Minnesota Department of Health Environmental Health Tracking & Biomonitoring Advisory Panel Meeting March 8, 2011 1:00 pm – 4:00 pm Snelling Office Park Red River Room 1645 Energy Park Drive St. Paul, Minnesota ENVIRONMENTAL HEALTH TRACKING AND
BIOMONITORING ADVISORY PANEL
MEETING AGENDA
MARCH 8, 2011
Time Agenda item
Presenter(s)
1:00
Beth Baker, Chair
Welcome and
introductions
Item type/Anticipated outcome
TRACKING
1:05
Development of the
MN DATA Secure
Portal
Chuck Stroebel
David Stewart
Discussion item.
Staff will review planning efforts for the
development of the secure portal.
Panel members are invited to provide input on the
development and enhancements of the secure portal.
1:35
ETS Exposure as a
New Content Area
for Tracking in
Minnesota
Blair Sevcik
Jeannette Sample
Pete Rode
Decision item.
Staff will review the selection process for new
Minnesota-specific content areas for Tracking and
review ETS Exposure’s progress through that
selection process.
Panel members are invited to ask questions or
provide input on ETS Exposure as a new content
area. The chair will invite panel members to vote to
recommend this content area for ongoing tracking.
2:20 Break
2:35
Project Year 3
Proposal for
Tracking &
Biomonitoring
Jean Johnson
Chuck Stroebel
Discussion Item
Staff will present a progress report on meeting goals
for the CDC-funded Tracking grant and proposals for
year 3.
Panel members are invited to ask questions and
provide input on proposed future work and Tracking
priorities.
i
Time Agenda item
Presenter(s)
Item type/Anticipated outcome
Great Lakes
Biomonitoring
Project
Rita Messing
David Jones
Information sharing.
PFC2 Update
Jessica Nelson
Carin Huset
BIOMONITORING
3:00
3:30
Environmental Health staff will review the Great
Lakes Biomonitoring Project, which aims to evaluate
contaminant levels of residents living in the St. Louis
River Area of Concern (SLRAOC), especially the
members of the Fond du Lac (FDL) Band living near
the SLRAOC.
Information sharing.
Staff will provide a status update of the PFC Followup Biomonitoring Project (PFC2).
OTHER
3:45
Updates
Jean Johnson
Chuck Stroebel
Biomonitoring:
 Lake Superior
Mercury Project
 Riverside
Prenatal Project
Information sharing.
No formal presentations will be made on these topics.
Panel members are invited to ask questions or
provide input on any of the written tracking and
biomonitoring project updates included in the
meeting materials.
3:55
Tracking:
 New reports
 Website, GIS, and
MN DATA
 Communications
and Outreach
 Collaborations
New business
Beth Baker
4:00
Adjourn
The chair will invite panel members to suggest topics
for future discussion.
Beth Baker
Next meeting:
Tuesday, June 7, 2011, 1-4 p.m. Red River Room, Snelling Office Park
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TABLE OF CONTENTS
Agenda ...............................................................................................................i Table of Contents ............................................................................................. iii MATERIALS RETATED TO SPECIIFC AGENDA ITEMS Section overview: Development of the MN DATA Secure Portal.....................................................................................1 Section overview: ETS Exposure as a New Content Area for Tracking in Minnesota .......................................................................................7 Section overview: Project Year 3 Proposal for Tracking & Biomonitoring .......37 Section overview: Great Lakes Biomonitoring Project.....................................39 Section overview: East Metro PFC Biomonitoring Follow‐up (PFC2) Project Update ................................................................................................45 Section overview: Tracking & Biomonitoring Updates ....................................47 Biomonitoring Updates:.............................................................................49 Tracking Updates: ......................................................................................50 Section overview: Other Information ..............................................................57
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SECTION OVERVIEW: DEVELOPMENT OF THE MN DATA SECURE PORTAL In September 2010, MN EPHT launched the MN DATA portal, a web‐based query and information system designed to provide public access to summary data about health and the environment. There are preliminary plans for developing a system for secure access by July 31, 2011. MN EPHT has proposed to develop a limited system with role‐based access for sharing custom MN EPHT data with authorized/approved data users (i.e., state and local health professionals). This would fill a need that exists for MDH programs to share public health data with external parties using identity management tools and standards. Phase I includes development and implementation of a limited system with role‐based access. During Phase I, the target audience for the Secure DATA system is state and local public health professionals. Later phases (Phase II‐III) include enhancements of the system based on input from target audiences and CDC requirements and feedback. MN EPHT is seeking comments and suggestions from potential users of this system (state and local public health professionals) to inform its short and long‐term development plans. Upon receiving a request for data, approved data sets will be uploaded to the Secure DATA system per specifications in the request and the terms of use determined in consultation with data stewards. No data will be provided to users without prior authorization/approval from data stewards. ACTION NEEDED: Panel members are invited to ask questions or provide input on the development of the secure portal for MN DATA. In particular, members asked to consider the questions:  What are the key audiences for the Secure DATA system?  What features, data or services, would make this system most useful?  What are the key challenges, concerns or issues with its implementation?  What uses would key audiences likely have for custom data sets? 1 This page intentionally left blank. 2 Secure DATA System Background In September 2010 MN EPHT launched the MN DATA portal, a web‐based query and information system designed to provide public access to summary data about health and the environment. Under cooperative agreement with CDC, MN EPHT also is required to develop and implement a system for secure access to MN EPHT data by July 31, 2011. Some states in the National EPHT Network have launched web‐based systems (portals) that provide secure access to EPHT data (e.g., California, Wisconsin, Maine, and Missouri). MN EPHT is consulting with these states, CDC, MDH data stewards and others to determine the requirements for this system, including standards for identity management and appropriate measures to protect data privacy. The following is a description of preliminary plans for developing this system for secure (role‐based) access. Purpose MDH programs share public health data with external parties in accordance with MDH policies and MN Statutes (e.g., Minnesota Government Data Practices Act). However, currently there is no department‐
wide web‐based system for sharing these data using identity management tools or standards. MN EPHT has proposed to develop a limited system with role‐based access for sharing custom MN EPHT data with authorized/approved data users (i.e., state and local health professionals). The proposed system will provide access to data for specific projects, such as preparing a grant proposal or conducting a research project. Data, for example, may be needed at a spatial scale or format that is not available on the public portal. Similar to the public portal, these data may be used to: 
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Inform actions and policies that protect public health Develop and evaluate public health interventions Determine opportunities for research This system also will make accessible data documentation, including lists of data elements and data steward contacts, so that users can consult directly with the appropriate MDH staff, and evaluate whether existing data will meet their needs (assess feasibility). While information about data elements may be obtained by calling MDH, this information is not easy to access via a web‐based system. Audience During Phase I, the target audience for the Secure DATA system is state and local public health professionals. Later phases of the project (Phases II‐III) may include additional audiences, such as academic researchers and states/grantees in the National EPHT Network. MN EPHT has developed a plan to gather information from health professionals to assess user needs to inform development of this system. This input is critically important since the needs of user groups are diverse and highly specialized. Examples of information gathering activities have been/or are planned by MN EPHT include: in‐person demonstrations and meetings local public health professionals (data users groups); and an electronic survey to assess needs of target audiences in Minnesota. 3 Schedule MN EPHT has proposed a phased approach to develop and implement this system to communicate information about procedures about measures to protect data privacy; to ensure that the system is designed to meet target audience needs; and to effectively manage resources/staff directed to protect public health. Phase I includes development and implementation of a limited system with role‐based access that provides custom data sets in response to specific requests from authorized data users. Phase II‐III (grant Year 3) includes enhancements of the system based on input from target audiences and CDC requirements and feedback. Phase I II III Description Completion Date ‐ Limited system with role‐based access; custom data sets ‐ Usability testing; demonstrations; user feedback ‐ System enhancements ‐ CDC evaluation ‐ Expanded data sets ‐ Upgrades to meet state (OET) standards for identity management ‐ Expanded data sets & services July 31, 2011 December 31, 2011 July 31, 2012 Data Request Process Requests for data will be evaluated by MN EPHT on a case‐by‐case basis to determine data classification and feasibility. Approved data sets will be uploaded to the Secure DATA system per specifications in the request and the terms of use determined in consultation with data stewards. No data will be provided to users without prior authorization/approval from data stewards (i.e., the people and programs that collect and maintain the data in the system). Users will be required to sign and submit an access agreement form. In addition, MN EPHT will have technical security protections procedures that specify password policies, notifications/reporting, and audits. MN EPHT currently is consulting with MDH information security and data practices staff to develop the process for administering this system. 4 Scope The following items are in‐scope for Phase I: 
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Secure system with role‐based access (user names and passwords) Administrative interface and tools to ensure security; manage accounts and permissions Automated process for requesting data Limited data sets (3‐5 example data sets; customized summary data only) Development of data documentation (data elements, data steward contacts) Demonstrations for MDH data stewards, management Usability testing with external audiences Needs assessment survey of MN public health professionals Compliance with MDH information security and data practices requirements (MN Government Data Practices Act) Out of scope for Phase I: 
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Access to record‐level and private data Access to broad data sets for all core content areas (Nationally Consistent Data and Measures or NCDMs) (beyond those already on the public portal, MN DATA) GIS; geo‐coding services Compliance with new (yet to be adopted) state (OET) standards for identity management Next Steps MN EPHT is seeking comments and suggestions from potential users of this system (state and local public health professionals) to inform its short and long‐term development plans. By the end of July 2011 MDH will provide access to a limited system with role‐based access on the MN DATA portal. In grant Year 3, enhancements and data will be added to the system based on user needs, CDC requirements, and available MDH resources. Questions for discussion by the Advisory Panel: 1.
2.
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What are the key audiences for the Secure DATA system? What features, data or services, would make this system most useful? What are the key challenges, concerns or issues with its implementation? What uses would key audiences likely have for custom data sets? 5 This page intentionally left blank. 6 SECTION OVERVIEW: ETS EXPOSURE AS A NEW CONTENT AREA FOR TRACKING IN MINNESOTA Minnesota state law (Minn. Stat. Section 144.998) states that the EHTB advisory panel shall advise the commissioner of MDH and the Legislature on priorities for tracking, including specific chronic diseases and specific environmental hazards. In March 2010, the advisory panel provided input on a draft set of criteria for evaluating new tracking content areas and/or new measures within existing content areas. In September 2010, MN EPHT staff presented a refined selection process that incorporated feedback from panel members (such as a phased approach and earlier input by the advisory panel). In March 2011, the refined selection process will be used to present a new Minnesota‐specific content area that is under consideration: ETS Exposure. Selection Process The selection process, as currently conceived, is broken down into several phases: exploration, feasibility, recommendation, and implementation. The selection process includes many points at which the Advisory Panel may be approached or updated throughout the selection process. ETS Exposure as a New Content Area for Tracking in Minnesota ETS Exposure was used to pilot the selection process’s criteria and list of tasks. Phase III includes a presentation to the Advisory Panel of all criteria evaluated thus far in addition to a display of data & measures. At the March 2011 advisory panel meeting, MN EPHT staff will provide an overview of the selection process for ETS Exposure. Panel members are encouraged to ask questions or provide input on ETS Exposure as a new Minnesota‐specific content area. Panel members will then be invited to vote whether to recommend to the Commissioner that this content area be adopted and implemented as part of the Tracking program. The following items are included in this section of the meeting materials:  Selection process and criteria for new Minnesota‐specific tracking content areas and measures  Summary of evaluation criteria and piloted data & measures for ETS Exposure ACTION NEEDED: Panel members are invited to ask questions or provide input on ETS Exposure as a new content area for Tracking. In particular, members are asked to consider the following questions: 1) There is not county‐level data for these data sources. Can this content area still be informative if it is limited to state‐level data? 2) Both surveys are assumed to be reliable and valid by MDH. Do the reliability and validity need to be tested before adopting the data sources? 3) Which are the best exposure settings to display for adults? 5 options: “any other location,” car/home/work, and all combined 4) Which are the best exposure settings to display for youth? 4 options: car/room combined, car, room, and work (2008 only) 5) Should youth be classified into age groups? Panel members are invited to vote whether to recommend to the Commissioner of Health that this content area be adopted for ongoing Tracking in Minnesota. 7 This page intentionally left blank. 8 Overview of Selection Process In March 2011, the selection process for adding new content areas to Tracking in Minnesota will be discussed. Below is a summary of the process developed by the EPHT Technical Team on how new content areas are selected, including the four phases and the criteria, tasks, deliverables, and involvement in each phase. Once staff have compiled information on the potential content area from the first three phases, the Advisory Panel will be asked to vote on whether to recommend to the Commissioner of Health that the content area be included in MN EPHT. 9 Selection process and criteria for new Minnesota-specific
tracking content areas and measures (DRAFT)
The selection of new content areas and measures to be incorporated into MN EPHT will be done
on an ongoing basis throughout the year. The technical team plays a vital role in identifying,
exploring and providing input on new content areas and measures. The PM/PI will determine if
the rationale provided supports advancing to the next phase in the selection process, and give
the green light for continuing work. The Advisory Panel is informed and consulted at each phase
of the selection process and given the opportunity to provide input.
The process described below includes general guidelines for how new content areas and
measures may be selected. Specific decisions related to the process will be made at the
discretion of MN EPHT program management.
PHASE 1 (EXPLORATION):
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The Principal Investigator (PI)/Program Manager (PM) assigns members of the Technical
Team to initiate the development of a content area. Staff and student interests are one driver
for identifying new content areas and measures to initiate. Recommendations for new content
areas or measures may also come from other sources, including advisory panel members and
local public health. In future years, the EPHT program may seek recommendations for new
content from the public through a more formal process. Assigned members consider whether
resources are available to identify and explore new content areas.
Assigned members of the technical team build a rationale for the new content area(s) that
addresses the public health importance of the issue in Minnesota. Factors to be considered at
this stage include prevalence, causation, public health impact and actionability.
Assigned staff should also address preliminary issues of feasibility by making contact with
data stewards to collect information on available data sources and legal authority (e.g.,
data fields and years, statutes that govern data collection and use) and complete a data source
inventory template describing the available data sources in detail.
The initial rationale submitted to the technical team should make recommendations for which
data sources are most appropriate for further development and exploration. The initial
rationale should also include a list of potential indicators or measures.
The preliminary rationale/proposal is presented for discussion at a technical team meeting.
Team members ask questions, suggest additional data sources, provide technical advice, etc.
If the rationale does not support further exploration, the PI/PM will present a
recommendation to the advisory panel to discontinue work.
At this stage, each new content area and measure is considered on its own merits rather than
rated against other content areas and measures.
If input is needed by PI/PM to help reach consensus among numerous priorities that could be
further pursued (e.g., if staffing resources limit the number of options that can realistically be
pursued), the advisory panel will be consulted.
If data are not available for a content area of high public health importance, the advisory
panel may be asked to make a recommendation for gathering new data.
10 Specific criteria that are considered in the exploration phase include the following, which may influence whether a decision is made to move on to the stage of exploring and piloting a new content area. 1. Resources Available a) Staff time, staff interest, staff expertise (including outside staff, interns, student workers) b) Financial and technical resources are available 2. Degree of prevalence a) High estimated prevalence of disease/outcome in U.S. population, state or MN sub‐
population. b) High estimated proportion of population in state or sub‐population potentially exposed to hazard within particular media. 3. Causality a) Evidence exists that the disease has an environmental component cause. b) Evidence exists that the hazard or exposure is a component cause of an adverse health outcome. 4. Public health impact a) Population attributable risk or public health impact of the hazard is known or can be estimated from the available data. b) Severity of the disease effect is known and contributes to mortality or morbidity in the population. 5. Actionability a) Disease or hazard has existing prevention or control program (intervention, education, service) at MDH, local public health or other organization. b) Level of hazard, exposure or disease can be modified through policy, regulatory or personal actions. c) Disease or hazard prevention is tied to state or federal public health objectives d) Data and measures can be used to develop new program initiatives 5. Feasibility a) One or more data sources exist for exploration of “trackable” indicators. b) MDH has the legal authority to collect and use the data. c) Private data are classified and protected according to state and federal law. 11 
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PHASE TWO (FEASIBILITY):
Assigned staff select data source(s) and measures to be piloted to assess feasibility.
Feasibility criteria at this stage include data quality, timeliness, continuity of data over
time, comparability to other jurisdictions, and aggregation possibilities.
Assigned staff obtain a sample “cut” of the data from the data steward (which may require
developing a data use agreement/authorization) and develop new measures. New measures
are displayed in tables, maps and/or graphs to show temporal and/or geographic trends.
Assigned staff continue piloting the indicators, possibly over a period of many months, and
present to the technical team to get feedback and to refine the measures. Assigned staff
document the work done to develop and refine the measures.
When the content areas/measures have been fully piloted and feasibility has been assessed,
the technical team (or a subgroup of the technical team) gives input on whether to
recommend to the advisory panel that the content area or measure be adopted as an ongoing
part of the tracking program.
If the piloting process shows that the available data sources are not adequate for tracking a
content area of high public health importance, the advisory panel may be asked to make a
recommendation regarding strengthening the data sources.
Specific criteria that are considered in the exploration phase include the following, which may influence whether a decision is made to make a recommendation to adopt a new content area. 1. Feasibility a) Data quality  Population‐based  Representative of disease, hazard or exposure in the state.  Reliability  Validity b) Continuity, consistent ongoing data collection over time c) Timeliness, lag times are acceptable for surveillance purposes d) Comparability of indicators/measures to other jurisdictions. e) Aggregation possible at different geographic levels (e.g., state, county, ZIP code, census block) f) Cost to MDH of obtaining necessary data is not prohibitive 12 PHASE THREE (RECOMMENDATION STAGE):
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Assigned staff provide written summaries of the content areas and measures with
recommendations for consideration by the advisory panel.
For content areas that are recommended for inclusion in the tracking program, assigned staff
will assemble background information that addresses all of the selection criteria, including
whether the content area is an emerging issue, the potential for information building,
outside interest, the balance between hazard/exposure and disease content areas, and
economic impact. Provide a list of strengths and limitations of the content area based on all
selection criteria and data.
The advisory panel will make a recommendation about which content areas and measures
should be adopted as an ongoing part of the tracking program.
The commissioner, represented by the Steering Committee, is informed about the
recommendations of the advisory panel and makes a final decision about the adoption of new
content areas or measures.
Specific criteria that may be considered by advisory panel members in the recommendation phase, in addition to those listed above, include the following, which may influence whether a new content area is adopted as an ongoing part of MN‐EPHT. 1. Emerging issues a) Incidence or prevalence of disease is changing or perceived to be changing. b) Degree or level of exposure is changing or perceived to be changing. 2. Potential for information building a) Disease with unknown environmental etiology or unknown prevalence. b) Hazard with unknown association to health outcomes or unknown level of exposure in the population.  Can be used to inform or guide research initiatives 3. Outside interest or public concern a) High concern regarding prevalence and etiology of disease or outcome. b) High concern regarding proportion of the population exposed to a hazard or changes in exposure to a hazard. c) Priority previously identified by environmental health professionals and organizations (e.g. CDC, WHO, NHANES, EPA, NIOSH, ASTHO, etc.). 4. Balance between hazard/exposure and disease content areas tracked. 5. Balance in age groups affected (children, adults, elderly). 6. Economic impact on EPHT Program and partners (optionally: State, healthcare systems and industry) PHASE FOUR (IMPLEMENTATION STAGE):
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Once adopted, assigned technical team members incorporate the new content areas and
measures into the tracking program.
Assigned staff develop documentation related to the new content areas and measures,
including a description of how measures are calculated, and a description of metadata.
13 This page intentionally left blank. 14 Summary of Evaluation Criteria: for a New Tracking Content Area in Minnesota Environmental Tobacco Smoke (ETS) Exposure Phase I: Exploration ........................................................................................................................... 16 Available Resources Prevalence Causality Actionability Public Health Impact Initial Feasibility Phase II: Feasibility ............................................................................................................................ 19 Detailed Feasibility Pilot of Potential Measures Phase III: Recommendation ............................................................................................................ 21 Emerging Issues Information Building Outside Interest Balance Economic Impact Summary of Criteria Acronyms ATS ETS YTS MN EPHT MDH NHANES Adult Tobacco Survey Environmental Tobacco Smoke Youth Tobacco Survey Minnesota Environmental Public Health Tracking (“Tracking Program”) Minnesota Department of Health National Health and Nutrition Examination Survey 15 Phase I: Exploration Note: presented and discussed at the EPHT Technical Team’s June and July 2010 meetings Prevalence Question: Is there a high estimated proportion of the population that is exposed or potentially exposed to ETS, in the state or a subpopulation? Yes a high proportion of the general population of the US, adults and children, are exposed to ETS, including the subpopulation of nonsmokers in the US.  About 43% of nonsmokers aged 4+ years in the US have cotinine levels ≥0.5µg/dL, indicating ETS exposure (NHANES III)  About 47% of children aged ≤3 years and about 58% of non‐smoking children aged 3‐19 years in the US lived in a home with at least one smoker (NHANES III)  In Minnesota, about 48% of high school students and about 38% middle school students that did not currently smoke reported being exposed to ETS in the last week, while about 10% of non‐
smokers in high school and middle school reported being exposed every day in the last week (2008 Minnesota Youth Tobacco and Asthma Survey, MDH) Causality Question: Is there evidence that ETS exposure is a component cause of adverse health outcomes? Yes, there are several known adverse health effects linked to ETS exposure, both in children and adults.  ETS is known to be a human carcinogen and especially linked to lung cancer  In children, it is causally associated with developmental effects (e.g. fetal growth, low birthweight, SIDS) and respiratory effects (e.g. asthma induction, asthma exacerbation, acute lower respiratory tract infections)  In adults, it is causally associated with respiratory, carcinogenic, and cardiovascular effects Actionability Question: Are there existing prevention or control programs at MDH or other Minnesota organizations for the hazard of ETS exposure or its adverse health outcomes? Yes, there are several existing programs in the state that measure or attempt to prevent ETS exposure or its adverse health outcomes. Some of these include:  Tobacco Prevention and Control (TPC) Program at MDH  Center for Health Statistics at MDH  Youth and Adult Tobacco Surveys  Asthma Program at MDH  Minnesota Cancer Surveillance System  American Lung Association of Minnesota  ClearWay Minnesota and QUITPLAN 16 Question: Can the level of ETS exposure be modified through policy, regulatory, or personal actions? Freedom to Breathe (October 2007) prohibits smoking in virtually all indoor public places and indoor places of employment, protecting non‐smokers from ETS exposure in public. However, the FTB law does not prohibit smoking in outdoor or private spaces. Therefore, smoking bans enforced by adults or other non‐smokers and other personal actions can further reduce ETS exposure, especially in private spaces like the home or the car. Question: Is ETS exposure tied to state or federal public health objectives? Yes, there are five Healthy People 2020 Objectives in the Tobacco Use (TU) topic that target ETS exposure (http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=41).  TU‐11: Reduce the proportion of nonsmokers exposed to secondhand smoke o Among children aged 3‐11 years (target: 74%) o Among adolescents aged 12‐17 years (target: 70.2%) o Among adults aged 18 years and older (target: 68%)  TU‐12: Increase the proportion of persons covered by indoor worksite policies that prohibit smoking (target: 100%)  TU‐13: Establish laws… on smoke‐free indoor air that prohibit smoking in public places and worksites o Including, but not limited to: private and public workplaces, restaurants, bars, commercial and home‐based daycare centers, vehicles with children  TU‐14: Increase the proportion of smoke‐free homes (target: 87%)  TU‐15: Increase tobacco‐free environments in schools, including all school facilities, property, vehicles, and school events Question: Can data and measures in this content area be used to develop new program initiatives? Currently, existing programs target either ETS exposure (e.g. Tobacco Prevention and Control at MDH) or adverse health outcomes (e.g. Asthma Program at MDH, Minnesota Cancer Surveillance System). This content area could link these topics by bringing together silos of information via MN EPHT’s online web portal. Public Health Impact Question: Can the population attributable risk or public health impact of exposure to ETS be estimated from the available data (or is it known)? Public health impact is far‐ranging, as there are several known and suspected adverse health outcomes associated with ETS exposure in different populations. Waters et al. (2009) explored the substantial economic burden of ETS exposure in Minnesota, using claims data from Blue Cross and Blue Shield of Minnesota. They estimated that the total cost of treatment for conditions that are causally linked to ETS exposure (according to the 2006 U.S. Surgeon General’s Report) was about $229 million in 2003, or about $45 per Minnesota resident. 17 These conditions included: low birth weight, acute lower‐respiratory illness, otitis media and middle‐ear effusion, asthma or wheeze illness, lung cancer, and coronary heart disease. Waters et al. (2009) also provides the population attributable risk (PAR) for several adverse health outcomes in Minnesota. In 2003, the PAR due to ETS exposure among Minnesota children aged 0‐17 years was 18% of low birth weight, 25% of acute lower‐respiratory illnesses, 14% of otitis media and middle‐ear effusion, and 35% of asthma or wheeze illness. The PAR due to ETS exposure among Minnesota adults aged 18+ years: 4.9% of lung cancer and 6.9% of coronary heart disease. Source: Waters HR, Foldes SS, Alesci NL, Samet J. The Economic Impact of Exposure to Secondhand Smoke in Minnesota. Am J Public Health. 2009; 99 (4): 754‐759. (Initial) Feasibility Question: Is there a data source for exploration of “trackable” indicators? Yes, there are two data sources that could provide data on ETS exposure among nonsmokers in Minnesota. These include the Minnesota Youth Tobacco Survey (or Youth Tobacco and Asthma Survey) and the Minnesota Adult Tobacco Survey, conducted by Center for Health Statistics at Minnesota Department of Health (Data Steward: Pete Rode, Minnesota Center for Health Statistics). Question: Does MDH have the legal authority to collect and use the data? Yes, the Center for Health Statistics has legal authority to collect:  Youth Tobacco Survey data as a state that is implementing core questions from the CDC’s National Youth Tobacco Survey  Adult Tobacco Survey data as a collaborator directing the Minnesota Adult Tobacco Survey Question: Are private data classified and protected according to state and federal law? Yes, private data are classified and protected. There are either no personal identifiers (YTS) or data can be requested without identifiers (ATS). Furthermore, cells less than 5 could be suppressed. **END OF PHASE I: EXPLORATION**
18 Phase II: Feasibility Note: presented and discussed at the EPHT Technical Team’s October 2010 meeting Detailed Feasibility Question: What is the level of quality of the data? The data are population‐based.  The Youth Tobacco Survey (YTS) represents a random sample of middle and high school classrooms in Minnesota.  The Adult Tobacco Survey (ATS) is a representative, random sample of all adult Minnesotans and can be weighted to reflect the entire adult population of Minnesota. The data are representative of ETS exposure. Both the YTS and ATS provide a representative estimate of exposure among the targeted population in Minnesota. The data are assumed to be reliable and valid. The YTS has been conducted nationally by the CDC since 1999, and the Minnesota YTS draws from a core bank of nationally‐consistent questions. The ATS methodology report addresses reliability and validity via set requirements. Question: Is there continuity? In other words, is there consistent data collection over time? Yes, there is consistent data collection over time.  The YTS has been conducted since 2000 and will continue in the foreseeable future. The next survey is scheduled for 2011 and should be available at the end of 2011.  The ATS has been conducted since 2003 and will continue in the foreseeable future. There should be another year of survey data available in 2011. Question: Is the data timely? Yes, datasets for both surveys are typically available within a year of data collection. Question: Is the data comparable? For both surveys, there is the possibility to compare data to its national counterpart and to other states that conduct that survey.  Office on Smoking & Health (CDC) indicates that many states conducted the YTS between 2000 and 2010. Most recently, Minnesota and 15 other states conducted the YTS in 2008. Comparability at the state‐level could be explored in further detail later but is theoretically possible. The ETS exposure questions are part of the core bank of questions.  CDC also has a set of core questions for states conducting an ATS, but it is unclear how many states ask standardized questions on ETS exposure. Comparability at the state‐level could be explored later.  The National ATS was conducted in late 2009‐early 2010 and should have data on ETS exposure in the home, at work, in a car, and other exposure in indoor or outdoor public spaces. 19 Question: Is aggregation possible at different geographic levels? Data is available at the state‐level only for both surveys, and not available at a more specific geographic level (e.g. county or zip code). Aggregation is possible between years for both surveys. Question: What is the cost to MDH to obtain necessary data? There is not a prohibitive cost to MDH to obtain data and staff time to complete these steps is reasonable. Piloted Data & Measures Measure: Count and percent of nonsmokers exposed to ETS in Minnesota  By year o YTS: 2000, 2002, 2005, 2008 o ATS: 2003, 2007, 2010  By gender  By race/ethnicity o YTS: American Indian, White, Black, Hispanic or Latino, Pacific Islander, Asian o ATS: race/ethnicity categories are available  By age group o YTS: ≤12‐18+ years of age o ATS: 18‐24, 25‐44, 45‐64, 65+ years  By exposure setting Exposure Setting YTS ATS A home  “Same room”  “Inside your home” Car  “In a car”  “In a car” Work  “Where you work”  “In your work area” Other  “Near you at any place besides your home, workplace or car”  By education level (ATS only) and by school level (YTS only) Nonsmokers are defined as:  Youth who have not smoked cigarettes or other combustible tobacco products (e.g. cigars, pipes, or bidis) in the last 30 days.  Adults who are classified as “never” or “former” smokers (including cigarettes, pipes, or cigars) and have not smoked in the last 30 days. NOTE: data presented are unweighted **END OF PHASE II: FEASIBILITY**
20 Phase III: Recommendation Emerging Issues Question: Is the degree of level of exposure changing or perceived to be changing?  The level of exposure in indoor public spaces (e.g. work, restaurants, bars) has decreased with the enactment of Freedom to Breathe in October 2007.  However, the degree to exposure in homes, private cars, and in outdoor spaces has likely remaining the same on a population level.  It’s also possible that the level of exposure on the individual level is decreasing among parents or guardians that enforce smoking bans in the home and car. Potential for Information Building Question: Is this a hazard with unknown association to health outcomes or unknown level of exposure in the population?  Exposure to ETS has many known associations with adverse health outcomes. It is very possible that there are unknown associations to adverse health outcomes that have yet to be discovered.  The level of exposure to ETS at the population level is measured via cotinine (NHANES) and via survey question (Youth and Adult Tobacco Surveys). Question: Are there other programs at MDH that would be interested in this content area? Yes, the Center for Health Statistics, the Asthma Program, and the Tobacco Prevention and Control Program could all potentially benefit from MN EPHT displaying the data and on the web portal and/or from topical reports and messaging on ETS exposure among nonsmokers in Minnesota. The data steward at the Center for Health Statistics is interested in the key tables and figures that would display data on ETS exposure. The Asthma Program is interested in some resources that would be generated on this new content area, like a data brief on ETS exposure. Outside Interest or Public Concern Question: Is there a high concern regarding the proportion of the population exposed to a hazard? No, the proportion of the population exposed to ETS should not have increased; Freedom to Breathe laws probably decreased the overall exposure to ETS, especially among nonsmokers. However, there is high public concern regarding the vulnerability of the population being exposed to ETS, including children (e.g. infants, adolescents) and pregnant women. Question: Is ETS exposure a priority that has previously been identified by environmental health professionals and organizations (e.g. CDC, WHO, NHANES, EPA)?  Healthy People 2020 has several objectives under the Tobacco Use section that target reducing the level of exposure to ETS, especially among vulnerable populations, as well as reducing the venues of exposure to ETS (e.g. worksites, public spaces, smoke‐free homes).  NHANES: measures cotinine to track the level of ETS exposure among nonsmokers 21 Question: Would this content area utilize existing datasets in a new way? The Minnesota Center for Health Statistics currently publishes very detailed reports using Youth Tobacco Survey data, most recently “Teens and Tobacco in Minnesota, the View from 2008: Results from the Minnesota Youth Tobacco and Asthma Survey” (Dec 2008). However, MN EPHT would present data and measures on ETS exposure among nonsmokers, which is not currently addressed by the in‐depth tobacco reports. Similarly, there are detailed reports using Adult Tobacco Survey data that cover topics like prevalence of smoking and smoke‐free policies. MN EPHT would be able to present these data in a new way by focusing on ETS exposure among nonsmokers. Balance among Tracking content areas Question: Is there a balance between hazard/exposure and disease content areas tracked? Yes, there is balance. There are currently four content areas for each category: a. Hazard/exposure content areas: air quality, carbon monoxide poisoning, childhood lead poisoning, drinking water quality b. Disease content areas: hospitalizations (asthma, COPD, heart attack), birth defects, cancer, reproductive and birth outcomes Question: Is there a balance between age groups affected among content areas tracked? Exposure to ETS would be a content area that is of most concern to children, but affects adults and the elderly as well. Furthermore, there is not currently an unbalanced representation of age groups affected by current content areas: Children: birth defects, birth outcomes (e.g. prematurity, low birth weight), childhood lead poisoning, childhood cancers, asthma hospitalizations, drinking water quality (e.g. nitrates) Adults: air quality, CO poisoning, asthma hospitalizations, heart attack hospitalizations, drinking water quality, reproductive outcomes (e.g. fertility) Elderly: air quality, asthma hospitalizations, cancer, COPD hospitalizations, CO poisoning Economic Impact Question: What is the economic impact in Minnesota (e.g. MN EPHT Program, MDH, the state, or healthcare systems and other industries)? Adoption of “ETS exposure” as a new content area will require the time and resources of MN EPHT staff to incorporate the content area into the Tracking Program. These steps include but are not limited to: obtaining data from the steward, producing a How‐To Guide for creating measures, displaying selected measures (e.g. Static and Query Modules) and generating messaging about the data. Adoption of “ETS exposure” will also require the resources of and collaboration with the Minnesota Center for Health Statistics staff as the data steward for both data sources. It may also impact the work of the Tobacco Prevention & Control [unit] at Minnesota Department of Health as well as local public health programs at the county level that have ongoing initiatives to reduce ETS exposure. It would likely require collaboration with Tobacco Prevention & Control staff to produce messaging and interpretation of any data on ETS exposure that is displayed. **END OF PHASE III: RECOMMENDATION**
22 Piloted Data & Measures: for a New Tracking Content Area in Minnesota Environmental Tobacco Smoke (ETS) Exposure Youth Tobacco Survey (YTS) ........................................................................................................... 24 Measure: by year .................................................................................................................................... 24 Measure: by gender ................................................................................................................................ 25 Measure: by race/ethnicity..................................................................................................................... 26 Measure: by age...................................................................................................................................... 27 Measure: by school level ........................................................................................................................ 28 Adult Tobacco Survey (ATS)............................................................................................................ 29 Measure: by year .................................................................................................................................... 29 Measure: by gender ................................................................................................................................ 31 Measure: by race <in progress>.............................................................................................................. 33 Measure: by age group ........................................................................................................................... 33 Measure: by education level................................................................................................................... 35 23 Youth Tobacco Survey (YTS) Measure: by year Table 1. Percent of youth exposed to ETS* in past week among nonsmokers, Minnesota, 2000‐
2008. Year Count N % 2000 5144 8551 60.2 2002 4702 8367 56.2 2005 4121 8199 50.3 2008 1499 3737 40.1 Aggregated 15466 28854 53.6 * Exposed in the setting of “same room” OR “in a car” Figure 1. Percent of youth exposed to ETS* in past week among nonsmokers, Minnesota, 2000‐
2008 * Exposed in the setting of “same room” OR “in a car” 24 Measure: by gender Table 2. Percent of male and female youth exposed to ETS* in past week among nonsmokers, Minnesota, 2000‐2008 Year 2000 Gender Count N % Female 2726 4434 61.5% Male 2407 4102 58.7% 2002 Female 2532 4367 58.0% Male 2163 3983 54.3% 2005 Female 2188 4140 52.9% Male 1925 4043 47.6% 2008 Female 803 1958 41.0% Male 694 1771 39.2% Aggregated Female 8249 14899 55.4% Male 7189 13899 51.7% * Exposed in the setting of “same room” OR “in a car” Figure 2. Percent of male and female youth exposed to ETS* in past week among nonsmokers, Minnesota, 2000‐2008 * Exposed in the setting of “same room” OR “in a car” 25 Measure: by race/ethnicity Table 3. Percent of youth exposed to ETS* in past week among nonsmokers by race/ethnicity category, Minnesota, 2000‐2008 Race/ethnicity category Count N White 13427 24874 American Indian or Alaska Native 357 536 Asian 505 1189 Black or African American 585 1127 Hispanic or Latino 355 696 Pacific Islander 80 158 * Exposed in the setting of “same room” OR “in a car” % 54.0 66.6 42.5 51.9 51.0 50.6 Figure 3. Percent of youth exposed to ETS* in past week among nonsmokers by race/ethnicity category, Minnesota, aggregated 2000‐2008 * Exposed in the setting of “same room” OR “in a car” 26 Measure: by age Table 4. Percent of youth exposed to ETS* in past week among nonsmokers by age, Minnesota, 2000‐2008 Age group Count N % ≤ 12 3175 6830 46.5 13 2151 4315 49.8 14 2210 4225 52.3 15 2513 4546 55.3 16 2407 4097 58.8 17 2021 3239 62.4 18+ 987 1592 62.0 * Exposed in the setting of “same room” OR “in a car” Figure 4. Percent of youth exposed to ETS* in past week among nonsmokers by age, Minnesota, aggregated 2000‐2008. * Exposed in the setting of “same room” OR “in a car” 27 Measure: by school level Table 5. Percent of youth exposed to ETS* in past week among nonsmokers by school level, Minnesota, 2000‐2008 School Level Count N Middle 2143 3923 High 3001 4628 2002 Middle 2040 3987 High 2662 4380 2005 Middle 1645 3623 High 2476 4576 2008 Middle 773 2108 High 726 1629 Aggregated Middle 6601 13641 High 8865 15213 * Exposed in the setting of “same room” OR “in a car” Year 2000 % 54.6% 64.8% 51.2% 60.8% 45.4% 54.1% 36.7% 44.6% 48.4% 58.3% Figure 5. Percent of youth exposed to ETS* in past week among nonsmokers by school level, Minnesota, 2000‐2008 * Exposed in the setting of “same room” OR “in a car” 28 Adult Tobacco Survey (ATS) Measure: by year Table 1. Percent of nonsmokers exposed to ETS in the past week by exposure setting, Minnesota adults, 2003‐2010. Year 2003 2007 2010 Aggregated Count 497 399 157 1053 At home N 6996 10608 5922 23526 % 7.1% 3.8% 2.7% 4.5% Count 651 566 187 1404 At work N 4559 6264 3337 14160 % 14.3% 9.0% 5.6% 9.9% In a car N 7000 10622 5930 23552 Count 734 860 359 1953 % 10.5% 8.1% 6.1% 8.3% Figure 1. Percent of nonsmokers exposed to ETS in the past week by exposure setting, Minnesota adults, 2003‐2010. 29 Table 2. Percent of nonsmokers exposed to ETS in the past week in the community,† Minnesota adults, 2003‐2010. Year Count N % 2003 4015 6782 59.2% 2007 4885 10571 46.2% 2010 1889 5887 32.1% Aggregated 10789 23240 46.4% †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” Figure 2. Percent of nonsmokers exposed to ETS in the past week in the community, † Minnesota adults, 2003‐2010. †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” 30 Measure: by gender Table 3. Percent of female and male nonsmokers exposed to ETS in the past week by exposure setting, Minnesota adults, 2003‐2010. Year Gender 2003 Female Male 2007 Female Male 2010 Female Male Aggregated Female Male Count 254 243 231 168 94 63 579 474 At home N 4110 2886 6386 4222 3501 2421 13997 9529 % 6.2% 8.4% 3.6% 4.0% 2.7% 2.6% 4.1% 5.0% Count 229 422 174 392 57 130 460 944 At work N 2508 2051 3541 2723 1806 1531 7855 6305 % 9.1% 20.6% 4.9% 14.4% 3.2% 8.5% 5.9% 15.0% Count 384 350 447 413 187 172 1018 935 In a car N 4110 2890 6392 4230 3507 2423 14009 9543 % 9.3% 12.1% 7.0% 9.8% 5.3% 7.1% 7.3% 9.8% Figure 3. Percent of female and male nonsmokers exposed to ETS in the past week by exposure setting, Minnesota adults, 2003‐2010, aggregated. 31 Table 4. Percent of female and male nonsmokers exposed to ETS in the past week in the community, † Minnesota adults, 2003‐2010. Year 2003 Gender Count N % Female 2156 3961 54.4% Male 1859 2821 65.9% 2007 Female 2724 6366 42.8% Male 2161 4205 51.4% 2010 Female 1008 3485 28.9% Male 881 2402 36.7% Aggregated Female 5888 13812 42.6% Male 4901 9428 52.0% †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” Figure 4. Percent of female and male nonsmokers exposed to ETS in the past week in the community, † Minnesota adults, 2003‐2010. Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” †
32 Measure: by race <in progress> Race/ethnicity data is available from data steward at Center for Health Statistics Might be aggregated over 2003‐2010 to protect privacy due to low counts in some race categories Measure: by age group Table 5. Percent of nonsmokers exposed to ETS in the past week by exposure setting and by age group, Minnesota adults, 2003‐2010, aggregated. Age Group 18‐24 25‐44 45‐64 65+ Count 188 224 417 224 At home N 2235 6429 8821 6041 % 8.4% 3.5% 4.7% 3.7% Count 334 489 532 49 At work N 1629 5167 6529 835 % 20.5% 9.5% 8.1% 5.9% Count 501 531 681 240 In a car N 2248 6437 8821 6046 % 22.3% 8.2% 7.7% 4.0% Figure 5. Percent of nonsmokers exposed to ETS in the past week by exposure setting and by age group, Minnesota adults, 2003‐2010, aggregated. 33 Table 6. Percent of nonsmokers exposed to ETS in the past week in the community† by age group, Minnesota adults, 2003‐2010, aggregated. Age Group Count N % 18‐24 1535 2227 68.9% 25‐44 3273 6335 51.7% 45‐64 4000 8708 45.9% 65+ 1981 5970 33.2% †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” Figure 6. Percent of nonsmokers exposed to ETS in the past week in the community† by age group, Minnesota adults, 2003‐2010, aggregated. †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” 34 Measure: by education level Table 7. Percent of nonsmokers exposed to ETS in the past week by exposure setting and by education level, Minnesota adults, 2003‐2010, aggregated. Education Level Count < High school 111 H.S. Graduate 404 Some college 358 ≥ College graduate 174 At home N 1299 5864 7292 8960 % Count 8.5% 95 6.9% 478 4.9% 525 1.9% 298 At work In a car N % Count N % 399 23.8% 172 1303 13.2% 2980 16.0% 690 5877 11.7% 4594 11.4% 696 7297 9.5% 6128 4.9% 383 8965 4.3% Figure 7. Percent of nonsmokers exposed to ETS in the past week by exposure setting and by education level, Minnesota adults, 2003‐2010, aggregated. 35 Table 8. Percent of nonsmokers exposed to ETS in the past week in the community† by education level, Minnesota adults, 2003‐2010, aggregated. Education Level Count N % < High school 581 1283 45.3% H.S. Graduate 2854 5800 49.2% Some college 3568 7207 49.5% ≥ College graduate 3736 8842 42.3% †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” Figure 8. Percent of nonsmokers exposed to ETS in the past week in the community† by education level, Minnesota adults, 2003‐2010, aggregated. †
Exposure in the community is measured by the following survey question: “In Minnesota, in the past 7 days, has anyone smoked near you at any place besides your home, workplace or car?” 36 SECTION OVERVIEW: PROJECT YEAR 3 PROPOSAL FOR TRACKING & BIOMONITORING Tracking Looks Ahead The MH EPHT program is currently in the process of drafting a (Year 2) Interim Progress Report to the CDC and developing a proposal for new or extended work under our cooperative agreement for the next year (Year 3 ). Progress in implementing our state EPHT program and online information system has been significant over the past year. In this section’s presentation, MN EPHT staff will share briefly highlights of our progress and proposals for future work in attaining each of our 4 program goals: Goal 1. Develop a strong environmental public health tracking system based on the collection and analysis of high‐quality data. Goal 2. Ensure that environmental public health data are accessible and used. Goal 3. Build awareness, knowledge and skills among potential data users related to environmental public health tracking in order to inform actions to improve public health. Goal 4. Build collaborations to enhance environmental public health tracking in Minnesota. Minnesota is unique among the 23 CDC‐funded states because we have state legislation that directs MDH to work with our Advisory Panel to identify state priorities for tracking. In addition, our legislation directs us to gather biomonitoring data and to integrate that data within the Tracking program. The CDC shares this vision and is considering a new initiative to examine national and state‐based biomonitoring data for inclusion in the national Tracking network. Panel members are asked to provide input on activities proposed for the next year and to consider how the state resources can best be applied to supplement the grant activities to meet state‐specific needs. ACTION NEEDED: There is no action needed on this item and no materials for review. After the presentation, Panel members are invited to ask questions or provide input on the proposal for Project Year 3 activities for Tracking & Biomonitoring. In particular, members will be asked to consider the questions: 

In addition to those presented, are there any additional activities or state priorities that the MDH should build into a proposal for future years of work under our EPHT program? How can our state activities and resources best be used to supplement the work that is funded under our CDC EPHT cooperative agreement? 37 This page intentionally left blank. 38 SECTION OVERVIEW: GREAT LAKES BIOMONITORING PROJECT Status Update In September 2010, ATSDR awarded MDH a three‐year grant using Great Lakes Restoration Initiative funds that had been passed through EPA to conduct biomonitoring with the Fond du Lac (FDL) Band of Lake Superior Chippewa living on or near the FDL Reservation. The Great Lakes Biomonitoring Program aims to evaluate body burden levels of persistent, bioaccumulative, toxic contaminants in Great Lakes residents, particularly those at highest risk of exposure. The project MDH will conduct, with staff from FDL Public Health Nursing program, will focus on the St. Louis River Area of Concern, which lies in Northeastern Minnesota at the western end of Lake Superior, and specifically on the Fond du Lac Community. The FDL Reservation is partially situated within the St. Louis River Area of Concern and approximately 20 miles west of Duluth. Members of this community may have greater exposure to contaminants in the Great Lakes Basin environment due to higher consumption of fish and wildlife. Biomonitoring will be conducted by testing blood and urine samples from a representative sample of approximately 500 people. Role of Minnesota’s Biomonitoring Pilot Program Biomonitoring Pilot Program staff serve on an MDH interdivisional team providing scientific and ethical consultation for the Great Lakes Biomonitoring Project, and will serve as a liaison to the EHTB Advisory Panel, our program partners and stakeholders. Biomonitoring Pilot Program staff also provide a resource for epidemiological and statistical support to the project as needed. Timeline The project period is expected to be from September 30, 2010 to September 29, 2013. ACTION NEEDED: There is no action required of panel members at this time. Panel members are invited to ask questions or provide input on the Great Lakes Biomonitoring Project. 39 This page intentionally left blank. 40 Great Lakes Biomonitoring Project Background This project evaluates body burdens of contaminants in a population‐based sample of members of the Fond du Lac (FDL) Band of Lake Superior Chippewa living on the reservation or within the larger St. Louis River Area of Concern (SLRAOC) (see Figure for map of SLRAOC). FDL members have been identified as a susceptible population due to life‐ways that may increase exposure to these contaminants. Within the tribal population, certain subgroups are also more sensitive to the effects of contaminants due to life stage, such as the elderly, women of child‐bearing age, and children. The SLRAOC includes the St. Louis River/Interlake/Duluth Tar and US Steel National Priorities List Site, two distinct areas near the mouth of the St. Louis River where it empties into Lake Superior. Other industrial activities, including a large paper mill have also occurred along the St. Louis River between Duluth and Cloquet, resulting in contamination of the river. Contaminants of concern include mercury, polycyclic aromatic hydrocarbons (PAHs), dioxins and polychlorinated bisphenyls (PCBs). Fish advisories for mercury and PCBs are in effect for the St. Louis Area from Cloquet to Lake Superior. Goals and Objectives The project purpose is to assess exposure of FDL members to several International Joint Commission priority contaminants as well as other selected environmental chemicals and to use this information to develop public health interventions. The first objective is to identify: 1) pollutants to which tribal members are exposed; 2) the levels of those substances in comparison to background levels in the general population; and 3) potential exposure pathways, including consumption of fish and other traditional foods. The second objective is to use the biomonitoring data to inform and guide public health actions to protect sub‐populations at increased risk of exposure to these contaminants. Methods The goal sample size is 500 participants. The project will be conducted by MDH with collaboration from FDL and their Tribal Health Services clinics in Cloquet and Duluth. MDH and the FDL community will collaborate with the Agency for Toxic Substances and Disease Registry (ATSDR) to develop a population‐
based sampling and biomonitoring plan, including required and optional chemicals to be analyzed by the MDH Public Health Laboratory and other participating laboratories (see analytes in Table 1). An advisory committee will provide guidance for the project, with a subcommittee dedicated to addressing ethical issues arising from biomonitoring. Throughout the project, MDH and the FDL community will engage in community activities to inform FDL members and the surrounding communities about the project, exposure pathways, the benefits of eating fish and strategies to safely eat fish. Following the completion of biomonitoring, individuals will be informed of their results and where applicable, follow‐up recommendations will be provided if any values exceed established health based guidance levels. Extensive community education and outreach will also occur in the broader community and throughout Minnesota, so that people will be empowered to take actions to protect their health and the health of their families. 41 Anticipated Outcomes Results will inform and guide public health actions to reduce exposures to environmental contamination and to enhance protection of more highly exposed or vulnerable subpopulations through a public health action plan focused on the risks and benefits of consuming fish and other Great Lakes resources. The results will also be used in conjunction with findings from other projects in Great Lakes states to inform fish advisories and other public health education and outreach activities for other susceptible populations (such as non‐tribal anglers) in the SLRAOC and throughout Minnesota. Public health actions taken as a result of this project are anticipated to result in reduced body burdens of Great Lakes contaminants within susceptible subpopulations. Table 1: Analytes included in the Great Lakes Biomonitoring Project proposal. Analyte Type Analytes Required by ATSDR grant PCBs Mercury Lead Mirex Hexachlorobenzene DDT/DDE Optional under ATSDR grant Speciated mercury 1‐hydroxypyrene PFCs Selenium Cadmium BPA Parabens: methyl, ethyl, butyl, propyl Benzophenone Triclosan Toxaphene PCBs (total) Other proposed Creatinine Cotinine Omega‐3 fatty acids Glycohemoglobin (A1c) Total cholesterol Table 2: List of investigators. FDL Public Health Nurses Deb Smith Bonnie LaFromboise Minnesota Department of Health Rita Messing
Dave Jones
Larry Souther
Carin Huset
42 Deanna Scher Pat McCann Eileen Grundstrom Sharon Smith Jill Korinek Betsy Edhlund Paul Swedenborg Jessica Nelson Figure: Map of St. Louis River Area of Concern (SLRAOC). Source: http://www.epa.gov/greatlakes/aoc/stlouis.html Source: http://www.epa.gov/greatlakes/aoc/stlouis.html 43 This page intentionally left blank. 44 SECTION OVERVIEW: EAST METRO PFC BIOMONITORING FOLLOW­UP (PFC2) PROJECT UPDATE The PFC Biomonitoring Pilot Project was conducted in 2008. The PFC Biomonitoring Follow‐up Project (or “PFC2”) began two years after the pilot project, with participant recruitment starting in November 2010. The follow‐up project’s objective is to measure the change in blood levels of PFCs in residents of the East Metro area and assess whether recent improvements to the community’s water systems have successfully reduced PFC exposures. Sample collection should be completed by the end of February 2011, at which time the MDH Public Health Laboratory will begin analysis of blood levels of PFCs. At the March 2011 Advisory panel meeting, staff will report on the final outcomes of participant recruitment and sample collection, a comparison between participants and non‐participants, and an issue regarding serum sample quality that arose during sample collection. ACTION NEEDED: There is no action required of panel members at this time. Panel members are invited to ask questions or provide input on the PFC Biomonitoring Follow‐up Project. 45 February 2011 Project summary The East Metro PFC Biomonitoring Follow‐up Project will measure the two‐year change in blood levels of perfluorochemicals (PFCs) in residents of the East Metro area in order to assess whether improvements to the community’s water systems have successfully reduced PFC exposures. Recruitment and sample collection All participants in the 2008 PFC Biomonitoring Pilot Project who agreed to future contact (186 out of 196 total participants) were asked to participate via mail and follow‐up phone calls starting in November 2010. Recruitment of participants and sample collection is near completion. One hundred sixty‐seven people (90% of those agreeing to contact) consented to participate and returned the 14‐page study questionnaire on possible sources of PFC exposure. Nineteen people declined to participate, some of whom agreed to a short phone‐based interview on residential, water use, and occupational history. As of February 18, 160 serum samples had been collected from the HealthEast Oakdale Clinic, where participants’ blood is being drawn. In a comparison of participants to non‐participants, the two groups had similar geometric mean 2008 serum PFOA levels, but geometric mean PFOS and PFHxS levels were slightly higher in non‐participants. The two groups were similar in age. Regarding city of residence in 2008, participants were split evenly between Oakdale and Lake Elmo/Cottage Grove, whereas a greater proportion of non‐participants lived in Lake Elmo/Cottage Grove. Quality of serum samples An unanticipated issue has arisen regarding the quality of serum samples received from the clinic. Staff noticed that not all samples received were the “normal” white/yellow color; some serum tubes were more pink or orange in color. Consultation with the MDH Public Health Laboratory (PHL) clinical staff and with the CDC indicated that this variation in color is not uncommon, and that these samples would not be rejected by their labs. A re‐examination of samples from the 2008 pilot project revealed that some were in fact pink or orange. This situation may present an opportunity to investigate whether PFC concentrations differ in the yellow v. orange/pink samples. Timeline Sample collection will be completed by February 28, and the PHL will begin PFC analysis. Results will be presented at the June meeting of the Advisory Panel. After discussion with the Panel, results will be communicated to participants and to the community at large via results letters, public meetings, etc. (in mid‐ to late‐summer 2011). Participants will be given the opportunity to speak with a physician working with the study, and staff will provide seminars or other educational opportunities for healthcare providers in the area. 46 SECTION OVERVIEW: TRACKING & BIOMONITORING UPDATES SECTION OVERVIEW: TRACKING & 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 the following: Biomonitoring Status Updates:  Riverside Prenatal Biomonitoring Project  Lake Superior Mercury in Newborns Project Tracking Status Updates:  New tracking reports  MN DATA, GIS, Program Website  MN EPHT communications and outreach  MN EPHT collaborations 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. 47 This page intentionally left blank. 48 BIOMONITORING UPDATES Riverside Prenatal Biomonitoring Project February 2011 The status of this project has not changed since the December Advisory Panel meeting. Participants (n=66) have been recruited from the larger Riverside Birth Study, conducted by Dr. Logan Spector at the University of Minnesota. Sample collection is complete, and the MDH PHL is currently analyzing urine samples for 7 environmental phenols (bisphenol A, triclosan, benzophenone‐3, methyl paraben, ethyl paraben, propyl paraben, and butyl paraben). The laboratory analysis has continued to be delayed by QA/QC issues, but results should be available soon. Once the laboratory results are available, statistical analyses of the data will be conducted and presented to the Advisory Panel. Development of informational fact sheets on environmental phenols and cotinine has begun. Information will accompany results communication to stakeholder groups in the Riverside clinic community and others concerned with protecting children’s health. Lake Superior Mercury in Newborns Project February 2011 Recruitment: Participant recruitment in Minnesota is complete. There were 1,130 Minnesota newborns enrolled with parental consent. Blood Spot Mercury Analysis: All specimens have been received by the MDH Public Health Lab. Approximately 1,200 specimens (from Minnesota, Wisconsin, and Michigan) have been analyzed and meet quality control criteria. Specimen analysis is expected to be completed during March 2011. Status Details: Data analysis and reporting will be complete by June 30, 2011. 49 TRACKING UPDATES New Tracking Reports February 2011 Four tracking reports are currently available on the MN EPHT website at www.health.state.mn.us/tracking. Two additional reports will be published this spring:  Reproductive Outcomes – Prematurity, Growth Restriction, Infant Mortality, Fertility, Sex Ratio Data and Measures Birth Years 2000‐2008  Birth Defects Data and Measures 2006‐2008. These data reports join the following data reports released earlier:  Carbon Monoxide Poisoning – Data and Measures (2000‐2007)  Drinking Water Quality – Community Water Data and Measures (1999‐2007)  Hospitalizations – Asthma, Heart Attack and COPD – Data and Measures (1999‐2007)  Childhood Lead Poisoning –Data and Measures (Birth Years 2000 – 2004) Additional reports in the series that will be released include data and measures for air quality and cancer. Hard copies of the reports are available upon request. Advisory panel members who would like copies of reports may request individual copies or a binder containing the full set of reports (beginning with the four currently available reports). To place a request, please email Mary Jeanne Levitt at [email protected] MN DATA, GIS, Program Website February 2011 MN DATA Update In September 2010 MN EPHT launched the Minnesota tracking data portal, MN DATA: (https://apps.health.state.mn.us/mndata/). Since that time we have been adding new content and features with a focus on meeting deliverables in our cooperative agreement with CDC. The following are highlights of recent accomplishments: Content “Topic” Areas MN EPHT developed and posted data and measures for 5 new (core) content or topic areas: reproductive & birth outcomes, air quality, cancer, blood lead, and birth defects. The activity brings us one step closer to meeting CDC requirements for posting Nationally Consistent Data and Measures (NCDMs) for all 8 core content areas. This accomplishment would not have been possible with out the collaboration and support of several data stewards, including: the MDH Environmental Health Division, MN Center for Health Statistics, Minnesota Cancer Surveillance System, Minnesota Birth Defects Monitoring and Analysis Unit, and the MPCA Environmental Analysis and Outcomes Division. 50 Query Enhancements MN EPHT implemented enhancements to the query modules for 2 existing core content areas (asthma, carbon monoxide). These enhancements allow users to conduct county‐level queries, and to customize analyses by selecting multiple years or counties at a time. One goal of the program is to make data available at finer spatial resolution levels, where possible, to increase the utility of the data at the local level. GIS Update Tracking staff are currently in the process of developing GIS web mapping modules for MN DATA. These modules initially will include two indicators – asthma hospitalizations and childhood lead poisoning. The asthma hospitalizations module will allow users to view age‐adjusted rates of asthma hospitalizations in Minnesota by county with the use of maps, tables and charts. The childhood lead poisoning module will allow users to view blood lead testing and blood lead levels by birth cohort in Minnesota by county, with the use of maps and tables. The modules will consist of interactive environments in which the maps, tables and charts are linked together to create a user‐friendly exploration of data, including demographic information. The Tracking program is working to ensure that GIS data are integrated with the appropriate messaging to provide important information for data interpretation. The anticipated date for the promotion of the GIS modules to MN DATA is mid July 2011. Additional MN DATA Highlights MN DATA accomplishments also have included: 
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Launch of a new Google‐powered search engine Collection of baseline data on portal use (Google Analytics) Update of MDH template (consistent with redesigned MDH home page) Enhancements based on usability testing with external audiences Plans (remainder of grant Year 2) MN EPHT’s focus for the remaining part of grant Year 2 (through July 31, 2011) is the implementation of county‐level queries for three of the four new core content or topic areas (air quality, cancer, and reproductive & birth outcomes). No query module is planned for birth defects because currently limited data are available. In Project Year 2, MN DATA activities also will include: 
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Usability testing of GIS and queries with external audiences (May) Portal demonstration at the National EPHT workshop (April, New York City) Hard launch including a press release and broad public announcement (May) Implementation of GIS for blood lead and asthma data (July) Implementation of roll‐based access for secure data access (July) MN DATA enhancements also will include the addition of a glossary and the ability to export query data in standard formats (e.g., csv). 51 Program Website In January 2011 MN EPHT launched a redesigned program website that includes new graphics and updated content (http://www.health.state.mn.us/tracking/). This website includes links to data reports and the CDC National EPHT Program, as well as the MN DATA public portal. For comments or questions about MN DATA or the program website, please contact Dave Stewart, MN EPHT Program Consultant, [email protected], 651/201‐5193. Communications and Outreach February 2011 Overview Currently, MN EPHT communication activities are primarily focused on reaching Minnesota state governmental agencies and local public health to explain what the MN EPHT program is, bring awareness of our partnership with CDC national tracking program, and to encourage our audience of the value of using the Minnesota tracking data portal and the National Tracking Network. We intend to achieve this goal by broadening our target audience’s knowledge of tracking and promoting the message that the data tracking portal can greatly assist them in their work. Since the MN EPHT Communications Team last contributed to the Advisory Panel book in June 2010, MN EPHT communications outreach has conducted several communications outreach activities (see below), initiated planning for grant Year 3, and participated in CDC national tracking workgroup activities focused on collaborative program outreach. MN EPHT activities are highlighted below. Brown bag seminars MN EPHT conducted seminars for state agency staff, in collaboration with MPCA and other state programs to share information about emerging environmental health topics. Our target audience and outreach announcements focused on staff from MDH, the Minnesota Department of Agriculture (MDA) and the Minnesota Pollution Control Agency (MPCA). Seminar topics and presenters included: 
In July 2010, the MN EPHT brownbag seminar: “Is it in Us? Does it Matter? Biomonitoring in a Public Health Context” was presented by MN EPHT staff, Jean Johnson and Michonne Bertrand and Director of the MDH Public Health Laboratory Division Joanne Bartkus. Fifty two people attended. 
In October 2010, MN EPHT staff health geographer Eric Hanson and MDH epidemiologist Jim Peacock from the Heart Disease and Stroke Prevention Unit presented: Geovisualization, GIS and Chronic Disease to an audience of sixty. 
In January 2011, MN EPHT staff epidemiologist Naomi Shinoda and MPCA environmental scientist Kari Palmer collaborated to present Air Quality in Minnesota: Challenges & Implications for Public Health. Thirty people attended this winter seminar. MN EPHT will continue to offer seminars in 2011 with announcements to a broadened audience via the program website and our email subscription service (GovDelivery). Seminars also will be made available as webinars. 52 MN EPHT collaboration with CDC national and state tracking outreach efforts MN EPHT communications staff work on several national tracking marketing workgroups/subcommittees that develop education and outreach materials to promote the national and state grantee tracking efforts. Recently, MN EPHT staff participated in revising and pilot testing the web‐based Environmental Public Health Tracking (EPHT) 101 and creating an EPHT PowerPoint presentation template for the 23 grantee states. The revised EPHT tracking 101 was launched in January 2011 http://ephtracking.cdc.gov/training The EPHT PowerPoint presentation template is going through a final review and approval process and should be released in spring 2011. MN EPHT also created and submitted an MN EPHT fact sheet required by the National Tracking program that CDC plans on releasing in 2011. MN EPHT Outreach materials developed since last report to Advisory Panel 
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MN EPHT brochure to explain the program MN EPHT display board MN EPHT notepads for distribution at data portal trainings. Plans for 2011 
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Seminars available via webinar and to a broader audience. Needs assessment survey of local public health to help guide communications and outreach activities, and development of the state tracking data portal. Development of a MN EPHT 101 as a recorded webinar (presentation). Printed materials to inform individuals about the data portal CDC email list The National Environmental Public Health Tracking Network sends out program announcements to an email list service. If you are interested in keeping abreast of major developments at the national level (e.g., new data sets added to the national network) and would like to be added to the CDC’s email list, please go to http://ephtracking.cdc.gov/showAbout.action and in the right hand column under Resources, click on “Join our List‐serv”. 53 MN EPHT Collaborations (Update) February 2011 Minnehaha‐Hiawatha Corridor Environmental Collaboration The Minnehaha‐Hiawatha Corridor Environmental Collaboration is a new recipient of a Level I CARE cooperative agreement that will be convened by Hennepin County. Through this CARE cooperative agreement, the Minnehaha‐Hiawatha Corridor Environmental Collaboration will empower residents and businesses to deal with environmental issues in their community through a collaborative process to address environmental contamination issues, ensure a community engagement process that is inclusive of all residents in the project area, facilitate a broader collaboration with additional stakeholders in environmental justice, health, multi‐cultural communities, and community and business groups and provide data and expertise on toxic environmental pollutants and risks. This is the first CARE cooperative agreement awarded by USEPA in the State of Minnesota. MN EPHT will join this partnership to help facilitate community access to data on health, biomonitoring and environmental measures. The project presents an opportunity for MN EPHT to develop measures (or understand the limitations and data gaps) that meet the needs of local communities. This proposal focuses on the Minnehaha‐Hiawatha corridor in south Minneapolis, and includes portions of Longfellow and the East Phillips neighborhoods. The corridor area includes the region’s first light rail transit line, a four‐lane highway with up to 45,000 vehicles per day, a freight rail line, and high‐power transmission lines. Some of the environmental issues these communities face are: an arsenic‐based pesticide manufacturing plant, contaminated soil and groundwater, petroleum and polynuclear aromatic hydrocarbons (PAHs), lead‐based paint contamination, organic compounds, air quality, and asthma. Prospective CARE Partners include: Alexander’s Import Auto Repair, American Lung Association, Blue Construction Inc., Minneapolis Department of Community Planning & Economic Development, East Phillips Improvement Coalition, Environmental Justice Advocates of Minnesota, Gardening Matters, Groundwork Minneapolis, Hennepin County Human Services and Public Health Department, Hennepin‐
University Partnership, Indigenous People’s Green Job Coalition, Institute for Agriculture and Trade Policy, Lake Street Council, Little Earth of United Tribes, Longfellow Business Association, Longfellow Community Council, The Pastors/Leaders of the Churches in the Longfellow Lutheran Parish, Minnehaha Creek Watershed District, Minnesota Center for Environmental Advocacy, Minnesota Department of Health, Minnesota Pollution Control Agency, Mississippi Watershed Management Organization, Preventing Harm in Minnesota and Women’s Environmental Institute. 54 Academic Research Partners: University of Illinois‐Chicago Minnesota’s EPHT program is collaborating on two National EPHT Network academic partner research projects. At the December panel meeting, members heard from investigators at the University of Illinois‐
Chicago (UIC), School of Public Health on one proposed project entitled, “A Linkage Study of Health Outcome Data in Children and Agrichemical Water Contamination Data in the Midwest.” The proposed project will be to explore potential associations between agrichemical contamination of drinking water by atrazine and nitrate with adverse reproductive/birth outcomes and childhood leukemia through a series of linkage studies using existing birth records, birth defects and cancer registries, and agrichemical data in drinking water from 8 Midwestern States (IL, IN, IO, MI, MO, MN, OH, WI). The second objective of this study is to advance the methodology of water contaminant and health data linkage studies for the CDC Environmental Public Health Tracking (EPHT) Program and state health departments. In early December, MN EPHT hosted UIC investigators for a visit to share information about the study with the Minnesota Department of Health. The purpose of the visit was for UIC investigators to develop a relation with MN EPHT, the Minnesota Cancer Surveillance System, and the MN Drinking Water Information System, and to gain an understanding of the available data. In late December, MN staff sent UIC investigators a document addressing questions that came up during the visit regarding the use of birth certificate data for birth outcomes and birth defects measures. In January, MN EPHT, UIC, and Minnesota Center for Health Statistics staff participated in a conference call to discuss the use of birth certificate data for the project and the procedures for obtaining this data. In February, UIC investigators contacted MN EPHT and Minnesota Center for Health Statistics staff to submit a formal application for public health research using birth record data and to request data on: 1) monthly crude county‐level rates of prematurity, low birth weight, mortality, and male births for years 2004‐2008; and 2) monthly number of live singleton births for each county over the same time period.
55 This page intentionally left blank. 56 SECTION OVERVIEW: OTHER INFORMATION These documents are included in this meeting packet as items that may be of interest to panel members: 
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EHTB Advisory Panel 2011 Meeting Dates EHTB Advisory Panel Roster Glossary of terms used in EHTB Acronyms used in EHTB EHTB Statute: Minnesota Statutes 2010, section 144.995‐144.998 Additional reference materials are available online at www.health.state.mn.us/tracking/. 57 This page intentionally left blank. 58 EHTB Advisory Panel
2011 Meeting Dates
Tuesday, March 8, 2011
Tuesday, June 7, 2011
Tuesday, September 13, 2011
Tuesday, December 13, 2011
All meetings will be held from 1 - 4 pm and will take place at
MDH’s Snelling Office Park location at 1645 Energy Park Drive. 59 ENVIRONMENTAL HEALTH TRACKING AND
BIOMONITORING
ADVISORY PANEL ROSTER
As of December 2010 Bruce H. Alexander, PhD Alan Bender, DVM, PhD University of Minnesota School of Public Health Minnesota Department of Health Environmental Health Sciences Division Health Promotion and Chronic Disease Division MMC 807 Mayo 85 East 7th Place 420 Delaware Street SE PO Box 64882 Minneapolis, Minnesota 55455 Saint Paul, MN 55164‐0882 612‐625‐7934 651‐201‐5882 [email protected] [email protected] Minnesota House of Representatives appointee MDH appointee Fred Anderson, MPH Jill Heins Nesvold, MS Washington County Department of Public American Lung Association of Minnesota Health and Environment 490 Concordia Avenue 14949 62nd St N St. Paul, Minnesota 55103 Stillwater MN 55082 651‐223‐9578 651‐430‐6655 [email protected] Nongovernmental organization representative [email protected] At‐large representative Cathi Lyman‐Onkka, MA Preventing Harm Minnesota Beth Baker, MD, MPH 372 Macalester Street Specialists in Occupational and Environmental St. Paul, MN 55105 Medicine Fort Road Medical Building Home office 360 Sherman Street, Suite 470 651‐647‐9017 St. Paul, MN 55102 [email protected] 952‐270‐5335 Nongovernmental organization representative [email protected] At‐large representative Pat McGovern, PhD, MPH Thomas Hawkinson, MS, CIH, CSP University of Minnesota School of Public Health Toro Company Environmental Health Sciences Division 8111 Lyndale Avenue S MMC Mayo 807 Bloomington, MN 55420 420 Delaware St SE 952‐887‐8080 Minneapolis MN 55455 [email protected] 612‐625‐7429 Statewide business organization representative [email protected] University of Minnesota representative 60 Geary Olsen, DVM, PhD Vacant 3M Medical Department Minnesota Senate appointee Corporate Occupational Medicine MS 220‐6W‐08 St. Paul, Minnesota 55144‐1000 Cathy Villas‐Horns, MS, PG 651‐737‐8569 Minnesota Department of Agriculture [email protected] Pesticide and Fertilizer Management Division Statewide business organization representative 625 Robert Street North St. Paul, Minnesota 55155‐2538 651‐201‐6291 Gregory Pratt, PhD cathy.villas‐[email protected] MDA appointee Minnesota Pollution Control Agency Environmental Analysis and Outcomes Division 520 Lafayette Road Lisa Yost, MPH, DABT St. Paul, MN 55155‐4194 Exponent, Inc. 651‐757‐2655 15375 SE 30th Pl, Ste 250 [email protected] Bellevue, Washington 98007 MPCA appointee Local office St. Paul, Minnesota 651‐225‐1592 [email protected] At‐large representative Please submit changes and corrections to: [email protected] 61 GLOSSARY OF TERMS USED IN ENVIRONMENTAL HEALTH TRACKING & BIOMONITORING Biomarker: According to the National Research Council (NRC), a biomarker is an indicator of a change or an event in a human biological system. The NRC defines three types of biomarkers in environmental health, those that indicate exposure, effect, and susceptibility. Biomarker of exposure: An exogenous substance, its metabolites, or the product of an interaction between the substance and some target molecule or cell that can be measured in an organism. Biomarker of effect: A measurable change (biological, physiological, etc.) within the body that may indicate an actual or potential health impairment or disease. Biomarker of susceptibility: An indicator that an organism is especially sensitive to exposure to a specific external substance. Biomonitoring: As defined by Minnesota Statute 144.995, biomonitoring is the process by which chemicals and their metabolites are identified and measured within a biospecimen. Biomonitoring data are collected by analyzing blood, urine, milk or other tissue samples in the laboratory. These samples can provide physical evidence of current or past exposure to a particular chemical. Biospecimen: As defined by Minnesota Statute 144.995, biospecimen means a sample of human fluid, serum, or tissue that is reasonably available as a medium to measure the presence and concentration of chemicals or their metabolites in a human body. Community: As defined by Minnesota Statute 144.995, community means geographically or nongeographically based populations that may participate in the biomonitoring program. A nongeographical community includes, but is not limited to, populations that may share a common chemical exposure through similar occupations; populations experiencing a common health outcome that may be linked to chemical exposures; populations that may experience similar chemical exposures because of comparable consumption, lifestyle, product use; and subpopulations that share ethnicity, age, or gender. Designated chemicals: As defined by Minnesota Statute 144.995, designated chemicals are those chemicals that are known to, or strongly suspected of, adversely impacting human health or development, based upon scientific, peer‐reviewed animal, human, or in vitro studies, and baseline human exposure data. They consist of chemical families or metabolites that are included in the federal Centers for Disease Control and Prevention studies that are known collectively as the National Reports on Human Exposure to Environmental Chemicals Program and any substances specified by the commissioner after receiving recommendations from the advisory panel in accordance with the criteria specified in statute for the selection of specific chemicals to study. Environmental data: Concentrations of chemicals or other substances in the land, water, or air. Also, information about events or facilities that release chemicals or other substances into the land, water, or air. 62 Environmental epidemiology: According to the National Research Council, environmental epidemiology is the study of the effect on human health of physical, biologic, and chemical factors in the external environment. By examining specific populations or communities exposed to different ambient environments, environmental epidemiology seeks to clarify the relation between physical, biologic, and chemical factors and human health. Environmental hazard: As defined by Minnesota Statute 144.995, an environmental hazard is a chemical or other substance for which scientific, peer‐reviewed studies of humans, animals, or cells have demonstrated that the chemical is known or reasonably anticipated to adversely impact human health. People can be exposed to physical, chemical, or biological agents from various environmental sources through air, water, soil, and food. For EPHT, environmental hazards include biological toxins, but do not include infectious agents (e.g. E. coli in drinking water is not included). Environmental health indicators: Environmental health indicators or environmental public health indicators are descriptive summary measures that identify and communicate information about a population’s health status with respect to environmental factors. Within the environmental public health indicators framework, indicators are categorized as hazard indicators, exposure indicators, health effect indicators, and intervention indicators. See www.cste.org/OH/SEHIC.asp and www.cdc.gov/nceh/indicators/introduction.htm for more information. Environmental justice: The fair treatment and meaningful involvement of all people regardless of race, national origin, color or income when developing, implementing and enforcing environmental laws, regulations and policies. Fair treatment means that no group of people, including a racial, ethnic, or socioeconomic group, should bear more than its share of negative environmental impacts. Environmental health tracking: As defined in Minnesota Statute 144.995, environmental health tracking is the collection, integration, integration, analysis, and dissemination of data on human exposures to chemicals in the environment and on diseases potentially caused or aggravated by those chemicals. Environmental health tracking is synonymous with environmental public health tracking. Environmental public health surveillance: Environmental public health surveillance is public health surveillance of health effects integrated with surveillance of environmental exposures and hazards. Environmental Public Health Tracking Network: The National Environmental Public Health Tracking Network is a web‐based, secure network of standardized health and environmental data. The Tracking Network draws data and information from state and local tracking networks as well as national‐level and other data systems. It will provide the means to identify, access, and organize hazard, exposure, and health data from these various sources and to examine and analyze those data on the basis of their spatial and temporal characteristics. See http://ephtracking.cdc.gov/ Environmental Public Health Tracking (EPHT) Program: The Congressionally‐mandated national initiative that will establish a network that will enable the ongoing collection, integration, analysis, and interpretation of data about the following factors: (1) environmental hazards, (2) exposure to environmental hazards, and (3) health effects potentially related to exposure to environmental hazards. Visit www.cdc.gov/nceh/tracking/ for more information. Epidemiology: The study of the distribution and determinants of health‐related states or events in specified populations, and the application of this study to the control of health problems. 63 Exposure: Contact with a contaminant (by breathing, ingestion, or touching) in such a way that the contaminant may get in or on the body and harmful effects may occur. Exposure indicator: According to the Council of State and Territorial Epidemiologists (CSTE), an exposure indicator is a biological marker in tissue or fluid that identifies the presence of a substance or combination of substances that may potentially harm the individual. Geographic Information Systems (GIS): Software technology that enables the integration of multiple sources of data and displaying data in time and space. Hazard: A factor that may adversely affect health. Hazard indicator: A condition or activity that identifies the potential for exposure to a contaminant or hazardous condition. Health effects: Chronic or acute health conditions that affect the well‐being of an individual or community. Health effect indicator: The disease or health problem itself, such as asthma attacks or birth defects, that affect the well‐being of an individual or community. Health effects are measured in terms of illness and death and may be chronic or acute health conditions. Incidence: The number of new events (e.g., new cases of a disease in a defined population) within a specified period of time. Indicator: In Tracking, an indicator is a numeric measure or other characteristic found within each content area that will be assessed to provide information about a population's health status and their environment with the goal of monitoring trends, comparing situations, and better understanding the link between the environment and health. Institutional Review Board: An Institutional Review Board (IRB) is a specially constituted review body established or designated by an entity to protect the welfare of human subjects recruited to participate in biomedical or behavioral research. IRBs check to see that research projects are well designed, legal, ethical, do not involve unnecessary risks, and include safeguards for participants. Intervention: Taking actions in public health so as to reduce adverse health effects, regulatory, and prevention strategies. Intervention indicator: Programs or official policies that minimize or prevent an environmental hazard, exposure or health effect. Minnesota Data on Tracking and Assessment (MN DATA): MN DATA is a web based system that provides the user with access to Minnesota public health data, the environment, and other risk factors that could impact public health. 64 Minnesota Environmental Public Health Tracking Program (MN EPHT): MN EPHT is defined in Minnesota Statutes, section 144.995 as a state program for the ongoing collection, integration, interpretation, and dissemination of environmental hazard, exposure, and health effects data. MN EPHT produces a network or system of integrated data in the state about environmental hazards, population exposure, and health outcomes. MN EPHT works in partnership with other states as part of CDC’s National Environmental Public Health Tracking Network (Tracking Network). National Health and Nutrition Examination Survey (NHANES): A continuous survey, conducted by CDC, of the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. Since 1970, children in the survey were biomonitored for lead poisoning, and since 1999, an increasing number of environmental contaminants has been included in the survey. Visit www.cdc.gov/exposurereport/report.htm for more information. National Human Exposure Assessment Survey (NHEXAS): An EPA survey designed to evaluate comprehensive human exposure to multiple chemicals on a community and regional scale. The study was carried out in EPA Region V, of which Minnesota is a part. Individual households from four Minnesota Counties were included in the survey. Visit www.epa.gov/heasd/edrb/nhexas.htm for more information. Nationally Consistent Data and Measures (NCDM): An NCDM is an adaptation of a single set of national standards for data collection, analysis and reporting to enable CDC to compile a core set of nationally consistent data and measures across multiple states. Persistent chemicals: Chemical substances that persist in the environment, bioaccumulate through the food web, and pose a risk of causing adverse effects to human health and the environment. Population‐based approach: A population‐based approach uses a defined population or community as the organizing principle for targeting the broad distribution of diseases and health determinants. A population‐
based approach attempts to measure or shape a community’s overall health status profile, seeking to affect the determinants of disease within an entire community rather than simply those of single individuals. Prevalence: The number of events (e.g., instances of a given health effect or other condition) in a given population at a designated time. Public health surveillance: The systematic collection, analysis, interpretation, and dissemination of health data on an ongoing basis. Surveillance is conducted in order to identify potential public health threats or patterns of disease occurrence and risk in a community. Query: A tool that allows a user to retrieve information from a database. Standard: Something that serves as a basis for comparison. A technical specification or written report drawn up by experts based on the consolidated results of scientific study, technology, and experience; aimed at optimum benefits; and approved by a recognized and representative body. Revised February 24, 2011 Please submit additions and changes to: [email protected] 65 ACRONYMS USED IN ENVIRONMENTAL HEALTH TRACKING & BIOMONITORING ACGIH American Conference of Governmental Industrial Hygienists ATSDR Agency for Toxic Substances and Disease Registry, DHHS CDC CERCLA CSTE DHHS Centers for Disease Control and Prevention, DHHS EPA EHTB EPHI ICD IRB MARS MDA MDH MN DATA MN EPHT MNPHIN MPCA NCDM NCEH Comprehensive Environmental Response; Compensation and Liability Act (Superfund) Council of State and Territorial Epidemiologists US Department of Health and Human Services, including the US Public Health Service, which includes the CDC, ATSDR, NIH and other agencies US Environmental Protection Agency Environmental Health Tracking and Biomonitoring (the name of Minnesota Statutes 144.995‐144.998 and the program established therein) Environmental Public Health Indicators International Classification of Diseases Institutional Review Board Minnesota Arsenic Study, conducted by MDH in 1998‐1999 Minnesota Department of Agriculture Minnesota Department of Health Minnesota Data Access for Tracking & Assessment Minnesota Environmental Public Health Tracking Minnesota Public Health Information Network, MDH Minnesota Pollution Control Agency Nationally Consistent Data & Measures National Center for Environmental Health, CDC 66 NCHS NGO NHANES NHEXAS NIOSH NIEHS NIH NLM NPL NTP PFBA PFC PFOA PFOS PHL PHIN POP SEHIC National Center for Health Statistics Non‐governmental organization National Health and Nutrition Examination Survey, National Center for Health Statistics (NCHS) in the CDC National Human Exposure Assessment Survey, EPA National Institute for Occupational Safety and Health, CDC National Institute of Environmental Health Sciences, NIH National Institutes of Health, DHHS National Library of Medicine, NIH National Priorities List (Superfund) National Toxicology Program, NIEHS, NIH Perfluorobutanoic acid Perfluorochemicals, including PFBA, PFOA and PFOS Perfluorooctanoic acid Perfluorooctane sulfonate Public Health Laboratory, MDH Public Health Information Network, CDC Persistent organic pollutant State Environmental Health Indicators Collaborative Revised February 24, 2011 Please submit additions and changes to [email protected] 67 This page intentionally left blank. 68 EHTB statute: Minn. Statutes 144.995-144.998
Minnesota: Environmental Health Tracking and Biomonitoring
$1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount, $900,000 each year is
for transfer to the Minnesota Department of Health. The base appropriation for this program for fiscal year 2010 and
later is $500,000.
144.995 DEFINITIONS; ENVIRONMENTAL
HEALTH TRACKING AND
BIOMONITORING.
(a) For purposes of sections 144.995 to 144.998,
the terms in this section have the meanings given.
(b) "Advisory panel" means the Environmental
Health Tracking and Biomonitoring Advisory Panel
established under section 144.998.
(c) "Biomonitoring" means the process by which
chemicals and their metabolites are identified and
measured within a biospecimen.
(d) "Biospecimen" means a sample of human fluid,
serum, or tissue that is reasonably available as a
medium to measure the presence and concentration of
chemicals or their metabolites in a human body.
(e) "Commissioner" means the commissioner of the
Department of Health.
(f) "Community" means geographically or
nongeographically based populations that may
participate in the biomonitoring program. A
"nongeographical community" includes, but is not
limited to, populations that may share a common
chemical exposure through similar occupations,
populations experiencing a common health outcome
that may be linked to chemical exposures,
populations that may experience similar chemical
exposures because of comparable consumption,
lifestyle, product use, and subpopulations that share
ethnicity, age, or gender.
(g) "Department" means the Department of Health.
(h) "Designated chemicals" means those chemicals
that are known to, or strongly suspected of, adversely
impacting human health or development, based upon
scientific, peer-reviewed animal, human, or in vitro
studies, and baseline human exposure data, and
consists of chemical families or metabolites that are
included in the federal Centers for Disease Control
and Prevention studies that are known collectively as
the National Reports on Human Exposure to
Environmental Chemicals Program and any
substances specified by the commissioner after
receiving recommendations under section 144.998,
subdivision 3, clause (6).
(i) "Environmental hazard" means a chemical or
other substance for which scientific, peer-reviewed
studies of humans, animals, or cells have
demonstrated that the chemical is known or
reasonably anticipated to adversely impact human
health.
(j) "Environmental health tracking" means
collection, integration, analysis, and dissemination of
data on human exposures to chemicals in the
environment and on diseases potentially caused or
aggravated by those chemicals.
144.996 ENVIRONMENTAL HEALTH
TRACKING; BIOMONITORING.
Subdivision 1. Environmental health tracking. In
cooperation with the commissioner of the Pollution
Control Agency, the commissioner shall establish an
environmental health tracking program to:
(1) coordinate data collection with the Pollution
Control Agency, Department of Agriculture,
University of Minnesota, and any other relevant state
agency and work to promote the sharing of and
access to health and environmental databases to
develop an environmental health tracking system for
Minnesota, consistent with applicable data practices
laws;
(2) facilitate the dissemination of aggregate public
health tracking data to the public and researchers in
accessible format;
(3) develop a strategic plan that includes a mission
statement, the identification of core priorities for
research and epidemiologic surveillance, and the
identification of internal and external stakeholders,
and a work plan describing future program
development and addressing issues having to do with
compatibility with the Centers for Disease Control
and Prevention's National Environmental Public
Health Tracking Program;
(4) develop written data sharing agreements as
needed with the Pollution Control Agency,
Department of Agriculture, and other relevant state
agencies and organizations, and develop additional
procedures as needed to protect individual privacy;
(5) organize, analyze, and interpret available data,
in order to:
(i) characterize statewide and localized trends and
geographic patterns of population-based measures of
chronic diseases including, but not limited to, cancer,
respiratory diseases, reproductive problems, birth
69 defects, neurologic diseases, and developmental
disorders;
(ii) characterize statewide and localized trends and
geographic patterns in the occurrence of
environmental hazards and exposures;
(iii) assess the feasibility of integrating disease rate
data with indicators of exposure to the selected
environmental hazards such as biomonitoring data,
and other health and environmental data;
(iv) incorporate newly collected and existing
health tracking and biomonitoring data into efforts to
identify communities with elevated rates of chronic
disease, higher likelihood of exposure to
environmental hazards, or both;
(v) analyze occurrence of environmental hazards,
exposures, and diseases with relation to
socioeconomic status, race, and ethnicity;
(vi) develop and implement targeted plans to
conduct more intensive health tracking and
biomonitoring among communities; and
(vii) work with the Pollution Control Agency, the
Department of Agriculture, and other relevant state
agency personnel and organizations to develop,
implement, and evaluate preventive measures to
reduce elevated rates of diseases and exposures
identified through activities performed under sections
144.995 to 144.998; and
(6) submit a biennial report to the chairs and
ranking members of the committees with jurisdiction
over environment and health by January 15,
beginning January 15, 2009, on the status of
environmental health tracking activities and related
research programs, with recommendations for a
comprehensive environmental public health tracking
program.
Subd. 2. Biomonitoring. The commissioner shall:
(1) conduct biomonitoring of communities on a
voluntary basis by collecting and analyzing
biospecimens, as appropriate, to assess environmental
exposures to designated chemicals;
(2) conduct biomonitoring of pregnant women and
minors on a voluntary basis, when scientifically
appropriate;
(3) communicate findings to the public, and plan
ensuing stages of biomonitoring and disease tracking
work to further develop and refine the integrated
analysis;
(4) share analytical results with the advisory panel
and work with the panel to interpret results,
communicate findings to the public, and plan ensuing
stages of biomonitoring work; and
(5) submit a biennial report to the chairs and
ranking members of the committees with jurisdiction
over environment and health by January 15,
beginning January 15, 2009, on the status of the
biomonitoring program and any recommendations for
improvement.
Subd. 3. Health data. Data collected under the
biomonitoring program are health data under section
13.3805.
144.997 BIOMONITORING PILOT
PROGRAM.
Subdivision 1. Pilot program. With advice from
the advisory panel, and after the program guidelines
in subdivision 4 are developed, the commissioner
shall implement a biomonitoring pilot program. The
program shall collect one biospecimen from each of
the voluntary participants. The biospecimen selected
must be the biospecimen that most accurately
represents body concentration of the chemical of
interest. Each biospecimen from the voluntary
participants must be analyzed for one type or class of
related chemicals. The commissioner shall determine
the chemical or class of chemicals to which
community members were most likely exposed. The
program shall collect and assess biospecimens in
accordance with the following:
(1) 30 voluntary participants from each of three
communities that the commissioner identifies as
likely to have been exposed to a designated chemical;
(2) 100 voluntary participants from each of two
communities:
(i) that the commissioner identifies as likely to
have been exposed to arsenic; and
(ii) that the commissioner identifies as likely to
have been exposed to mercury; and
(3) 100 voluntary participants from each of two
communities that the commissioner identifies as
likely to have been exposed to perfluorinated
chemicals, including perfluorobutanoic acid.
Subd. 2. Base program. (a) By January 15, 2008,
the commissioner shall submit a report on the results
of the biomonitoring pilot program to the chairs and
ranking members of the committees with jurisdiction
over health and environment.
(b) Following the conclusion of the pilot program,
the commissioner shall:
(1) work with the advisory panel to assess the
usefulness of continuing biomonitoring among
members of communities assessed during the pilot
program and to identify other communities and other
designated chemicals to be assessed via
biomonitoring;
(2) work with the advisory panel to assess the pilot
program, including but not limited to the validity and
accuracy of the analytical measurements and
adequacy of the guidelines and protocols;
(3) communicate the results of the pilot program to
the public; and
(4) after consideration of the findings and
recommendations in clauses (1) and (2), and within
the appropriations available, develop and implement
a base program.
70 Subd. 3. Participation. (a) Participation in the
biomonitoring program by providing biospecimens is
voluntary and requires written, informed consent.
Minors may participate in the program if a written
consent is signed by the minor's parent or legal
guardian. The written consent must include the
information required to be provided under this
subdivision to all voluntary participants.
(b) All participants shall be evaluated for the
presence of the designated chemical of interest as a
component of the biomonitoring process. Participants
shall be provided with information and fact sheets
about the program's activities and its findings.
Individual participants shall, if requested, receive
their complete results. Any results provided to
participants shall be subject to the Department of
Health Institutional Review Board protocols and
guidelines. When either physiological or chemical
data obtained from a participant indicate a significant
known health risk, program staff experienced in
communicating biomonitoring results shall consult
with the individual and recommend follow-up steps,
as appropriate. Program administrators shall receive
training in administering the program in an ethical,
culturally sensitive, participatory, and communitybased manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that address
the science and practice of biomonitoring to be
utilized and procedures for changing those protocols
to incorporate new and more accurate or efficient
technologies as they become available. The
commissioner and the advisory panel shall be guided
by protocols and guidelines developed by the Centers
for Disease Control and Prevention and the National
Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up counseling
and support; and communicating findings to
participants, communities, and the general public.
The informed consent used for the program must
meet the informed consent protocols developed by
the National Institutes of Health;
(3) educational and outreach materials that are
culturally appropriate for dissemination to program
participants and communities. Priority shall be given
to the development of materials specifically designed
to ensure that parents are informed about all of the
benefits of breastfeeding so that the program does not
result in an unjustified fear of toxins in breast milk,
which might inadvertently lead parents to avoid
breastfeeding. The materials shall communicate
relevant scientific findings; data on the accumulation
of pollutants to community health; and the required
responses by local, state, and other governmental
entities in regulating toxicant exposures;
(4) a training program that is culturally sensitive
specifically for health care providers, health
educators, and other program administrators;
(5) a designation process for state and private
laboratories that are qualified to analyze
biospecimens and report the findings; and
(6) a method for informing affected communities
and local governments representing those
communities concerning biomonitoring activities and
for receiving comments from citizens concerning
those activities.
(b) The commissioner may enter into contractual
agreements with health clinics, community-based
organizations, or experts in a particular field to
perform any of the activities described under this
section.
144.998 ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
ADVISORY PANEL.
Subdivision 1. Creation. The commissioner shall
establish the Environmental Health Tracking and
Biomonitoring Advisory Panel. The commissioner
shall appoint, from the panel's membership, a chair.
The panel shall meet as often as it deems necessary
but, at a minimum, on a quarterly basis. Members of
the panel shall serve without compensation but shall
be reimbursed for travel and other necessary
expenses incurred through performance of their
duties. Members appointed by the commissioner are
appointed for a three-year term and may be
reappointed. Legislative appointees serve at the
pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner shall
appoint eight members, none of whom may be
lobbyists registered under chapter 10A, who have
backgrounds or training in designing, implementing,
and interpreting health tracking and biomonitoring
studies or in related fields of science, including
epidemiology, biostatistics, environmental health,
laboratory sciences, occupational health, industrial
hygiene, toxicology, and public health, including:
(1) at least two scientists representative of each of
the following:
(i) nongovernmental organizations with a focus on
environmental health, environmental justice,
children's health, or on specific chronic diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a representative of
the University of Minnesota.
(b) Two citizen panel members meeting the
scientific qualifications in paragraph (a) shall be
appointed, one by the speaker of the house and one
by the senate majority leader.
(c) In addition, one representative each shall be
appointed by the commissioners of the Pollution
71 Control Agency and the Department of Agriculture,
and by the commissioner of health to represent the
department's Health Promotion and Chronic Disease
Division.
Subd. 3. Duties. The advisory panel shall make
recommendations to the commissioner and the
legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based on
sound science and practice, and that will advance the
state of public health in Minnesota;
(3) specific chronic diseases to study under the
environmental health tracking system;
(4) specific environmental hazard exposures to
study under the environmental health tracking
system, with the agreement of at least nine of the
advisory panel members;
(5) specific communities and geographic areas on
which to focus environmental health tracking and
biomonitoring efforts;
(6) specific chemicals to study under the
biomonitoring program, with the agreement of at
least nine of the advisory panel members; in making
these recommendations, the panel may consider the
following criteria:
(i) the degree of potential exposure to the public or
specific subgroups, including, but not limited to,
occupational;
(ii) the likelihood of a chemical being a carcinogen
or toxicant based on peer-reviewed health data, the
chemical structure, or the toxicology of chemically
related compounds;
(iii) the limits of laboratory detection for the
chemical, including the ability to detect the chemical
at low enough levels that could be expected in the
general population;
(iv) exposure or potential exposure to the public or
specific subgroups;
(v) the known or suspected health effects resulting
from the same level of exposure based on peerreviewed scientific studies;
(vi) the need to assess the efficacy of public health
actions to reduce exposure to a chemical;
(vii) the availability of a biomonitoring analytical
method with adequate accuracy, precision,
sensitivity, specificity, and speed;
(viii) the availability of adequate biospecimen
samples; or
(ix) other criteria that the panel may agree to; and
(7) other aspects of the design, implementation,
and evaluation of the environmental health tracking
and biomonitoring system, including, but not limited
to:
(i) identifying possible community partners and
sources of additional public or private funding;
(ii) developing outreach and educational methods
and materials; and
(iii) disseminating environmental health tracking
and biomonitoring findings to the public.
Subd. 4. Liability. No member of the panel shall
be held civilly or criminally liable for an act or
omission by that person if the act or omission was in
good faith and within the scope of the member's
responsibilities under sections 144.995 to 144.998.
INFORMATION SHARING.
On or before August 1, 2007, the commissioner of
health, the Pollution Control Agency, and the
University of Minnesota are requested to jointly
develop and sign a memorandum of understanding
declaring their intent to share new and existing
environmental hazard, exposure, and health outcome
data, within applicable data privacy laws, and to
cooperate and communicate effectively to ensure
sufficient clarity and understanding of the data by
divisions and offices within both departments. The
signed memorandum of understanding shall be
reported to the chairs and ranking members of the
senate and house of representatives committees
having jurisdiction over judiciary, environment, and
health and human services.
Effective date: July 1, 2007
This document contains Minnesota Statutes, sections
144.995 to 144.998, as these sections were adopted in
Minnesota Session Laws 2007, chapter 57, article 1,
sections 143 to 146. The appropriation related to
these statutes is in chapter 57, article 1, section 3,
subdivision 4. The paragraph about information
sharing is in chapter 57, article 1, section 169. The
following is a link to chapter 57:
http://ros.leg.mn/bin/getpub.php?type=law&year=20
07&sn=0&num=57
72