to advise the
commissioner about research data requests.
Issues/barriers
Sharing de-identified data for presentation in aggregate should not be a problem. The MDH IRB
should approve the use of birth defects data by the EH Tracking program if it is considered a
research activity. For some birth defects there are very few cases per year. In general when cell
sizes are less than five, the data should be presented as “<5” to preserve anonymity. Any
memorandum of understanding should include a phrase stating that Birth Defects staff must
review any reports generated by the data prior to their release. Birth Defects staff should be
involved in determining the way Birth Defects data are presented on the EH Tracking portal. The
Birth Defects program will not release data until it has been checked for completeness and
accuracy. Bear in mind that the BDIS currently performs surveillance for only Hennepin and
Ramsey Counties, and only for 45 birth defects as defined by the National Birth Defects
Prevention Network and CDC.
22
Lead poisoning data
Legal authority
The Blood Lead Information System is authorized by Minnesota Statutes 144.9501 through
144.9504, with additional statutes and rules governing licensing of lead professionals and
inspection of homes where children have had a confirmed elevated blood lead level. Any
laboratory performing analysis of blood lead specimens from Minnesota residents must submit
the results to MDH, regardless of the blood lead level and age of the patient. Accurate statewide
blood lead data are available going back to 1995.
Limitations to data sharing and re-release
Blood lead data are considered private. The statute allows sharing of individual private blood
lead data with a very limited set of agencies, including local health departments, tribal entities,
and the commissioner of labor and industry (Minnesota OSHA). Sharing of data that does not
contain identifying information is not mentioned.
Issues/barriers
For the most part, issues related to sharing of de-identified or aggregate blood lead data will be
identical to the issues described above for birth defects.
23
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24
Section overview: Tracking 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 status updates on the following items:

Tracking data reports

Tracking communications and outreach

New national EPHT content areas

Climate change capacity-building grant
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
A series of tracking reports is planned for release on the updated MN EPHT website later this
fall. Each report will contain a primer on MN EPHT, a summary of the data and measures for
each indicator, data highlights as well as detailed data tables and graphs, and resources for more
information. Report content will be reviewed by the appropriate MDH data stewards and
stakeholders. Each report has a unique cover created by a graphic designer. Prints of this year’s
reports and any updates will be presented in a three-ring binder for desktop reference.
The first reports to be completed will be for the hospitalization, reproductive outcomes, water
quality and carbon monoxide poisoning measures. Childhood lead poisoning, air quality, and
birth defects reports will follow.
27
Status Update: Tracking Communications and Outreach
As of August 1, 2009, MN EPHT joined CDC’s national Environmental Public Health Tracking
Network (EPHTN). The EPHTN is a system of integrated health, exposure, and hazard
information and data from a variety of national, state, and city sources. As a grantee, MN
EPHT’s long-term communications goal is to build awareness, knowledge and skills among data
users related to environmental health tracking to inform actions that improve public health. Our
communications efforts will include updating existing program messages to reflect the broader
goals and scope for the MN EPHT program as a partner in EPHTN.
Two new program bookmarks were recently printed and will be distributed at the state fair. Work
continues on finalizing a MN EPHT brochure and developing a new website; both of these
should be completed later this fall.
28
Update: New national EPHT content areas
Two new content areas were recently added as core measures for the national EPHT program –
pesticides and climate change.
Pesticides
A Pesticide Content Workgroup (CWG) has been created within the national EPHT program.
The first formal meeting for this CWG took place in August 2009 during the Portland workshop.
An initial proposal for pesticide tracking is currently being drafted and will be submitted to the
EPHT CWG Steering Committee. Potential data sources for pesticide tracking being discussed
include poisoning data (Poison Control Center calls, hospitalizations, ED visits), agricultural
pesticide use and sales data, and pesticide exposure data (drinking water, surface/groundwater,
soil, food, land use). Both agricultural and household pesticide use will be considered.
In the coming months, the Pesticide CWG will collaborate with federal (FDA, USDA, EPA, and
USGS) and state partners in order to: continue to discuss data sources, clarify how pesticides are
to be defined (e.g. inclusion of antimicrobials, how to address products with multiple active
ingredients), and further develop a vision for nationally consistent measures for pesticide
tracking.
Climate change
CDC tracking grantee states initiated preliminary discussions to develop and evaluate data sets,
measures/indicators, and metadata for climate change (ultimately to integrate climate change as a
core measure into EPHTN).
In mid-August the Content Work Group (CWG) Climate Change Team held their first
conference call to discuss environmental health indicators of climate change (e.g., indicators for
health outcomes, population vulnerabilities, and adaptive policy responses). Examples of
content areas being considered for development include (but are not limited to): vector-borne
diseases, heat-related illnesses, food and water-borne pathogens, allergens, air quality, and
wildfires. This work is expected to build on climate change indicator activities conducted
through the State Environmental Health Indicators Collaborative (SEHIC).
SEHIC is a state-led group of epidemiologists working in collaboration with the Council of State
and Territorial Epidemiologists (CSTE) and CDC (web site: http://www.cste.org/OH/SEHIC.asp).
SEHIC activities have included the formation of several workgroups on climate change. These
workgroups have assessed surveillance data sources and indicators on a variety of climatesensitive health outcomes. SEHIC’s findings are summarized in a May 2009 issue of
Environmental Health Perspectives (http://www.ehponline.org/members/2009/0900708/0900708.pdf).
SEHIC climate change workgroup members are discussing ways to share information and
coordinate activities with the new Environmental Public Health Tracking Climate Change Team.
MDH participates in regular (monthly) conference calls with workgroup members.
29
Update: Climate change capacity-building grant
In August 2009 MDH received notification of an award ($90k) from the Association of State and
Territorial Health Officials (ASTHO) to build state capacity to address the public health impacts
of climate change. As part of this project, MDH will develop a climate change web site; conduct
employee training about climate change impacts on vector borne disease, population
vulnerability, and heat-related illnesses; and prepare a 5-year MDH strategic plan. Project
partners include the University of Minnesota (Extension Service), Minnesota Pollution Control
Agency, Minnesota Department of Commerce, Local Public Health Association of Minnesota,
and MN local health departments. For questions about this project, contact Chuck Stroebel
([email protected], 651/201-4927).
30
Section overview: East Metro PFC Biomonitoring Project
The East Metro PFC Biomonitoring Project is nearing completion. This section provides a brief
status update on the project, focusing on steps taken to communicate project results to the
community. Also included in this section is a list of questions/suggestions from each of the two
public meetings held to present project results, a copy of a document submitted to the Minnesota
Pollution Control Agency by the Minnesota Center for Environmental Advocacy for
consideration at their Citizen Board meeting, and a summary of the meeting evaluations received
at the two public meetings.
ACTION NEEDED: At this time, no formal action is needed by the advisory panel. However,
panel members are invited to provide feedback and to recommend further action or education
based on the community response.
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32
Status update: East Metro PFC Biomonitoring Project
Results dissemination
The complete technical report for the East Metro Perfluorochemical Biomonitoring Pilot Project
has been finalized and is now posted at
http://www.health.state.mn.us/divs/eh/tracking/finalpfcrpt.pdf
Community outreach
Two public meetings were held in July 2009 to share the results of the pilot PFC biomonitoring
project with the communities and to solicit comments, suggestions and feedback. The meetings
were preceded by a news release and a media availability session that received considerable
response in metro wide and local press. Both meetings, one in Oakdale and the other in Cottage
Grove, were each attended by more than 50 residents. MDH staff from Drinking Water
Protection, EHTB, Site Assessment and Consultation, the Public Health Laboratory hosted
displays and talked one on one with residents during an “open house” that preceded and followed
the formal slide presentation of results. Several legislators as well as city and county officials
also attended.
At both public meetings the formal presentation was followed by an animated and engaged
question and answer period. (A complete list of community members’ questions is included on
the following.) Several speakers thanked MDH for the work completed, but pressed for future
studies. Some suggested that, to verify the reduction in PFC blood levels over time,
biomonitoring be repeated with the same group in the future and that additional participants be
added. Others requested a health study, a cancer (particularly in Cottage Grove) investigation or
research into the link between PFCs and another specific health concern. Residents also felt that
there should be more research to identify ways (other than through drinking water) that people
are exposed and that there should be increased health education about PFCs and exposure
through consumer products.
A written evaluation was conducted of the meetings. A total of 29 evaluations were returned
from both meetings. Results from the evaluation are summarized on the following pages.
Data analysis
Analysis of the correlation of the water and blood PFC levels is underway and will be reported to
the advisory panel at a future meeting.
33
East Metro PFC Biomonitoring Project: Community feedback
Questions from the Oakdale/Lake Elmo Presentation 07/21/2009
1. Pamphlet with charts – back page – the word somewhat higher is used to describe the graphs
on the community report. But the charts show the East Metro to be 1 ½ to 4 times higher
than the U.S. population, how can you describe this as somewhat?
2. Does your study – of Oakdale – do the participants live in certain parts of the city? Cluster
where it was higher? Are you going to look at blood levels geographically?
3. Has the water analysis been funded? And what is the time frame?
4. There is a cluster where the individual and all the neighbors have cancer – is MDH doing a
follow up MDH study? Will they look at cancer clusters?
5. What will be a follow up from these studies? Is there a relationship between water levels and
blood levels?
6. Do we have information on the type of filters participants in the biomonitoring study had?
7. Will we look at where participants live in Oakdale and compare blood levels and disease?
8. Do any options for water filters work fro PFCs?
9. Past law has us being taken for, no money has been allocated to clean up the water after
study. What was the intent of study? What have we learned?
10. The other areas doing studies, have they looked into some more specific effects?
11. What do you tell your physician about study results?
12. 20 years ago were they a lot higher? Individual shared health history of her family and asked
if the PFCs were the cause of this.
13. What do we this the blood levels were 20 years ago?
14. Reading the list of PFCs in materials – is there a risk associated with using Teflon pans?
15. Are there certain areas of the body that he chemicals accumulate in?
16. In the general population what was the highest for PFOS?
17. In the East Metro what was the length of residence for the person with the highest PFOS?
18. Was there a strong correlation of how long someone had lived in the east metro, age and the
levels of the chemicals in the body?
19. Does the new water ever have PFC’s in it?
20. I don’t think I feel reassured by the results that the blood levels can’t be tied to health effects.
21. Did you ask as part of the study whether participants were blood donors?
22. Follow up to see if PFC levels are going down because of filters.
23. Was the information given to study participants, any different from the info given to the
general public?
24. Is 3M working with MDH – have they been a source of information.
25. What have the studies shown on health effects for 3M workers?
26. Have the results from the 3M studies been released? Is it available to the general public?
27. Will there be a need to expand the study group or expand the study?
34
Questions from the Cottage Grove Presentation 07/22/2009
1. Regarding the chemicals’ half lives: How long does it stay on the planet? Can they get it out
of the environment?
2. Regarding page one of the booklet that was sent to participants: MDH should do an ad
campaign for consumers on what types of makeup and personal care products contain PFCs;
it’s hard for people to stay on top of all the things in different products.
3. The question is how PFCs affect our health? What can citizens do to get research going in
this direction?
4. The research being conducted out of the DuPont law suit – is that by DuPont scientists or
other individuals?
5. For the municipal water group in Oakdale did you look statistically at equal amounts of
people on filters and not on filters?
6. Do we know if the Cottage Grove participants are significantly different from the other
private well participants and from the municipal water participants?
7. The pilot project did its purpose, but now we need to move to a larger study. Is there a way
or would it be wise to include whether there is significant disease outcomes?
8. Are there weaknesses in how the study was formulated – did 3M design the study? Should
there be independent health studies of 3M workers?
9. If we did deep tissue specimens would that be another way to look at levels in the body?
10. Rep. Sieben – Requested guidance from local government and citizens for direction on future
projects and getting PFCs designated as hazardous.
11. Why is PFHxS higher than national average?
12. What is PFHxS?
13. Will there be a follow up on PFHxS?
14. Can you separate PFCs from the water? Is it hazardous?
15. Can MDH work with a private individual who has a study design in mind? Roughly 2/3’s of
family’s have been affected by cancer.
16. Does the depth of the well make a difference?
17. Does cooking the water make a difference?
18. What is the density of PFCs in comparison to water weight?
19. Can we extrapolate any of these numbers down to children?
20. Comparisons on PFOA, but not PFOS and PFHxS on how they affect the body in terms of
neurological effects. Have there been any studies on elderly people and PFOS and long-term
exposure causing neurological effects?
21. Rep. Bingham - Recommendation to consult with the University of Minnesota or Mayo to
look into future studies, health, exposure, etc.
22. Rep Swails - A cancer cluster study should be completed.
35
Information submitted to Minnesota Pollution Control Agency’s Commissioner
and Citizen Board by Minnesota Center for Environmental Advocacy
36
37
38
39
40
East Metro PFC Biomonitoring Study: Meeting evaluation results
41
42
43
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44
Section overview: Biomonitoring 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 status updates on two of the biomonitoring
pilot projects:

Lake Superior Mercury Biomonitoring Study

Riverside Prenatal Biomonitoring Study
Also included in this section is a summary of grant application that was submitted by MDH (in
collaboration with the Morrison-Todd-Wadena County Community Health Board) to the
National Institute of Environmental Health Sciences. The application was not accepted for
funding at this time, but could potentially be resubmitted at a future date.
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.
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46
Status update: Lake Superior Mercury Biomonitoring Study
Participant recruitment
Participants continue to be enrolled in the Lake Superior Mercury Biomonitoring Study. As of
August 18, 2009, written informed consent has been received from 586 participants; 61 of these
were recruited through local public health staff. Recruitment will likely continue through 2009.
Wisconsin continues to collect specimens. (Informed consent is not required in Wisconsin.) To
date they have collected 126 specimens for the study. Michigan may be participating in the
project again, but details of their participation are still being worked out. (They previously
needed to withdraw from the study due to changes in the storage of specimens and informed
consent requirements in Michigan.)
Specimen analysis
The method to analyze for mercury in newborn bloodspots has been revised to accommodate the
use of 96-well plates. The adoption of the 96-well plates has three advantages. The first being
that only two, instead of four, bloodspot punches are analyzed for each sample. Consequently, a
higher fraction of the recruited newborns have residual specimens with enough blood for
enrollment in this pilot. The reduction in the required number of bloodspot punches also
decreases the volume of diluent required for the extraction and analysis. In addition, the samples
in the 96-well plate can now be filtered efficiently, reducing the possibility of clogging the
instrument with filter paper fibers.
Another change to the method is that the calibration curve and calibration verification samples
are no longer blood-based, but are now aqueous-based. In order to accommodate calibration
verification samples run for every 20 newborn samples and at the end of the analysis, the use of a
blood-based calibration curve would require the analysis of multiple blood blanks along with a
new aqueous blank each time patient samples are analyzed. Additionally, the actual amount of
blood in a patient sample is extremely small; two punches contain only 6.2 µL of blood. The
amount in solution after the extraction and filtration would be even smaller, which questions the
appropriateness of a blood-based calibration curve with regards to matrix-matching to patient
samples. A comparison was made of an aqueous-based calibration curve and a blood-based
curve, using old proficiency testing (PT) samples supplied via CDC. Analyses performed using
an aqueous calibration curve generally have slightly higher R2 values than ones using a bloodbased curve, and the calibration verification samples are nearly identical. Percent recoveries for
old PT samples are comparable for each calibration matrix, and the variation is consistent
between analytical runs, no matter which calibration is used.
For our spiked, base blood dried on filter paper cards undergoing the extraction process, the
method detection limit (MDL) was determined to be 0.791 µg/L Hg, and the report level was set
to 2.42 µg/L Hg (i.e. 3 times the MDL). This is slightly higher than the MDL, 0.368 µg/L Hg, for
our laboratory’s method for Hg in whole blood, but not unexpected because the dried bloodspot
method requires an extraction process. Results for this project will be reported for analytical
values down to the MDL, although any results falling between the MDL and report level will be
47
“J” flagged to indicate that the value is estimated. Several sets of old whole blood PT samples
were spotted onto filter paper cards and have been analyzed as practice samples using the
bloodspot method, including one set that was punched using the automated punchers and
procedures to simulate actual samples. For these samples, all but a small handful would have
passed the PT studies that CDC administers for quantitating mercury in whole-blood samples,
using the criteria established by CDC for the less challenging matrix of whole blood.
Currently, a few small tasks remain before analysis of samples from Lake Superior basin
newborns begins. One is to analyze blank punches from the automated puncher in the Michigan
newborn screening lab to determine comparability to the Minnesota and Wisconsin punchers;
punches obtained from automated punchers in both Minnesota and Wisconsin are statistically
similar to those obtained using the hand punchers originally specified in the design for this
project. Other tasks include updating the Quality Assurance Project Plan (QAPP) and both the
bloodspot punching SOP and mercury analysis SOP. These updated documents must be
reviewed by the EPA program office before analysis begins.
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Status update: Riverside Prenatal Biomonitoring Study
Laboratory analysis
The analysis of environmental phenols in urine is done using an online solid phase extraction
(SPE) system; the sample preparation and extraction are performed by the autosampler of the
HPLC, which is connected to the mass spectrometer. The sequence of sample extraction,
separation, and analysis is performed in ~20 minutes per sample. The method is one that CDC
has developed for the analysis of these compounds in serum and urine. Many publications
describe its setup and use. One advantage to the MDH Public Health Laboratory in
implementing this setup is that we gain experience in using the system in a high throughput
setting, which would be useful for future, larger-scale biomonitoring projects. The online-SPE
setup has required additional pumps to supply the solvents for the SPE steps and an extra valve
to perform the required column switching. We’ve configured the additional components, and we
have adjusted the timing of the valve switching steps and the gradient and mobile phase
compositions to minimize the analysis time, while ensuring maximum recovery. Due to the extra
tubing and connections in the system, extra rinse steps seem to be necessary to prevent carryover
and contamination from one sample to the next. The method requires that one set of samples be
prepared and analyzed for free analytes, while a second set of samples be prepared and treated
with an enzyme to deconjugate any conjugated species present. We are evaluating the
deconjugation step right now.
Recruitment
As of August 17, 2009, 20 urine samples (of the 90 samples required by statute) have been
received. The initial goal was to enroll 30 women in each of three ethnic/racial communities
(Hispanic, non-Hispanic black, and non-Hispanic white). The study as a whole has had a difficult
time enrolling Hispanic women, so the biomonitoring study may be unable to reach its goal of
enrolling 30 Hispanic women.
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Update: Partnerships for Environmental Public Health Grant
Proposal:
Assessing and Addressing Exposures to Pesticide Drift in a Rural Community in Minnesota, submitted
for review April 1, 2009
MDH and the Community Board of Health for Morrison, Todd and Wadena counties submitted an
application for a grant funded through the National Institute of Environmental Health Sciences
(NIEHS). The grant period is for four years and the maximum award is $250,000 per year. If awarded,
funding would likely begin in the fall.
What is NIEHS?
Located in Research Triangle Park, North Carolina, NIEHS is one of 27 research institutes and centers
that make up the National Institutes of Health. NIEHS funds environmental health studies across the US
and within its own facility. NIEHS provides grants for many different types of studies; this grant is
funded under a new program called Partnerships for Environmental Public Health.
What is Partnerships for Environmental Public Health (PEPH)?
PEPH brings together scientists, community members, educators, health care providers, public health
officials, and policy makers to address science-based inquiries of environmental health concerns in
communities. By fostering these partnerships, vital information about links between exposures and
disease can be used to promote health and reduce the risk of disease. Local public health is a valuable
partner in tackling the environmental health concerns of the communities they serve.
Who is conducting this project?
If funded, the project would bring together the tri-county community represented by the Community
Board of Health, with environmental scientists in the Environmental Health Tracking and Biomonitoring
program at the Minnesota Department of Health (MDH) to address concerns about exposures to pesticide
drift from agricultural applications as well as other potential sources of pesticide exposure. The project
has 3 parts: research, education and evaluation.
How would the community be involved in guiding this project?
The Community Board of Health would establish a 15-member steering committee to guide and
participate in planning the project. For example, the Steering Committee can help decide which
pesticides are a concern in the community, and who should be included in the study. The steering
committee would include: one county commissioner from each county, medical providers, pesticide
applicators, soil water district representatives, sustainable farmers, crop farmers, non-farm residents, and
educators.
What research is proposed in the application and how would it be conducted?
The research component has 3 phases described below.

Phase 1: Planning The first year of the research would be devoted to planning: identifying the
specific pesticide chemicals of concern and methods for the study. Based on the chemicals of
concern that are identified by the community partnership, a detailed plan for measuring exposure
would be made.

Phase 2: Collect and analyze data In the second year, the enrollment of study participants and
sample collection would be conducted. We propose to invite 100 adults and 50 children to
participate with informed consent; households would include farm families, non-farm families
50
and applicators’ families. Urine samples would be collected to measure how much chemical gets
in to the body. A household questionnaire would ask participants to report their use of pesticides
in and around the home and the occupations of all adults in the home. Swab samples would
measure pesticide residues in the home.

Phase 3: Present and interpret the findings MDH scientists would analyze the data and
summarize the results. The community results would be compared to results from the CDC’s
national biomonitoring program and with similar studies in other communities. We would look
for differences based on proximity to fields, use of chemicals in the home, and occupation.
Research participants would receive private individual results with recommendations about ways
to prevent exposures to pesticides. Medical consultants in each county would provide individual
medical counseling as needed.
How would we educate the community about the findings?
Community education is a big part of this project. The audience for education and outreach includes all
residents of the 3 counties. A community health educator would be hired in the county to conduct
education and outreach activities. The educator would offer a range of programs to include general
information about pesticides and health, introducing the research study to the community, explaining the
study methods, and programs to share the study results. A community wide forum and a new
environmental health science curriculum for involvement of area high school students is proposed.
Health care providers would be offered training to improve communications with patients and medical
case management of pesticide associated illnesses. Pesticide applicators and farmers would be offered
information about ways to prevent exposures on the job.
How would we evaluate whether these activities were helpful?
Evaluation activities would be ongoing throughout the four year project period. An evaluation plan
includes surveys at events to measure outcomes of increased community engagement and knowledge
about pesticides, the health risk of exposure, and ways to prevent exposure; and increased knowledge
among healthcare providers.
A “logic model” is used to describe the steps in reaching our project goals and outcomes.
What are the important outcomes of this work for our community?
Important outcomes of this project include increased community engagement and knowledge about
pesticides and ways to prevent exposure; and increased knowledge among healthcare providers on
recognition of pesticide associated illnesses. Over time, we hope to achieve safer use of pesticides in the
community, increased use of personal protective equipment by farmers and applicators, and improved
ability of health care providers to address patient concerns.
Links:
NIEHS: http://www.niehs.nih.gov/about/index.cfm
Partnerships for Environmental Public Health: http://www.niehs.nih.gov/research/supported/programs/peph/index.cfm
.
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Section overview: Biomonitoring program next steps
The biomonitoring program is at a transition point, with the four statutorily mandated pilot
projects wrapping up and an increased emphasis on environmental health tracking due to the
receipt of federal funds.
At the September 15 meeting, John Stine, EHTB steering committee chair, will briefly review
the past, present and future of the biomonitoring program and will invite input from the advisory
panel in terms of establishing priorities.
The following materials are included in this section of the meeting materials:

EHTB statute excerpts: These excerpts are provided as background and as a means to
assess which statutory requirements have been met and which are still underway.

Draft biomonitoring strategic plan: This draft is provided to summarize the progress
made to date with developing a strategic plan and to briefly outline plans for completing
the draft in the future.
ACTION NEEDED: At this time, no formal action is needed by the advisory panel. However,
panel members are invited to provide input on establishing priorities and positioning the
biomonitoring program for future opportunities.
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Excerpts from EHTB statute
The following excerpts relate to the state’s statutory requirements for biomonitoring:
144.996 ENVIRONMENTAL HEALTH TRACKING; BIOMONITORING.
Subdivision 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.
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 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
55
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
community-based 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, communitybased organizations, or experts in a particular field to perform any of the activities described
under this section
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Biomonitoring strategic plan (DRAFT)
June 2009
The following language was developed based on discussions during four meetings between
November 2008 and June 2009. Program staff will continue working on the strategic plan to
incorporate additional details, including further consideration of strategies for carrying out
biomonitoring in a state context. Once fully drafted, the strategic plan will be presented to the
EHTB advisory panel for input. Ultimately, a set of recommendations for an ongoing
biomonitoring program will be submitted to the legislature as required by statute.
Vision for a state biomonitoring program
Vision statement
Minnesota’s biomonitoring program will have the capacity to accurately and efficiently measure
and track exposures in people from the environment, and to protect public health through
improving the understanding of risk and disease so that Minnesotans will lead healthier lives and
live in safer environments.
Vision elements
Biomonitoring data are collected and effectively used to protect public health
Biomonitoring will protect the health of all Minnesotans by measuring and tracking the
concentrations of chemicals that get in to people’s bodies from the environment. Knowing more
about people’s exposure to chemicals will help state and local officials, advocacy groups,
industry, decision makers better determine the health risk and take actions that can best help to
reduce risk, promote health, and eliminate disparities.
Risk and disease are better understood
Biomonitoring will provide a base of information that will help public health scientists to study
the connections between environmental hazards and disease. Public health officials will better
understand and be able to share new information with the public, and will be better able to track
progress in improving environmental public health. Minnesotans will know more about the risks
of chemicals in their environment in order to make wise choices to promote their own health and
the health of their communities.
Adequate capacity and resources are maintained
Minnesota’s biomonitoring program will have the capacity and expertise needed to measure
environmental chemicals in people’s bodies accurately and efficiently. The program will be a
resource for public health officials to use as needed for providing a scientifically grounded
response to the public health concerns of communities in Minnesota.
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Purpose of a state biomonitoring program
Core purpose
The core purpose of Minnesota’s biomonitoring program is to monitor and track trends over time
in the distribution of exposure to designated chemicals among the general population of
Minnesota and communities within the population in order to:
 identify exposure disparities;
 assess the need for public health interventions;
 evaluate the efficacy of interventions in reducing exposure; and
 assess the need for continued biomonitoring of a designated chemical.
Other beneficial purposes
Other important secondary purposes are anticipated and should be achieved as resources allow.
These purposes can best be accomplished through collaborations with external and internal
partners, and leveraging of supplemental resources:
1. Investigate sentinel exposure events, emerging contaminants, and highly exposed individuals
identified by public health officials for targeted exposure assessments and interventions.
2. Provide information about exposures to local public health officials and community
representatives in response to community concerns about chemicals in the environment.
3. Provide data about exposure distributions and trends to support research studies that measure
the association of health outcomes with exposure and identify the sources of exposure.
4. Provide data about exposure distributions and trends to support the establishment of healthbased criteria for regulating chemicals in the environment.
58
Models
Future strategic planning activities will examine existing models for conducting biomonitoring
in a public health context and will develop a set of recommended strategies and methods aimed
at achieving the vision and purposes set forth in this document.
Three primary biomonitoring models apply and can be combined in a single program to fulfill
program purposes:
1.
2.
3.
Statewide Population Exposure Tracking
Targeted Population Exposure Tracking
Community-based Special Investigations
One factor in considering strategies is that the federal Centers for Disease Control (CDC) will
fund surveillance or tracking activities and special investigations for public health purposes, but
will not fund research. Therefore a research model is not proposed for a state-based public
health program that may be eligible for CDC funding.
59
Partners
MDH Internal Partners: Environmental Public Health Tracking, Site Assessment and
Consultation (ATSDR), Indoor Air Quality Investigations, Risk Assessment, Tobacco Control,
Drinking Water, Blood Lead Surveillance, Injury Prevention and Control, Office of Emergency
Preparedness
External state partners: MPCA, DNR, MDA, University of Minnesota, Poison Control Center
Federal partners: ATSDR, CDC National Center for Environmental Health, EPA
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Section overview: Other information
Two new documents are included in this meeting packet as items that may be of interest to panel
members:

New PFC citations (added since December 9, 2008)

Draft EHTB advisory panel meeting summary (from June 9, 2008) [Note: Technical
difficulties led to a delay in writing the meeting summary, which is still in draft format. The
first order of business at the September 15 meeting will be to finalize the meeting summary.]
In previous meeting packets, a number of items were included as reference materials. To limit
the amount of paper used and to contain costs, unless changes are made to these documents, they
will no longer be included in the meeting packet. These materials are available online at
www.health.state.mn.us/tracking/.
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New PFC Citations (Added since December 9, 2008)
The following articles and reports have recently been added to the EHTB program’s PFC
citation list, which is updated on an ongoing basis. This list is not intended to be comprehensive
and reflects only a small portion of the available research on PFCs. Note that some citations on
this list may not have been published in peer-reviewed journals. A study’s inclusion on this list
does not imply endorsement by the EHTB program.
Bloom MS et al. (2009) “Exploratory assessment of perfluorinated compounds and human
thryoid function.” Physiology & Behavior.
Abstract. Thyroid hormones play critical roles in human neurodevelopment and adult
neurocognitive function. Persistent organohalogenpollutants, such as perfluorinated
compounds (PFCs), may interfere with thyroid homeostasis and thus exposures to these
compounds might represent risk factors for neurologic and cognitive abnormalities. In this
study, serumspecimens collected fromthirty-one licensed anglers inNewYork Statewere
analyzed for levels of thyroid stimulating hormone (TSH), free thyroxine (FT4),
perfluorodecanoic acid (PFDA), perfluorononanoic acid (PFNA), perfluoroheptanoic acid
(PFHpA), perfluorohexanesulfonate (PFHxS), perfluorooctanoic acid (PFOA),
perfluorooctanesulfonate (PFOS), perfluorooctanesulfonamide (PFOSA), and
perfluoroundecanoic acid (PFUnDA). PFOS and PFOA occurred in the highest
concentrations with geometric means of 19.6 ng/mL (95% CI 16.3–23.5) and 1.3 ng/mL
(95% CI 1.2–1.5), respectively. In a cross-sectional analysis, no statistically significant
associations were detected for PFCs, or their sum, with TSH or FT4 at α=0.05. However,
post hoc power analyses, though limited, suggested that moderate increases in sample size, to
86 and 129 subjects, might facilitate 80% power to detect statistically significant associations
for FT4 and PFDA (β=0.09) and PFUnDA (β=0.08), respectively. The consumption of
sportfish may have contributed to PFDA (r=0.52, P=0.003) and PFUnDA (r=0.40, P=0.025)
levels. This preliminary study does not indicate associations between non-occupational PFCs
exposures and thyroid function. However, the possibility for weak associations for FT4 with
PFDA and PFUnDA, PFCs measured in low concentrations, is raised. Given the ubiquity of
PFCs in the environment and the importance of thyroid function to neurodevelopmental and
neurocognitive endpoints, a confirmatory study is warranted.
Costa G, Sartori S, Consonni D. (2009) “Thirty years of medical surveillance in perfluooctanoic
acid production workers.” J Occup Environ Med. 51(3): 364-372.
Abstract. Objective: To report health outcomes of 30 years (1978–2007) of medical
surveillance of workers engaged in a perfluooctanoic acid (PFOA) production plant.
Methods: Fifty-three males workers (20 to 63 years) were submitted every year to medical
examination and blood chemical chemistry tests, and serum PFOA dosage. Results: In the
latest survey PFOA serum levels ranged from 0.20 to 47.04 μg/mL in currently exposed
workers, and from 0.53 to 18.66 μg/mL in those formerly exposed. No clinical evidence of
any specific trouble or disease has been recorded over the 30 years, and all the biochemical
parameters, including liver, kidney and hormonal functions, turned out to be within the
63
reference ranges, but a significant association of total cholesterol and uric acid with and
PFOA serum level was evidenced. Conclusions: A probable interference of PFOA on
intermediate metabolism deserves further investigations.
Eriksen KT et al. (2009) Perfluorooctanoate and perfluorooctanesulfonate plasma levels and risk
of cancer in the general Danish population. J Natl Cancer Inst. 101(8): 605-609.
Abstract. Perfluorooctanoate and perfluorooctanesulfonate are used in many industrial
products and have been widely detected in human blood. Both chemicals are associated with
tumor development in animal studies, but data on carcinogenic potential in humans are
sparse. We investigated the association between plasma levels of perfluorooctanoate and
perfluorooctanesulfonate and cancer risk within a prospective Danish cohort of participants
with no previous cancer diagnosis at enrollment. From enrollment, between December 1,
1993, and May 31, 1997, and through July 1, 2006, we identified 713 participants with
prostate cancer, 332 with bladder cancer, 128 with pancreatic cancer, and 67 with liver cancer
in the entire cohort and we selected a comparison subcohort of 772. Plasma concentrations of
perfluorooctanoate and perfluorooctanesulfonate were measured in each participant by use of
high-pressure liquid chromatography coupled to tandem mass spectrometry. We found no
clear differences in incidence rate ratios for these cancers in relation to plasma concentrations
of perfluorooctanoate or perfluorooctanesulfonate. A 30% – 40% increase in risk estimates
for prostate cancer was observed for the three upper quartiles of perfluorooctanesulfonate
concentration compared with the lowest quartile (eg, for the lowest vs the fourth quartile,
incidence rate ratio = 1.38, 95% confidence interval = 0.99 to 1.93). Plasma concentrations of
perfluorooctanoate and perfluorooctanesulfonate in the general Danish population appear not
to be associated with risk of prostate, bladder, pancreatic, or liver cancer.
Fei C et al. (2009) Maternal levels of perfluorinated chemicals and subfecundity. Hum Reprod.
1(1): 1-6.
Abstract. BACKGROUND: Perfluorooctanoate (PFOA) and perfluorooctane sulfonate
(PFOS) are ubiquitous man-made compounds that are possible hormonal disruptors. We
examined whether exposure to these compounds may decrease fecundity in humans.
METHODS: Plasma levels of PFOS and PFOA were measured at weeks 4–14 of pregnancy
among 1240 women from the Danish National Birth Cohort recruited from 1996 to 2002. For
this pregnancy, women reported time to pregnancy (TTP) in five categories (< 1, 1–2, 3–5,
6–12 and >12 months). Infertility was defined as having a TTP of .12 months or received
infertility treatment to establish this pregnancy. RESULTS: Longer TTP was associated with
higher maternal levels of PFOA and PFOS (P < 0.001). Compared with women in the lowest
exposure quartile, the adjusted odds of infertility increased by 70–134 and 60–154% among
women in the higher three quartiles of PFOS and PFOA, respectively. Fecundity odds ratios
(FORs) were also estimated using Cox discrete-time models. The adjusted FORs were
virtually identical for women in the three highest exposure groups of PFOS (FOR = 0.70,
0.67 and 0.74, respectively) compared with the lowest
quartile. A linear-like trend was observed for PFOA (FOR = 0.72, 0.73 and 0.60 for three
highest quartiles versus lowest quartile). When all quartiles were included in a likelihood
ratio test, the trends were significant for PFOS and PFOA (P = 0.002 and P < 0.001,
respectively). CONCLUSIONS: These findings suggest that PFOA and PFOS exposure at
64
plasma levels seen in the general population may reduce fecundity; such exposure levels are
common in developed countries.
Halldorsson TI et al. (2008) Dietary predictors of perfluorinated chemicals: a study from the
Danish National Birth Cohort. Environ Sci Technol. 42(23): 8971-8977.
Abstract. This study investigated the association between dietary variables and plasma levels
of perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) among 1076
pregnant women. Diet was assessed at midpregnancy by a food-frequency questionnaire.
Mean first trimester plasma PFOS and PFOA levels were 35.1 and 5.6 ng/mL, respectively.
PFOS levels were positively associated (p < 0.05) with intake of red meat, animal fats, and
snacks (e.g., popcorn, potato chips), whereas intake of vegetables and poultry was inversely
associated. The adjusted mean differences between the 75th and 25th intake percentiles were
4.3 ng/mL [95% CI: 2.1, 6.5] for red meat, 3.4 ng/mL [95% CI: 1.2, 5.6] for animal fats, and
2.0 ng/mL [95% CI: 0.3, 3.6] for snacks. Similar but weaker associations were observed for
PFOA. Furthermore, a comparison between women reporting low (e25th percentile) red meat
and high (g75th percentile) vegetable intake and women reporting low vegetable and high red
meat intake resulted in differences in plasma PFOS and PFOA concentrations equal to 31%
and 18% of mean levels, respectively. Studies quantifying levels of perfluorinated
compounds in food have suggested that diet could be an important route of human exposure.
The observed associations in our study between dietary variables and maternal exposure
further support that conclusion.
Haug L, Thomsen C, Becher G. (2009) Time Trends and the Influence of Age and Gender on
Serum Concentrations of Perfluorinated Compounds in Archived Human Samples. Environ Sci
Technol. 43(6): 2131-2136.
Abstract. Fifty-seven pooled archived human serum samples were analyzed to assess the
time trends as well as influence of age and gender on selected perfluorinated compounds
(PFCs) in Norwegian residents. The study comprised determinations of 19 PFCs in serum
samples pooled according to year of collection from 28 years in the period 1976 to 2007. A
9-fold increase in the serum concentrations of perfluorooctyl sulfonate, perfluorooctanoic
acid, and perfluoroheptyl sulfonate was measured for men (40-50 years) from 1977 to the
mid 1990s where the concentrations reached a plateau before starting to decrease around year
2000. A similar trend was also seen for perfluorohexyl sulfonate, perfluorononanoic acid,
perfluorodecanoic acid, and perfluoroundecanoic acid, but no clear decline was observed for
these PFCs in the recent years. No statistically significant difference was observed between
the PFC levels in the male and female serum pools, though the statistical power is low due to
few data points. For most PFCs, the concentrations in the human serum samples were found
to increase with age in the pools from 2007, while the results for 1976, 1987, and 1998 were
more varying. Several PFCs were significantly intercorrelated.
Hölzer J et al. (2009) One-year follow-up of perfluorinated compounds in plasma of German
residents from Arnsberg formerly exposed to PFOA-contaminated drinking water. International
Journal of Hygiene & Environmental Health. 212(5): 499-504.
Abstract. In Arnsberg, Sauerland area Germany, 40000 residents were exposed to PFOAcontaminated drinking water (500-640ng PFOA/l; May 2006). In July 2006, the PFOAconcentrations in drinking water were lowered significantly by activated charcoal filtering in
65
the waterworks, mostly below the limit of detection (10ng/l). A first human biomonitoring
study performed in autumn 2006 revealed that PFOA-concentrations in blood plasma of
residents living in Arnsberg were 4.5–8.3 times higher than in the reference groups. One year
after the first survey, all participants (2006: 164 mothers, 90 children, 101 men) were invited
to take part in a follow-up study. It was the aim of the study to determine the decline of the
PFOA-concentrations in blood plasma. 288 persons (81%) were included in the statistical
analysis. The (geometric) mean PFOA-concentrations in blood plasma of Arnsberg''s
residents decreased from 22.1 to 17.4μg/l in children, from 23.4 to 18.8μg/l in mothers and
from 25.3 to 23.4μg/l in men within one year. The average (geometric mean) changes in each
individual''s PFOA-concentrations were approximately 10 (men), 17 (mothers) and 20
(children) percent/year. The observed decline in PFOA-concentrations indicates a slow
elimination in humans. This finding in groups of the general population is in agreement with
data on long elimination half-lives observed in occupationally exposed workers.
Holzer J et al. (2008) Biomonitoring of perfluorinated compounds in children and adults exposed
to perfluorooctanoate-contaminated drinking water. Environ Health Perspect. 116(5): 651-657.
Abstract. OBJECTIVE: 40,000 residents in Arnsberg, Germany, had been exposed to
drinking water contaminated with perfluorinated compounds (PFCs). Internal exposure of the
residents of Arnsberg to six PFCs was assessed in comparison with reference areas. DESIGN
AND PARTICIPANTS: One hundred seventy children (5–6 years of age), 317 mothers (23–
49 years), and 204 men (18–69 years) took part in the cross-sectional study.
MEASUREMENTS: Individual consumption of drinking water and personal characteristics
were assessed by questionnaire and interview. Perfluorooctanoate (PFOA),
perfluorooctanesulfonate (PFOS), perfluorohexanoate, perfluorohexanesulfonate (PFHxS),
perfluoropentanoate, and perfluorobutanesulfonate (PFBS) in blood plasma and PFOA/PFOS
in drinking water samples were measured by solid-phase extraction, high-performance liquid
chromatrography, and tandem mass spectrometry detection. RESULTS: Of the various PFCs,
PFOA was the main compound found in drinking water (500–640 ng/L). PFOA levels in
blood plasma of residents living in Arnsberg were 4.5–8.3 times higher than those for the
reference population (arithmetic means Arnsberg/controls: children 24.6/5.2 μg/L, mothers
26.7/3.2 μg/L, men 28.5/6.4 μg/L). Consumption of tap water at home was a significant
predictor of PFOA blood concentrations in Arnsberg. PFHxS concentrations were
significantly increased in Arnsberg compared with controls (p < 0.05). PFBS was detected in
33% of the children, 4% of the women, and 13% of the men in Arnsberg compared with 5%,
0.7%, and 3%, respectively, in the reference areas (p < 0.05). Regression analysis showed
that age and male sex were significant predictors of PFOS, PFOA, and PFHxS; associations
of other regressors (diet, body mass index) varied among PFCs. CONCLUSIONS: PFC
concentrations in blood plasma of children and adults exposed to PFC-contaminated drinking
water were increased 4- to 8-fold compared with controls.
Joensen U et al. (2009) Do Perfluoroalkyl Compounds Impair Human Seman Quality?
Environmental Health Perspectives. 117(6): 923-927.
Abstract. Background: Perfluoroalkyl acids (PFAAs) are found globally in wildlife and
humans and are suspected to act as endocrine disruptors. There are no previous reports of
PFAA levels in adult men from Denmark or of a possible association between semen quality
and PFAA exposure. Objectives: We investigated possible associations between PFAAs and
testicular function. We hypothesized that higher PFAA levels would be associated with lower
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semen quality and lower testosterone levels. Methods: We analyzed serum samples for levels
of 10 different PFAAs and reproductive hormones and assessed semen quality in 105 Danish
men from the general population (median age, 19 years). Results: Considerable levels of
perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorohexane
sulfonic acid were found in all young men (medians of 24.5, 4.9, and 6.6 ng/mL,
respectively). Men with high combined levels of PFOS and PFOA had a median of 6.2
million normal spermatozoa in their ejaculate in contrast to 15.5 million among men with low
PFOS–PFOA (p = 0.030). In addition, we found nonsignificant trends with regard to lower
sperm concentration, lower total sperm counts, and altered pituitary–gonadal hormones
among men with high PFOS–PFOA levels. Conclusion: High PFAA levels were associated
with fewer normal sperm. Thus, high levels of PFAAs may contribute to the otherwise
unexplained low semen quality often seen in young men. However, our findings need to be
corroborated in larger studies.
Karrman A et al. (2009) Relationship between dietary exposure and serum perfluorochemical
(PFC) levels--a case study. Environ Int. 35(4): 712-717.
Abstract. Daily dietary intake of perfluorinated chemicals (PFCs) in relation to serum levels
was assessed by determination of nine PFCs including perfluorooctane sulfonate (PFOS) and
perfluorooctanoic acid (PFOA) in matched daily diet duplicates and serum samples. Diet and
serum were collected in year 2004 from 20 women in Osaka and Miyagi, Japan. Only PFOS
and PFOA were detected in the diet samples and no significant difference between cities was
seen. After adjusted by water content, diet concentration of PFOA was significantly higher in
Osaka. The median daily intake calculated using the measured diet concentrations was 1.47
ng PFOS/kg b.w. and 1.28 ng PFOA/kg b.w. for Osaka, and 1.08 ng PFOS/kg b.w. and 0.72
ng PFOA/kg b.w. for Miyagi. A significant difference between cities was seen for the serum
concentrations with median of 31 ng/mL PFOS and PFOA in Osaka, compared to 14 ng/mL
PFOS and 4.6 ng/mL PFOA in Miyagi. Carboxylates such as perfluorononanoic acid (PFNA)
and perfluoroundecanoic acid (PFUnDA) were also detected in serum at median levels 6.9
ng/mL and 3.2 ng/mL (Osaka), and 2.8 ng/mL and 5.1 ng/mL (Miyagi). Based on onecompartment model under steady state, dietary intake of PFOS and PFOA accounted for only
22.4% and 23.7% of serum levels in Osaka females, and in contrast 92.5% and 110.6% in
Miyagi females, respectively.
Kato K et al. (2009) Polyfluoroalkyl Compounds in Pooled Sera from Children Participating in
the National Health and Nutrition Examination Survey 2001-2002. Environ Sci Technol. 43(7):
2641-2647.
Abstract. To assess exposure of polyfluoroalkyl compounds (PFCs) among children, we
measured the concentrations of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid
(PFOA), perfluorohexane sulfonic acid, and 8 other PFCs in 24 pooled serum samples. The
individual serum samples used to make the pools were collected from U.S. children who
were participants in the 2001-2002 National Health and Nutrition Examination Survey. These
children were from three major races/ ethnicities (non-Hispanic blacks, non-Hispanic whites,
and Mexican Americans), two age categories (3-5 and 6-11 years), and both sexes. PFCs
were extracted from 100 μL of serum using online solid-phase extraction coupled to isotope
dilution high performance liquid chromatography tandem mass spectrometry; detection limits
ranged from 0.1 to 0.4 ng/mL. In the final ANOVA models, race was the only significant
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demographic factor, and concentrations appeared to be lower for Mexican Americans than for
the other two racial groups. For example, for Mexican American children 6-11 years old, the
least-squares means (LSM) estimates were 30.45 ng/mL (PFOS) and 6.125 ng/mL (PFOA),
while for non-Hispanic white children of the same age group, the LSM estimates were 42.45
ng/mL (PFOS) and 7.575 ng/mL (PFOA). However, after adjusting for the potential
underestimation of variance associated with the sampling design, race did not remain a
significant factor. Nevertheless, these findings suggest that human exposure to PFCs among
the population groups of children examined may differ and stress the importance of
identifying the environmental sources and routes of exposure to PFCs.
Leonard R et al. (2008) Retrospective Cohort Mortality Study of Workers in a Polymer
Production Plant Including a Reference Population of Regional Workers. Ann Epidemiol. 18(1):
15-22.
Abstract. PURPOSE: Based on previous reports of increased serum lipid levels in workers at
a U.S. polymer manufacturing facility, the study objective was to investigate ischemic heart
disease (IHD) mortality as well as a broad range of mortality causes for an occupational
cohort at the facility. METHODS: The cohort comprised 6,027 men and women who had
worked at the facility between 1948 and 2002; these years delimit the mortality follow-up
period. Standardized mortality ratios (SMR) were estimated to compare observed numbers of
deaths to expected numbers derived from mortality rates for 3 reference populations: the U.S.
population, the West Virginia state population, and an 8-state regional employee population
from the same company. RESULTS: Most SMR estimates based on U.S. and state
populations were below 100. Comparison to the employee population also resulted in many
SMR estimates at or near a no-effect level. Relative to the regional worker population, a
nonsignificant elevation for IHD mortality was observed (SMR = 109, 95% confidence
interval [CI]: 96, 124). Mortality associated with diabetes was significantly increased
compared to the regional worker population (SMR = 197, 95% CI: 123, 298). A
corresponding increase in the SMR for IHD and diabetes mortality was not detected for
comparisons with the two general populations. CONCLUSIONS: The results reported herein
show little evidence of increased cause-specific mortality risks for workers at the plant. This
study demonstrates the utility of comparing occupational cohorts with a similar worker
reference population in order to reduce bias associated with the healthy worker effect.
Lin C et al. (2008) Association Among Serum Perfluoroalkyl Chemicals, Glucose Homeostasis
and Metabolic Syndrome in Adolescents and Adults. Environmental Health Perspectives. 32(4):
702-707.
Abstract. Objective: Perfluoroalkyl chemicals (PFCs) have been used worldwide in a variety
of consumer products. The effect of PFCs on glucose homeostasis is not known. Research
design and methods: We examined 474 adolescents and 969 adults with reliable serum
measures of metabolic syndrome (MS) profile from the National Health and Nutrition
Examination Survey 1999-2000 and 2003-2004. Results: In adolescents, increased serum
perfluorononanoic acid (PFNA) concentrations were associated with hyperglycemia (OR =
3.16, 95% CI = 1.39-7.16, P < 0.05). Increased serum PFNA concentrations also have
favorable associations with serum HDL-C (OR = 0.67, 95% CI = 0.45-0.99, P < 0.05).
Overall, increased serum PFNA concentrations were inversely correlated with the prevalence
of the MS (OR = 0.37, 95% CI = 0.21-0.64, P < 0.005). In adults, increased serum
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perfluorooctanoic acid (PFOA) concentrations were significantly associated with increased β
cell function (βcoeff = 0.07±0.03, P < 0.05). Increased serum perfluorooctane sulfate (PFOS)
concentrations were associated with increased blood insulin (βcoeff = 0.14±0.05, P < 0.01),
HOMA-IR (βcoeff = 0.14±0.05, P < 0.01) and β cell function (βcoeff = 0.15±0.05, P < 0.01).
Serum PFOS concentrations were also unfavorably correlated with serum HDL-C (OR =
1.61, 95% CI = 1.15-2.26, P < 0.05). Conclusions: Serum PFCs were associated with glucose
homeostasis and indicators of MS. Further clinical and animal studies are warranted to clarify
putative causal relationships.
Nolan LA et al. (2009) The relationship between birth weight, gestational age and
perfluorooctanoic acid (PFOA)-contaminated public drinking water. Reprod Toxicol. 27(3-4):
231-238.
Abstract. BACKGROUND: Recent studies have examined the associations between
perfluorooctanoic acid (PFOA) levels in cord blood and maternal plasma with lowered birth
weight and gestational age in humans; however, no study has examined these effects in a
population of known high PFOA exposure. Residents drinking PFOA-contaminated water
from the Little Hocking Water Association (LHWA) in Washington County, Ohio have
serum PFOA levels approximately 80 times those in the general U.S. population.
OBJECTIVES: To compare birth weights and gestational ages of neonates born to mothers
residing in zip codes with water service provided completely, partially or not at all by the
LHWA. METHODS: Multiple logistic and linear regression analyses were performed on
singleton neonatal birth weight data supplied by the Ohio Department of Health to examine
the associations between LHWA water service category (used as a surrogate for PFOA
exposure) with mean birth weight, mean gestational age, the likelihood of low birth weight
(<2500 g), and the likelihood of preterm birth (<37 completed weeks of gestation). All
models were adjusted for maternal age, gestational age, sex, race and population-level
socioeconomic status. RESULTS: The incidence of low birth weight, preterm birth, mean
birth weight and mean gestational age of neonates did not significantly differ among water
service categories. CONCLUSION: Markedly elevated PFOA exposure, as categorized by
water service category, is not associated with increased risk of lowered birth weight or
gestational age. This study does not confirm earlier findings of an association between PFOA
and lowered birth weight observed at normal population levels
Olsen GW, Butenhoff JL, Zobel LR. (2009) Perfluoroalkyl chemicals and human fetal
development: An epidemiologic review with clinical and toxicological perspectives. Reprod
Toxicol. 27(3-4): 212-230.
Abstract. Epidemiologists began to focus on human developmental outcomes with
perfluorooctanesulfonate (PFOS) and perfluorooctanoate (PFOA) as a consequence of dosedependent developmental toxicological studies that reported effects of lowered birth weight,
increased postnatal mortality, and decreased postnatal growth in surviving rats and mice.
Contributing to the epidemiologic interest was the widespread presence of PFOS and PFOA
in the general population, lengthy serum elimination half-lives in humans, and the placental
transfer of PFOS and PFOA in humans that was established via measurement of paired
maternal and umbilical cord blood samples. The purpose of this paper is to qualitatively
review the published epidemiologic literature as it pertains to the potential association of
exposure to PFOS and PFOA with human fetal development. The published research has
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focused on birth weight and other measurements that reflect human fetal development. A
total of eight epidemiologic studies were reviewed that focused on six general (nonoccupational) and two occupational populations. Of the six general population studies, five
examined associations between birth weight and other anthropometric measurements in
relation to maternal blood and/or umbilical cord concentrations of PFOS and PFOA. In the
sixth study, three geographical areas in Washington County, Ohio, were categorized by their
public drinking water sources that contained PFOA that had resulted in higher serum
concentrations than observed in other general population studies. The occupational studies
focused on a perfluorochemical manufacturing site (Decatur, AL) with exposure categorized
from work history and biomonitoring data. There were inconsistent associations reported for
several different birth outcomes, including birth weight, birth length, head circumference, and
ponderal index, among the five general population studies that measured PFOS and PFOA in
the study subjects. No association with birth weight or gestational age was reported in the
community drinking water study. Only one general population study examined infant Apgar
scores and developmental milestones at 6 and 18 months of age with no associations
reported. No association with self-reported birth weight and occupational exposure to PFOS
materials was observed among female perfluorochemical productionworkers. These
epidemiologic data are discussed in relation to their methodological strengths and
weaknesses, coherence with toxicological results, consistency of associations between
studies, and plausible alternative explanations. Epidemiological, clinical, and toxicological
insights are offered that may be useful for human health risk characterization. Studies
scheduled for completion in the next few years are also cited. An appendix to this review
describes the results of the only investigation that attempted to determine whether a causal
association existed between maternal (4–14 weeks gestation) PFOS and PFOA
concentrations in a general population and fecundity, as measured by time to pregnancy
(TTP). Important issues are addressed regarding the methods and data analysis that may limit
inferences from this particular study.
Olsen GW et al. (2009) A comparison of the pharmacokinetics of perfluorobutanesulfonate
(PFBS) in rats, monkeys, and humans. Toxicology. 256(1-2): 65-74.
Abstract. Materials derived from perfluorobutanesulfonyl fluoride (PBSF, C4F9SO2F) have
been introduced as replacements for eight-carbon homolog products that were manufactured
from perfluorooctanesulfonyl fluoride (POSF, C8F17SO2F). Perfluorobutanesulfonate (PFBS,
C4F9SO3−) is a surfactant and potential degradation product of PBSF-derived materials. The
purpose of this series of studies was to evaluate the pharmacokinetics of PFBS in rats,
monkeys, and humans, thereby providing critical information for human health risk
assessment. Studies included: (1) intravenous (i.v.) elimination studies in rats and monkeys;
(2) oral uptake and elimination studies in rats; and (3) human serum PFBS elimination in a
group of workers with occupational exposure to potassium PFBS (K+PFBS). PFBS
concentrations were determined in serum (all species), liver (rats), urine (all species), and
feces (rats). In rats, the mean terminal serum PFBS elimination half-lives, after i.v.
administration of 30mg/kg PFBS, were: males 4.51±2.22h (standard error) and females
3.96±0.21h. In monkeys, the mean terminal serum PFBS elimination half-lives, after i.v.
administration of 10mg/kg PFBS, were: males 95.2±27.1h and females 83.2±41.9h. Although
terminal serum half-lives in male and female rats were similar, without statistical
significance, clearance (CL) was significantly greater in female rats (469±40mL/h) than male
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rats (119±34mL/h) with the area under the curve (AUC) significantly larger in male rats
(294±77μg·h/mL) than female rats (65±5μg·h/mL). These differences were not observed in
male and female monkeys. Volume of distribution estimates suggested distribution was
primarily extracellular in both rats and monkeys, regardless of sex, and urine appeared to be a
major route of elimination. Among 6 human subjects (5 male, 1 female) followed up to 180
days, the geometric mean serum elimination half-life for PFBS was 25.8 days (95%
confidence interval 16.6–40.2). Urine was observed to be a pathway of elimination in the
human. Although species-specific differences exist, these findings demonstrate that PFBS is
eliminated at a greater rate from human serum than the higher chain homologs of
perfluorooctanesulfonate (PFOS) and perfluorohexanesulfonate (PFHxS). Thus, compared to
PFOS and PFHxS, PFBS has a much lower potential for accumulation in human serum after
repeated occupational, non-occupational (e.g., consumer), or environmental exposures.
Olsen GW et al. (2008) Decline in perfluorooctanesulfonate and other polyfluoroalkyl chemicals
in American Red Cross adult blood donors, 2000-2006. Environ Sci Technol. 42(13): 4989-4995.
Abstract. In 2000, 3M Company, the primary global manufacturer, announced a phase-out of
perfluorooctanesulfonyl fluoride (POSF,C8F17SO2F)-based materials after
perfluorooctanesulfonate (PFOS, C8F17SO3-) was reported in human populations and wildlife.
The purpose of this study was to determine whether PFOSandother polyfluoroalkyl
concentrations in plasma samples, collected in 2006 from six American Red Cross adult
blood donor centers, have declined compared to nonpaired serum samples from
thesamelocations in 2000-2001. For each location, 100 samples were obtained evenly
distributed by age (20-69 years) and sex. Analytes measured, using tandem mass
spectrometry, were PFOS, perfluorooctanoate (PFOA), perfluorohexanesulfonate (PFHxS),
perfluorobutanesulfonate (PFBS), N-methyl perfluorooctanesulfonamidoacetate (MePFOSA-AcOH), and N-ethyl perfluorooctanesulfonamidoacetate (Et-PFOSA-AcOH). The
geometric mean plasma concentrations were for PFOS 14.5 ng/mL (95% CI 13.9-15.2),
PFOA 3.4 ng/mL (95% CI 3.3-3.6), and PFHxS 1.5 ng/mL (95% CI 1.4-1.6). The majority of
PFBS, Me-PFOSA-AcOH, and Et-PFOSA-AcOH concentrations were less than the lower
limit of quantitation. Age- and sex-adjusted geometric means were lower in 2006
(approximately 60% for PFOS, 25% for PFOA, and 30% for PFHxS) than those in 20002001. The declines for PFOS and PFHxS are consistent with their serum elimination halflives and the time since the phase-out of POSF-based materials. The shorter serum
elimination half-life for PFOA and its smaller percentage decline than PFOS suggests PFOA
concentrations measured in the general population are unlikely to be solely attributed to
POSF-based materials. Direct and indirect exposure sources of PFOA could include historic
and ongoing electrochemical cell fluorination (ECF) ofPFOA,telomer production of PFOA,
fluorotelomer-based precursors, and other fluoropolymer production.
Sakr C et al. (2009) Ischemic Heart Disease Mortality Study among Workers with Occupational
Exposure to Ammonium Perfluorooctanoate. Occupational and Environmental Medicine.
Online.
Abstract. Objectives: Ammonium perfluorooctanoate (APFO) is a biopersistent surfactant
used in the manufacture of several types of fluoropolymers. Based on previous findings of
increased serum lipid levels associated with exposure to ammonium perfluorooctanoate
(APFO), we evaluated ischemic heart disease (IHD) mortality in a cohort of occupationally
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exposed workers. Methods: Relative risks (RR) were estimated from exposure-response
analyses of cumulative exposure measures using proportional hazards regression models.
Results: Two hundred thirty nine IHD deaths have occurred in the cohort of 4,747 workers
with work histories from 1948 through 2002. RR estimates indicate no statistically significant
increased mortality risk for IHD associated with estimated cumulative exposure. We observed
a positive trend only at an exposure lag of 10 years. This finding was not reproduced in other
5-year exposure lags and was attenuated when different cutpoints for exposure categorization
were used. Conclusion: This exposure-response study shows no convincing evidence of
increased IHD mortality risk for APFO-exposed workers at this plant. Further studies
evaluating incidence of IHD are being conducted.
Tao L et al. (2008) Biomonitoring of perfluorochemicals in plasma of New York State personnel
responding to the World Trade Center disaster. Environ Sci Technol. 42(9): 3472-3478.
Abstract. The collapse of the World Trade Center (WTC) on September 11, 2001 resulted in
the release of several airborne pollutants in and around the site. Perfluorochemicals including
perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA), which are used in soiland stain-resistant coatings on upholstery, carpets, leather, floor waxes, polishes, and in firefighting foams were potentially released during the collapse of the WTC. In this pilot study,
we analyzed 458 plasma samples of New York State (NYS) employees and National Guard
personnel assigned to work in the vicinity of the WTC between September 11 and December
23, 2001, to assess exposure to perfluorochemicals released in dust and smoke. The plasma
samples collected from NYS WTC responders were grouped based on estimated levels of
exposure to dust and smoke, as follows: more dust exposure (MDE), less dust exposure
(LDE), more smoke exposure (MSE), and less smoke exposure (LSE). Furthermore, samples
were grouped, based on self-reported symptoms at the time of sampling, as symptomatic and
asymptomatic. Eight perfluorochemicals were measured in 458 plasma samples. PFOS,
PFOA, perfluorohexanesulfonate (PFHxS), and perfluorononanoic acid (PFNA), were
consistently detected in almost all samples. PFOA and PFHxS concentrations were
approximately 2-fold higher in WTC responders than the concentrations reported for the U.S.
general population. No significant difference was observed in the concentrations of
perfluorochemicals between symptomatic and asymptomatic groups. Concentrations of
PFHxS were significantly (p < or = 0.05) higher in the MDE group than in the LDE group.
Concentrations of PFNA were significantly higher in the MSE group than in the LSE group.
Significantly higher concentrations of PFOA and PFHxS were found in individuals exposed
to smoke than in individuals exposed to dust. A significant negative correlation existed
between plasma lipid content and concentrations of certain perfluorochemicals. Our initial
findings suggest that WTC responders were exposed to perfluorochemicals, especially
PFOA, PFNA, and PFHxS, through inhalation of dust and smoke released during and after
the collapse of the WTC. The potential health implications of these results are unknown at
this time. Expansion of testing to include all archived samples will be critical to help confirm
these findings. In doing so, it may be possible to identify biological markers of WTC
exposure and to improve our understanding of the health impacts of these compounds.
Tao L et al. (2008) Perfluorinated compounds in human milk from Massachusetts, U.S.A.
Environ Sci Technol. 42(8): 3096-3101.
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Abstract. Perfluorinated compounds (PFCs), notably perfluorooctane- sulfonate (PFOS) and
periluorooctanoic acid (PFOA), have been reported in human blood. Furthermore, the
occurrence of PFCs in the blood of newborn babies, coupled with the need to study the
potential association of PFC exposure with birth outcomes in neonates, suggests the need for
determining the sources and magnitude of exposure in infants. In this study, nine PFCs were
measured in 45 human breast milk samples collected in 2004 from Massachusetts, U.S.A.
PFOS and PFOA were the predominant PFCs found at mean concentrations of 131 and 43.8
pg/mL, respectively. Comparison of the ratio of PFOS to PFOA in human milk with the ratios
published for human serum from the U.S. female population suggested preferential
partitioning of PFOA to milk. Concentrations of PFOA were significantly higher in the milk
of mothers nursing for the first time (n = 34) than in the milk of mothers who have previously
nursed (n = 8). Based on the estimated body weight and milk intake, the average and highest
daily intakes of total PFCs by infants were 23.5 and 87.1 ng/kg bw, respectively. We found
that the daily ingestion rates of PFOS and PFOA did not exceed the tolerable daily intake
recommended by the U.K. Food Standards Agency. This is the first study to measure the
occurrence of PFCs in human milk from the U.S.A.
von Ehrenstein OS et al. (2009) Polyfluoroalkyl chemicals in the serum and milk of
breastfeeding women. Reprod Toxicol. 27(3-4): 239-245.
Abstract. Polyfluoroalkyl chemicals (PFCs) comprise a group of man-made organic
compounds, some of which are persistent contaminants with developmental toxicity shown in
laboratory animals. There is a paucity of human perinatal exposure data. The US EPA
conducted a pilot study (Methods Advancement for Milk Analysis) including 34
breastfeeding women in North Carolina. Milk and serum samples were collected at 2–7weeks
and 3–4 months postpartum; 9 PFCs were assessed in milk and 7 in serum. Perfluorooctane
sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and
perfluorohexane sulfonic acid (PFHxS) were found in nearly 100% of the serum samples.
PFOS and PFOA were found at the highest concentrations. PFCswere belowthe limit of
quantification in most milk samples. Serum concentrations of PFOS, PFOA and PFHxSwere
lower (p < 0.01) at the second visit compared to the first visit. Living in North Carolina 10
years or longer was related to elevated PFOS, PFOA and PFNA (p≤0.03). These pilot data
support the need to further explore perinatal PFC exposures and potentially related health
effects, as planned in the upcoming National Children’s Study which provided the framework
for this investigation.
Wilhelm M et al. (2008) Assessment and management of the first German case of a
contamination with perfluorinated compounds (PFC) in the Region Sauerland, North RhineWestphalia. J Toxicol Environ Health: Part A. 71(11-12): 725-733.
Abstract. In May 2006 the first serious German perfluorinated compounds (PFC) case of
contamination became evident. Industrial waste with high concentrations of PFC was
manufactured into a soil improver by a recycling company and spread by farmers on
agricultural land of the rural area Sauerland, and led to substantial environmental pollution.
In parts of the affected area, perfluorooctanoic acid (PFOA) concentrations in drinking water
were > 0.5 microg/L. The German Drinking Water Commission assessed PFC in drinking
water and set a health-based guidance value for safe lifelong exposure of all population
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groups at 0.3 microg/L (sum of perfluorooctane sulfonate [PFOS] and PFOA). The Ministry
of Environment together with regional institutions initiated monitoring measurements and
actions to minimize further contamination. A human biomonitoring study with mother-child
pairs and men revealed that increased PFOA exposure via drinking water led to about four- to
eightfold higher PFOA levels in plasma compared to nonexposed groups. Analysis of PFC in
breast milk showed comparatively low levels, which seemed not to pose a risk for lactating
infants. Due to high levels of PFOS in fish from contaminated lakes and rivers,
recommendations for anglers to reduce fish consumption were initiated. Remediation of the
affected area is ongoing and PFC levels in various matrices are still above background levels.
Wilhelm M et al. (2009) Preliminary observations on perfluorinated compounds in plasma
samples (1977-2004) of young German adults from an area with perfluorooctanoatecontaminated drinking water. Int J Hyg Environ Health. 212(2): 142-145.
Abstract. In May 2006, a serious environmental contamination with perfluorinated
compounds (PFCs) became evident in a rural area of North Rhine-Westphalia (NRW)
(Region Sauerland), Germany. In autumn 2006, we performed a human biomonitoring study
in which a 4–8-fold increase in perfluorooctanoate (PFOA)-plasma concentrations of
children, their mothers and men living in Arnsberg (District Hochsauerlandkreis, NRW) was
observed compared with a reference population. The exposure was clearly related to the
consumption of PFOA-contaminated tap water. However, there is no clear information on the
duration of this contamination. The current investigation involves the analysis of PFCs in 30
blood samples of young adults (age 20–31 years) who had ever lived in the affected area. The
samples were taken between 1977 and 2004 and stored at the German Environmental
Specimen Bank for Human Tissues. Analyses of PFOA, perfluoroctanesulfonate (PFOS),
perfluorohexanoate (PFHxA), perfluorohexanesulfonate (PFHxS), perfluoropentanoate
(PFPA) and perfluorobutanesulfonate (PFBS) in blood plasma were performed by solidphase extraction, HPLC and MS/MS detection. PFOA values (median, range) were 6.1, 1.7–
40.7μg/l, PFOS values were 18.8, 8.1–150.7μg/l and PFHxS values were 1.7, 0.5–4.6μg/l.
The concentrations of PFHxA, PFPA and PFBS in plasma were all below limit of detection.
Time-trend analysis showed that between 1977 and 2004 PFOA and PFOS levels remained
fairly stable. PFOS and PFOA levels were in the range of current background levels of the
general population. In contrast, PFHxS plasma levels have steadily increased since 1977.
There was a close association between PFOS and PFOA-plasma levels. From this pilot study
there are no indications for an increased exposure to PFCs of residents in Arnsberg in the
years 1977–2004 prior to the contamination in 2006.
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EHTB advisory panel meeting summary (DRAFT)
Summary of the
Minnesota Department of Health (MDH)
Environmental Health Tracking and Biomonitoring Advisory Panel Meeting
June 2, 2009
1:00 p.m.-4:00 p.m.
DRAFT
Advisory Panel Members – Present
Beth Baker (chair)
John Adgate
Bruce Alexander
Alan Bender
Geary Olsen
Susan Palchick
Gregory Pratt
Dan Stoddard
Samuel Yamin
Lisa Yost
Advisory Panel Members – Regrets
Cecelia Martinez
Deb McGovern
Jill Heins Nesvold
Welcome and Introductions
Beth Baker, chairperson, convened the meeting, welcomed all participants and invited the panel
members and other participants to introduce themselves. Beth asked for any changes to the
minutes from the previous meeting and there were none.
East Metro PFC Biomonitoring Project Results
Adrienne Kari, EHTB Biomonitoring Coordinator, and Carin Huset, Public Health Laboratory,
presented a summary of the preliminary results of the PFC pilot project results.
Susan Palchik asked for information on how long Oakdale has been on municipal water, and how
long the contamination has existed. Geary Olsen provided a history of the chemical since first
manufactured in the 1950s, and disposed of in Washington County landfill sites, and the changes
in the Oakdale water system since the contamination was discovered.
Beth Baker and Lisa Yost asked whether the recent use of filtered water by participants on
private wells would affect chemical levels in the body, given the half life of PFCs. Also, Beth
asked whether the use of different water sources was prompted by MDH advisories. Adrienne
acknowledged MDH advisories did prompt the installation and use of filters and other alternative
water supplies in recent years. The decrease in drinking water exposure would be expected to
affect blood levels accordingly. She responded that she is currently reviewing the available water
test results for further analysis of a correlation between pre-filter well water concentrations and
blood levels.
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Ginny Yingling, MDH hydrogeologist, was asked to comment. Ginny stated that well data from
2005 – 2007 in Lake Elmo show concentrations are very stable during that time period, but
concentrations may be more highly variable in 2006-2008 Cottage Grove samples. She noted that
concentrations in Oakdale may vary based on geographical proximity to contaminated wells.
Beth asked if the test results have been provided to the community. Adrienne responded that only
individual results have been provided to participants. Following the panel meeting a final report
will be prepared to incorporate recommendations from the panel. A public meeting and release
of the report are expected in July to notify the community of the findings. Additional questions
from panel members, were asked regarding the information that has been released, inquiries
received from participants and medical professionals, and whether additional testing is planned.
Adrienne responded that she had received about 20-25 calls from participants requesting health
information and interpretations, several wanting to know if the testing would be repeated. Alan
Bender asked whether this pilot project is sufficient to establish baseline values for future
comparison and Geary responded that he thought it was sufficient for the population targeted. A
paired sample design, waiting 2-3 years, would work if there is not too much out-migration
before follow-up. Another option is to use a serial cross-sectional design which NHANES uses.
John Adgate stated it would be preferable to get 5 or 6 follow-up samples for time trends
analysis, to capture within- and between-individual variability.
John advised that the term “outlier” should not be used to describe extreme values in this data
set. The highest values are not errors in the data, and make sense in the distribution as seen on a
log scale.
Tannie Eshenhauer, Environmental Health Division, discussed the difficulties of communication
with the community and the plan for communication to this population, noting the difficulty of
answering questions about the health risk. Alan commented that the fact that the 3M workers
exposed at higher levels are not showing effects should give some indication for the population.
Geary asked if we can use the HRL code as a point of departure, look at the number and assume
safety. The concept of lifetime risk should be explained to the community. Beth questioned using
occupational data.
Susan asked what the next steps would be. Beth asked whether MDH has any plans for follow-up
studies in this population in the future. Jean Johnson, program director, answered that there was
no plan currently and that MDH is seeking advice on follow-up from the Advisory Panel as well
as comments from the community and legislators. Bruce Alexander stated that this project
demonstrates the utility of the program and needs follow-up. Susan recommended that we should
continue to raise the profile (continue with follow-up) only if we can answer an important
question. Geary suggested that the study should be repeated, either in the same people, or in a
repeat cross-section of the same population, to determine whether the exposure mitigation is
affecting blood levels as we expect. Bruce agreed that follow-up is warranted and more can be
learned. Alan noted that MDH starts preparing budgets in August so a recommendation from the
panel could be considered this fall for future funding. Samuel Yamin also recommended making
a statement now rather that waiting for the legislature to act or funding to be available. Susan
agreed and cautioned against having the legislature in the experiment design business, that the
panel should recommend designs for future scientific studies.
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After further discussion, a motion was made and members voted on the following
recommendation: Further biomonitoring on this population over time should be conducted for
future understanding of exposures and efficacy of the mitigation efforts. The motion passed.
John further advised that future follow-up be done with the engagement of all stakeholders in the
community.
Greg Pratt expressed concern for people with extreme results and asked whether further action
by MDH should be taken for these individuals. Beth responded that individuals have been given
results and advised to consult their physicians about health concerns. Susan recommended that
MDH should have a consistent message to give people about the health risks of PFCs and the
meaning of these results.
Geary recommended that MDH submit reports to peer-reviewed journals, noting that it is
valuable to get these findings published and searchable for others to use. John recommended
Environmental Health Perspectives. Jean agreed and stated that lessons learned from this project
(and others) will be provided in the next report to the Legislature and used for planning a future
state biomonitoring program.
Biomonitoring Project Updates
Jean Johnson noted that the materials provided to the panel contain written updates on the other
biomonitoring projects: arsenic, mercury and BPA/cotinine, and asked if panel members had any
comments or questions on these updates. Samuel Yamin asked if there is any follow-up planned
for the South Minneapolis Arsenic Study and whether the work being done by Smiley’s Clinic in
south Minneapolis to measure urinary arsenic among children seen at the clinic would continue.
Jean responded that there were no follow-up studies planned or recommended at this time. The
current recommendation was for continued education about the sources of arsenic exposure for
children and ways to avoid exposure. Adrienne Kari responded that the funding for the Smiley’s
Clinic study had also ended and she was not aware of plans by the clinic to continue offering
testing routinely. Smiley’s Clinic also reported their results at the community meeting in April.
Air Quality and Health Data Linkage Project
Jean Johnson and Chuck Stroebel presented a description of a data linkage research project being
conducted by staff in MDH and the MPCA, in collaboration with co-investigators at the MPCA
(Greg Pratt, PhD) and at the Olmsted Medical Center (Barbara Yawn, MD). The project is
funded by an EPA Science to Achieve Results (STAR) grant. The purpose is to develop EPA
indicators for measuring the public health impacts of environmental policies and actions for
reducing particulate matter (PM) exposure in the Twin Cities seven- county area and Olmsted
County. Chuck described several interventions currently under way and Jean described study
methods. Environmental data sources include PM2.5 monitoring and modeled data for years
2000-2009. Health data sources include respiratory and cardiovascular disease mortality,
hospitalizations and ambulance data for the Twin Cities, and administrative clinic visit data for
Olmsted County. Data linkage methods being tested include case-crossover and time series
regression for measuring associations between PM and health outcomes. The methods may also
be applied to future linkage projects for the Tracking program utilizing statewide data sources.
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Several states in the national EPHT program are testing similar methods for linking air quality
and health data.
Beth Baker asked how the project would determine that changes in health outcomes over a ten
year period were due to reductions in exposure. Jean responded that the indicator being tested
was change in the attributable fraction, or that portion of the outcomes attributable to the
exposure, and was calculated from the measured association or risk ratio. The attributable
fraction would be calculated in at least 3 periods of 3-4 years during the study period.
Strategic Planning for a State Biomonitoring Program
Barb Deming briefly recapped the most recent strategic planning activities and process, a
summary of the May retreat discussion, and explained that staff are seeking additional input and
clarification on some of the questions raised at the retreat. At the retreat, participants were asked
to brainstorm strategies to address four specific program purposes that were identified during
previous strategy sessions. At the retreat, it was suggested that the four purposes should be
condensed into one statement of purpose. Barb and the staff are requesting more clarification
about these purposes, what they imply for a state program, and then have some discussion on
whether we should still combine the purposes or leave them separate.
Jean gave a brief presentation and handed out a table that contrasted some differences between
purpose 1 (general population) and purpose 2 (targeted population) and what this means for
developing future strategies and methods for a program (such as sample selection). She noted
that the Legislators, when interviewed, stated that the advisory panel should determine how
targeted the program should be. They also stated that biomonitoring and tracking should be
integrated. She stated that a targeted population approach may or may not integrate with tracking
(surveillance data that is general statewide or county level data) depending on the spatial and
temporal scale. Jean stated she believes that the CDC is looking for states to lead the work on
this, and encourages the panel to use forward visioning process in thinking about a long-term
approach.
The panel discussed the options of combining the 4 purposes into one statement of purpose. The
combined statement includes an “and” which implies that we will do both purpose 1 and purpose
2, monitoring exposure in both the general population and in targeted populations. Panel
members noted that this strategy provides more flexibility and preferred a combined statement.
Jean noted the “general population” for a state program implies a statewide sample, versus
“targeted population,” which implies a selected subgroup or a stratified subset of the larger
population sample. Panel members requested that it would be helpful if more specific questions
about future strategies were mailed to them for consideration and response.
The meeting was adjourned by Beth Baker.
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