Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
June 7, 2011
1:00 p.m. – 4:00 p.m.
Snelling Office Park
Red River Room
1645 Energy Park Drive
St. Paul, Minnesota
Time
Agenda item
Presenter(s)
Item type/Anticipated outcome
1:00
Welcome and
introductions
Bruce Alexander,
Chair
Members and audience members are invited to
introduce themselves.
TRACKING
1:05
New State Tracking
Content Initiatives
1. Environmental
Tobacco Smoke
(ETS)
2. Arsenic in Private
Wells
1:40
MDH staff:
Jeannette Sample
Blair Sevcik
Larry Souther
Mike Convery
Decision Item
Staff will review the selection process for new
Minnesota-specific content areas for Tracking and
review the progress through that selection process for
ETS Exposure and Private Wells.
Panel members are invited to ask questions or provide
input on new content areas. The chair will invite panel
members to vote to recommend the ETS content area
for ongoing tracking. (see proposed language)
Tracking Updates
1.Portal launch
2.Communications
3. CDC initiatives
Updates are provided on Tracking topics in the panel
meeting materials. No presentation is planned. Panel
members are invited to ask questions about any of
these topics.
BIOMONITORING
1:45
CDC Biomonitoring
Communication
Research
Claudia Vousden,
CDC
Jean Johnson
Information sharing
Claudia Vousden (CDC) and Jean Johnson will describe
results of recent collaboration on a biomonitoring
communications research project in Minnesota’s East
Metro PFC project community. Panel members are
invited to ask questions or offer input on ways to
improve future biomonitoring communications with
affected communities.
i
Time
Agenda item
2:15
Project Updates:
1. East Metro PFC
Follow-up
2. Lake Superior
Mercury
2:25
Presenter(s)
Item type/Anticipated outcome
Brief updates on the biomonitoring projects are
provided (tentative). Panel members are invited to ask
questions or provide input about the status of any of
these projects.
Break
2:40
Riverside Prenatal
Project: Preliminary
results for
environmental
phenols
Jessica Nelson
Logan Spector
Discussion Item
Staff will present preliminary results from the Riverside
prenatal biomonitoring study and describe plans for
disseminating the results. Panel members are invited
to offer feedback on the analyses, and to make
recommendations for communicating the findings and
for further action based on pilot study results. UMN PI
Logan Spector will join the discussion, in which panel
members are asked to respond to the following
questions:
Considering the limitations in study size and the
available data presented, what conclusions can be
drawn and what, if any, additional analyses are
recommended?
Is further biomonitoring in this community
recommended?
3:20
Strategic Planning
Barbara Scott
Murdock
3:45
Legislative Update
Jeanne Ayers/
Aggie Leitheiser
Discussion item.
Update on stakeholder involvement & suggestions for
an ongoing MDH biomonitoring program: target
populations & analytes. Panel members are invited to
ask questions and provide input on future planning,
partnerships and funding strategies.
Assistant Commissioners will discuss the current state
budget proposals for fiscal years 2012-2013 and likely
impact on EHTB program.
3:55
New business
Bruce Alexander
4:00
Adjourn
The chair will invite panel members to suggest topics
for future meetings.
Next meeting:
Tuesday, September 13, 2011, 1-4 p.m. Red River Room, Snelling Office Park
ii
TABLE OF CONTENTS
Agenda............................................................................................................. i
Table of Contents ........................................................................................... iii
MATERIALS RELATED TO SPECIFC AGENDA ITEMS
Section overview: New Content Areas for Tracking in Minnesota .................... 1
Section overview: Tracking Updates.............................................................. 15
Section overview: CDC Biomonitoring Communications Evaluation Project ... 21
Section overview: Biomonitoring Updates .................................................... 23
Section overview: Riverside Prenatal Biomonitoring Pilot Project .................. 27
Section overview: Strategic Planning for an MDH Biomonitoring Program ..... 35
Section overview: Other Information ............................................................. 41
iii
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iv
SECTION OVERVIEW:
New Content Areas 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 was used to present a new Minnesota‐specific
content area that is under consideration: ETS Exposure.
In June 2011, another new Minnesota-specific content area of Arsenic in Private Wells will be
discussed using Phase I of the selection process.
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. The full selection
process and list of criteria for new Minnesota-specific content areas and measures can be found in the
March 2011 Advisory Panel meeting materials.
ETS Exposure as a New Content Area for Tracking in Minnesota
ETS Exposure was used to pilot the selection process criteria. At the March 2011 meeting, MN EPHT staff
provided an overview of the selection process for ETS Exposure. The panel considered a motion to
recommend the new content, but had no quorum.
At this meeting (June 2011), panel members will be invited to make a motion and vote
to recommend to the Commissioner that the ETS Exposure content area be adopted and
implemented as part of the Tracking program.
Arsenic in Private Wells as a New Content Area for Tracking in Minnesota
Staff will present evaluation criteria from Phase I of the selection process, exploring Arsenic in Private
Wells as a new Minnesota-specific content area. Panel members are invited to ask questions (no vote is
expected).
The following items are included in this section of the meeting materials:
Summary of evaluation criteria for ETS exposure
Selected data & measures for ETS exposure
Phase I of evaluation criteria for Arsenic in Private Wells
ACTION NEEDED: Panel members are invited to ask questions or provide input on ETS Exposure
and Arsenic in Private Wells as new content areas for Tracking.
The chair will invite panel members to make a motion and vote to recommend to the Commissioner
of Health that the ETS Exposure content area be adopted as a new content area for ongoing
Tracking in Minnesota. Suggested motion: I move that the panel recommend adding ETS as a new
content area for the environmental health tracking program.
1
Data Sources: (1) Youth Tobacco Survey and (2) Adult Tobacco Survey
NOTE: Both data sources are survey data
Phase I: Exploration
Prevalence
Question
Is there a high estimated proportion of
the population that is exposed to ETS?
Answer
Yes, a high proportion of the general population of
nonsmoking adults and children in the US are exposed to ETS;
43% of nonsmokers ≥4 years of age have cotinine levels that
indicate exposure to tobacco smoke (≥0.5µg/dL).
Causality
Question
Is there evidence that ETS exposure is a
component cause of adverse health
outcomes?
Answer
Yes, several known adverse health effects are linked to ETS
exposure in children and adults.
Known human carcinogen(s)
Developmental and respiratory effects in children
Respiratory, carcinogenic, and cardiovascular effects in
adults
Actionability
Question
Are there existing
prevention or control
programs at MDH or other
Minnesota organizations
for ETS exposure or its
adverse health outcomes?
Can the level of ETS
exposure be modified
through policy, regulatory,
or personal actions?
Is ETS exposure tied to
state or federal public
health objectives?
Answer
Yes, several existing programs measure or attempt to prevent ETS
exposure or its adverse health outcomes:
Youth and Adult Tobacco Surveys
Tobacco Prevention & Control Program (MDH)
Center for Health Statistics (MDH)
Asthma Program (MDH)
Minnesota Cancer Surveillance System (MDH)
American Lung Association of Minnesota
ClearWay Minnesota and QUITPLAN
Yes, smoking bans enforced by adults or other nonsmokers and other
personal actions can reduce ETS exposure. Freedom to Breathe (FTB),
enacted in Oct 2007, prohibits smoking in virtually all indoor public places
and indoor places of employment. FTB does not prohibit smoking in
outdoor places or private spaces such as a car or home.
Yes, five Healthy People 2020 Objectives under the Tobacco Use (TU) topic
target ETS exposure.
1. TU-11: Reduce the proportion of nonsmokers exposed to
secondhand smoke.
2
Can data and measures in
this content area be used
to develop new program
initiatives?
2. TU-12: Increase the proportion of persons covered by indoor
worksite policies that prohibit smoking.
3. TU-13: Establish laws… on smoke-free indoor air that prohibit
smoking in public places and worksites.
4. TU-14: Increase the proportion of smoke-free homes.
5. TU-15: Increase tobacco-free environments in schools, including all
school facilities, property, vehicles, and school events.
www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?to
picid=41
Existing programs target either ETS exposure or its adverse health
outcomes. Tracking this content area can link the topics of exposure with
health outcome by bringing together information on MN EPHT’s online
data access portal.
Public Health Impact
Question
Can the population
attributable risk (PAR) or
public health impact of
exposure to ETS be
estimated from available
data? Or is the PAR
known?
Answer
Yes, Waters et al. (2009) estimated the economic impact and PAR of ETS
exposure in Minnesota in 2003.
PAR: Waters et al. (2009) also provides the PAR for several adverse
health outcomes (see table below) among Minnesota children and
adults in 2003.
Public health impact: the total cost of treatments that are causally
linked to ETS (2006 U.S. Surgeon General’s Report) was estimated at
about $229 million, adjusted to 2008 dollars.
Table: Costs of Conditions
Attributable to Secondhand
Tobacco Smoke (SHS), by Age
Group, Minnesota, 2003.
Aged 0-17 years
Low birthweight
Acute lower-respiratory illnesses
Otitis media & middle-ear
effusion
Asthma, wheeze illness
Aged 18-64 years
Lung cancer
Coronary heart disease
Aged 65+ years
Lung cancer
Coronary heart disease
Grand total
Episodes
PAR, %
Episodes
attributable
to ETS
Cost per
episode,
2003 $
Total cost,
millions,
2008 $
4,413
31,953
235,333
18.0
25.0
14.0
794
7,988
32,947
41,790
848
521
40.3
8.2
20.9
50,135
35.0
17,547
1,052
22.4
3,466
73,914
4.9
6.9
170
5100
23,200
9,650
4.8
59.7
4,450
28,033
4.9
6.9
218
1934
58,303
24,252
15.4
56.9
228.7
Source: Table 4 from 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.
3
(Initial) Feasibility
Question
Is there a data source for exploration of
“trackable” indicators?
Answer
Yes, two data sources have data on ETS exposure
among nonsmokers in Minnesota: Minnesota
Youth Tobacco (and Asthma) Survey and
Minnesota Adult Tobacco Survey (Center for
Health Statistics, MDH).
Yes, the Center for Health Statistics has legal
authority to collect and use these data.
Yes, private data are classified and protected.
Personal identifiers do not exist in data provided
to the Tracking program. Suppression could be
applied to small cell counts for privacy.
Does MDH have the legal authority to collect and
use the data?
Are private data classified and protected according
to state and federal law?
**END OF PHASE I: EXPLORATION**
Phase II: Feasibility
Detailed Feasibility
Question
What is the level of
quality of the data?
Is there continuity?
Are the data timely?
Are the data
comparable?
Is aggregation possible at
different geographic
levels?
What is the cost to MDH
to obtain data?
Piloted Data & Measures
Answer
The data are:
population-based
representative of ETS exposure
assumed to be reliable and valid
Yes, data collection has been consistent over time; the YTS and ATS have
been conducted since 2000 and 2003, respectively.
Yes, datasets for both surveys are typically available within a year of data
collection.
Youth Tobacco Survey (YTS):
It is possible to compare the youth survey to its national counterpart and to
other states that conduct that survey. For example, CDC’s Office on
Smoking & Health indicates that Minnesota and 15 other states conducted
the YTS in 2008.
Adult Tobacco Survey (ATS):
The National ATS was conducted in 2009-2010 and should have data on
ETS exposure in different settings.
CDC 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.
For both surveys, data are available at the state level; in addition, it is
possible to compare regions, particularly the Twin Cities metro area vs. nonmetro regions. Aggregation is possible between years for both surveys.
The cost to MDH to obtain data is minimal staff time to complete these
steps is reasonable.
Measure: count (#) and percent (%) of nonsmokers exposed to ETS in
Minnesota.
**END OF PHASE II: FEASIBILITY**
4
Phase III: Recommendation
Emerging Issues
Question
Is the degree or level of
exposure changing or
perceived to be changing?
Answer
The level of exposure in indoor public spaces (such as worksites,
restaurants, and bars) has decreased with the enactment of Freedom to
Breathe in October 2007.
The degree of exposure in homes, cars, and outdoor spaces has likely
remained the same on a population level.
It’s possible that the individual level of exposure is decreasing where
parents or guardians enforce smoking bans in the home or car.
Potential for Information Building
Question
Is this a hazard with unknown
associations to health
outcomes or unknown levels of
exposure in the population?
Would other programs at MDH
be interested in this content
area?
Answer
Exposure to ETS has many known adverse health outcomes. It’s
possible that unknown associations are yet to be discovered.
The level of exposure to ETS at the population level is measured via
cotinine (NHANES) and via surveys (such as the Youth and Adult
Tobacco Surveys).
Yes, the Center for Health Statistics, the Asthma Program, and the
Tobacco Prevention & Control Program could all potentially benefit
from display of these data and measures on MN EPHT’s web-based
data access portal and/or from topical reports on this content area.
For example, the Asthma Program is interested in resources that
would be generated on this new content area, such as a data brief on
ETS exposure.
Outside Interest or Public Concern
Question
Is there a high concern about
the proportion of the
population exposed to the
hazard?
Is ETS exposure a priority that
has previously been
identified by environmental
health organizations?
Would this content area
utilize existing datasets in a
new way?
Answer
The proportion of the population exposed to ETS should not have
increased in recent years, especially among nonsmokers.
However, concern about exposure to ETS among vulnerable
populations, such as children and pregnant women, remains high.
Healthy People 2020 has several objectives that target reducing the
level of exposure to ETS, especially among vulnerable populations
like children and pregnant women; increasing smoke-free venues is
one way to achieve this.
NHANES measures cotinine to track the level of ETS exposure among
nonsmokers.
The Minnesota Center for Health Statistics (MDH) currently publishes
detailed reports using Youth or Adult Tobacco Survey data. MN EPHT
would present data and measures on ETS exposure among nonsmokers,
which is not currently addressed by existing reports. By focusing on
nonsmokers, MN EPHT would present these data in a new way.
5
Balance among content areas
Question
Is there balance between
hazard/exposure and disease
content areas?
Is there balance between age
groups affected among
content areas?
Answer
Yes, there is balance. MN EPHT currently tracks four hazard/exposure
content areas and four disease content areas.
Exposure to ETS would be a content area that especially affects
children, but also affects adults and the elderly. Moreover, the current
representation of age groups affected by the content areas that MN
EPHT tracks is balanced.
Economic Impact
Question
What is the economic impact
in Minnesota of adding this
content area?
Answer
Adoption of ETS exposure will require the time and resources of
MN EPHT staff to incorporate the content area into Tracking.
Adoption will also require the resources of Minnesota Center
for Health Statistics staff as the data steward for both data
sources.
Adoption may also affect the work of the Tobacco Prevention &
Control Program (MDH) as well as local public health programs
that have ongoing initiatives to reduce or measure ETS
exposure.
Adoption would require collaboration with Tobacco Prevention
& Control staff to produce standardized messaging and
interpretation of data.
**END OF PHASE III: RECOMMENDATION**
6
Youth Tobacco Survey (YTS)
Table 1. Proportion 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”
Weighted %
58.8%
56.5%
50.8%
41.1%
51.5%
Percent of nonsmokers exposed to ETS
in same room or same car
Figure 1. Proportion of youth exposed to ETS* in past week among nonsmokers, Minnesota,
2000-2008.
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2000
2002
2005
Year
* Exposed in the setting of “same room” OR “in a car”
7
2008
Adult Tobacco Survey (ATS)
Table 1. Proportion 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
N
6996
10608
5922
23526
At home
%
7.1%
3.8%
2.7%
4.5%
Weighted %
7.4%
4.4%
3.5%
5.0%
Year
2003
2007
2010
Aggregated
Count
651
566
187
1404
N
4559
6264
3337
14160
At work
%
14.3%
9.0%
5.6%
9.9%
Weighted %
13.9%
11.1%
7.4%
10.8%
N
7000
10622
5930
23552
In a car
%
10.5%
8.1%
6.1%
8.3%
Weighted %
10.5%
9.8%
8.2%
9.5%
Year
2003
2007
2010
Aggregated
Count
734
860
359
1953
Figure 1. Proportion of nonsmokers exposed to ETS in the past week by exposure setting,
Minnesota adults, 2003-2010.
At home
At work
In a car
Percent of nonsmokers exposed to ETS by
exposure setting
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
2003
2007
8
2010
Table 2. Proportion of nonsmokers exposed to ETS in the past week in the community,†
Minnesota adults, 2003-2010.
Year
Count
N
%
Weighted %
2003
3541
6946
51.0%
54.5%
2007
4236
10587
40.0%
41.0%
2010
1561
5896
26.5%
29.0%
Aggregated
9338
23429
39.9%
40.5%
†
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. Proportion of nonsmokers exposed to ETS in the past week in the community, †
Minnesota adults, 2003-2010.
Percent of nonsmokers exposed to ETS
at any location
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2003
2007
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?”
9
Content Area: Arsenic in Private Wells
Data Sources: Wells (linked to County W ell Index)
Phase I: Exploration
Resources available
Question
Is there staff time/interest/expertise?
Are there financial and technical
resources available?
Answer
Staff have expertise and interest; their time on the content
area depends on funding.
Completion of Phase II onward is resource dependent.
Resources after June 30, 2011 are unknown.
Prevalence
Question
Is there a high estimated proportion of
the population that is exposed? [OR] Is
there a high estimated prevalence of
disease or outcome?
Answer
Nearly 37 million Americans, many living in remote areas
outside of the public drinking water distribution system,
obtain their drinking water from private wells or other small
systems known as unregulated drinking water sources
(UDWS).1 About 1 million Minnesotans rely on private wells.2
The U.S. Environmental Protection Agency (U.S. EPA)
regulates the levels of arsenic and other contaminants
allowed in public drinking water. The standard for arsenic in
public drinking water supplies is a maximum contaminant
level (MCL) of 10 micrograms per liter (μg/L). After an initial
test at the time a private well is drilled, private drinking water
wells are not required to meet federal MCLs or any state
standards.3
Surveys of U.S. drinking water indicate that about 2% of water
supplies exceed 20 μg/L of arsenic.4 In Minnesota, 9% of new
1
Backer, Lorraine C. and Tosta, Nancy. “Unregulated Drinking Water Initiative for Environmental Surveillance and
Public Health.” Journal of Environmental Health. 73(7):31-32.
2
Minnesota Department of Health. Well Management Program. http://www.health.state.mn.us/divs/eh/wells/
Accessed May 17, 2011.
3
Minnesota Department of Health. “Arsenic in Drinking Water and Your Patients’ Health.” Available at:
http://www.health.state.mn.us/divs/eh/hazardous/topics/arsenicfct.pdf
4
Agency for Toxic Substances and Disease Registry (ATSDR). Toxicology Profile for Arsenic. August 2007.
10
wells sampled for arsenic levels exceeded 10 μg/L.5 Some
groundwater in Minnesota has arsenic as high as 150 μg/L.3
Arsenic can occur in groundwater nearly anywhere in
Minnesota. Groundwater from the Twin Cities to the South
Dakota border, and north along Minnesota’s border with the
Dakotas is more likely to contain elevated levels of arsenic.
However, arsenic levels can vary from one well to the next,
even within a very small area.6
Causality
Question
Is there evidence that exposure is a
component cause of adverse health
outcomes? [OR] Is there evidence that
that the disease has an environmental
component cause?
Answer
The health effects of arsenic depend on its chemical form,
how much enters the body, how it enters the body, how long
it stays in the body, and on the unique health status of the
exposed person.
Inorganic arsenic is fatal at doses much higher—60,000
micrograms (µg)—than naturally occurring concentrations in
the environment (most people consume about 3.5
micrograms of inorganic arsenic per day from food and
water).7 Over time, daily consumption of relatively lower
concentrations of arsenic found in drinking water, combined
with arsenic naturally occurring in the diet, can cause a
number of harmful effects on the human body. Arsenic is not
significantly absorbed through the skin, so activities such as
dishwashing and bathing or showering are not significant
exposure routes.8
Long-term consumption of drinking water with arsenic levels
over 100 μg/L has been associated with health effects
including nervous system problems, diabetes, and several
circulatory diseases.8 Some studies have now shown that
arsenic levels below 100 μg/L may also cause some health
effects, including nervous system problems, skin problems,
high blood pressure, and reduced intelligence in children.8
The most characteristic effect of long-term oral exposure to
inorganic arsenic is a pattern of skin changes. These include
5
Minnesota Department of Health. Minnesota Well Management News. “Arsenic Occurrence in Minnesota Wells.”
Volume 29, No. 2. Fall 2009/Winter 2010.
6
Minnesota Department of Health. Well Management: Arsenic in Minnesota’s Well Water.
http://www.health.state.mn.us/divs/eh/wells/waterquality/arsenic.html/ Accessed May 17, 2011.
7
Agency for Toxic Substances and Disease Registry (ATSDR). Toxicology Profile for Arsenic. August 2007.
8
Minnesota Department of Health. Minnesota Well Management News. “Arsenic Occurrence in Minnesota Wells.”
Volume 29, No. 2. Fall 2009/Winter 2010.
11
patches of darkened skin and the appearance of small "corns"
or "warts" on the palms, soles, and torso; these changes are
often associated with changes in the blood vessels of the
skin.7
The U.S. Department of Health and Human Services (DHHS),
the EPA, and the International Agency for Research on Cancer
(IARC) has determined that inorganic arsenic is carcinogenic
to humans.7 Long-term consumption of drinking water
containing arsenic has been linked to several cancers. The
most common types of cancers described in reports include
cancer of the skin, bladder, lungs, liver, and prostate. Other
cancers that may be associated with arsenic in drinking water
include cancers of the kidney, colon, bone, larynx, stomach,
lymph nodes, and nasal cavities.9
Actionability
Question
Are there existing prevention or control
programs at MDH or other Minnesota
organizations for the exposure or its
adverse health outcomes?
Can the level of exposure or disease be
modified through policy, regulatory, or
personal actions?
Is the exposure or disease tied to state
or federal public health objectives?
Answer
The national drinking water standard set by the EPA for
arsenic is a MCL of 10 μg/L. This standard applies to
community water-supply systems. Although Minnesota
Administrative Rules, Chapter 4725, Wells and Borings,
require that new wells must be tested for arsenic, no
enforceable standard for arsenic in private wells exists in
Minnesota.
MDH recommends that people not consume water with
arsenic levels that exceed 10 μg/L. The MDH Well
Management Program provides information on re-testing of
private wells and methods for reducing arsenic in drinking
water.
If the arsenic level in a well exceeds 10 μg/L, the well owner
is encouraged to look at options for reducing arsenic
exposure, including water treatment, connection to a public
water-supply system, or construction of a new well in a
different aquifer. Several types of water treatment systems
can effectively reduce arsenic levels in drinking water. These
include systems with special arsenic-removal media, reverse
osmosis with pre-oxidation, and distillation systems.
Yes. Healthy People 2020 Environmental Health Objective
24: Reduce the global burden of disease due to poor water
quality, sanitation, and insufficient hygiene.
Healthy People 2020 Environmental Health Objective 20.1:
9
Minnesota Department of Health. “Arsenic in Drinking Water and Your Patients’ Health.” Available at:
http://www.health.state.mn.us/divs/eh/hazardous/topics/arsenicfct.pdf
12
Can data and measures in this content
area be used to develop new program
initiatives?
Reduce exposure to selected environmental chemicals in the
population, as measured by blood and urine concentrations
of the substances or their metabolites.
The data may support the creation of drilling
recommendations, well construction recommendations,
special well construction areas, and public outreach
programs.
Public Health Impact
Question
Is the population attributable risk (PAR)
or public health impact of exposure
known or be estimated from available
data? [OR] Is the severity of the disease
effect known and contributes to mortality
or morbidity?
Answer
The estimates of cancer risk (for lung and bladder cancer
alone) associated with arsenic in water at 3 μg/L may be
between 4 and 10 additional cases in a population of
10,000.10
(Initial) Feasibility
Question
What are the data sources for
exploration of “trackable” indicators?
Answer
The joining of the County Well Index to the Wells database
provides a statewide database of Arsenic measurements.
The County Well Index (CWI) is a PC-based database system
developed by the Minnesota Geological Survey (MGS) for the
storage, retrieval, and editing of water well information.
Data are entered into the database by staff at the MGS and
the Minnesota Department of Health (MDH). The CWI
database contains basic information such as location (UTM
coordinates), depth, and static water level for wells drilled in
Minnesota. The database also includes information on well
construction, stratigraphy/geology, water level, and some
water chemistry for many of the wells.
Each well record uses a unique number. The unique number
is the key identifier for the location and geology of the well
and can be joined to water quality databases, such as the
Wells database.
Since August 2008, Minnesota water well construction code
requires all new potable water-supply well (public or private)
be tested for arsenic. This requirement generates data for
the Well database run by MDH Well Management. The
reporting level for total arsenic is 2 µg/L, and testing is done
10
Minnesota Department of Health. “Arsenic in Drinking Water and Your Patients’ Health.” Available at:
http://www.health.state.mn.us/divs/eh/hazardous/topics/arsenicfct.pdf. Data from National Research Council.
“Arsenic in Drinking Water: 2001 Update”. The National Academy Press. 2001.
13
Does MDH have the legal authority to
collect and use the data?
by MDH certified labs. Approximately 10,000 new wells are
drilled in Minnesota each year.
MDH has the authority to collect and use the data under
Minnesota Administrative Rules, Chapter 4725, Wells and
Borings.
Most information in the County Well Index is entered from
the Water Well Driller Log form, which is submitted by the
well driller to MDH at the time the well was constructed.
Submission of a Water Well Driller Log is a requirement of
the Minnesota Water Well Construction Code, passed by the
State Legislature in 1974.
Are private data classified and protected
according to state and federal law?
Revisions to the well code rules went into effect on August 4,
2008. These require all well contractors licensed by the
MDH, and any other person constructing a water-supply well
for personal use on their own property, to collect a water
sample and have it tested for arsenic by an MDH-certified
laboratory.
The Wells database and County Well Index do not contain
'non public' data.
14
SECTION OVERVIEW:
Tracking Updates
Updates for the following projects describe progress in program areas that are not part
of today’s agenda or that might alert panel members to material that will be discussed
in greater depth in a future meeting.
Status reports in this section include…
The Tracking Data Portal
Communications and Outreach
CDC Tracking Content Initiatives
ACTION NEEDED: Currently, no action is needed. Panel members are invited to ask questions
or comment on these projects during the time listed on the meeting agenda.
15
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16
Tracking Updates: Tracking Data Portal
May 2011
MN EPHT has implemented several enhancements to the tracking data portal (Minnesota Public
Health Data Access) since the March 2011 Advisory Panel meeting. These include the addition
of 2 new topic areas (air quality and cancer), as well as usability improvements to increase
flexibility and customization across all queries. For example, portal users can now easily select,
view, and compare state and county data for 2 queries (asthma, carbon monoxide poisonings),
as well as download (export) results in a standard format for analysis. Currently, tracking data
are available for 10 topic areas:
Air Quality
Asthma
Birth Defects
Cancer
Carbon Monoxide Poisonings
Childhood Lead Poisoning
Chronic Obstructive Pulmonary Disease (COPD)
Drinking Water Quality
Heart Attacks
Reproductive Outcomes
Access the tracking data portal via the MN EPHT program web site:
http://www.health.state.mn.us/tracking
Press Release
In May, MDH issued a broad public announcement about the tracking data portal, including a
press release to MN news networks and other media announcements (e.g., web pages,
newsletters, email subscription lists). In addition, MN EPHT completed demonstrations (in
person and via webinar) to increase portal awareness and use.
Usability Testing
In May, MN EPHT conducted external usability testing with 12 participants to evaluate the
tracking data portal. This activity provided valuable feedback about the portal’s content and
design, including GIS maps that are planned for release in August 2011. Summary results about
the usability testing of the portal are in a report that is available on request. To receive a copy,
contact the EPHT Program Consultant, Dave Stewart, by email, [email protected] or
phone, 651/201-5913.
Next Steps
MN EPHT is preparing to roll out GIS maps for asthma hospitalizations and childhood lead
poisonings by August 2011. These maps allow users to view and analyze data in an interactive
format, as well as download images for presentations and reports. MN EPHT also is preparing to
update the portal by including new years of data on existing topics, and adding new measures
that are adopted by the National EPHT Network. In addition, we will be adding county-level
data for 4 topic areas (i.e., air quality, childhood lead poisoning, cancer, and reproductive and
birth outcomes).
17
Tracking Updates: Communications and Outreach
Overview
May 2011
In year 2 of the CDC tracking grant, MN EPHT communication activities continue to focus on
reaching staff throughout the Minnesota Department of Health (MDH), other Minnesota state
agencies, and local public health agencies to introduce or update them about
The MN EPHT program and the Minnesota Public Health Tracking Network (MN Tracking
Network) portal;
The MN EPHT partnership with CDC’s national tracking program;
The value of using the MN Tracking Network and the CDC National Tracking Network.
Our goal now is to broaden our target audience’s knowledge of tracking and to promote the MN
Tracking Network as an asset in their work.
Since the MN EPHT Communications Team last updated the Advisory Panel book in March 2011,
MN EPHT communications outreach has focused primarily on the May 25, 2011 launch of the
MN Tracking Network. The team has developed an outreach plan, a bookmark about the portal,
and prepared announcements of the portal launch (MDH press release, MDH intranet
announcement, Gov.Delivery announcement, information for the Local Public Health
Association of Minnesota website’s home page), as well as working with Minnesota Pollution
Control Agency communications staff on channels for announcing the launch. In grant year 3,
we will continue outreach activities, including an application to the Community Health Services
Conference in September 2011.
In summer 2011, MN EPHT will offer a new brownbag seminar and will continue to offer
seminars in 2011 to a broader audience via the program website and our email subscription
service (GovDelivery). Seminars will also be available as webinars.
MN EPHT collaboration with CDC national and state tracking outreach efforts
MN EPHT communications staff serve on several CDC national tracking marketing
workgroups/subcommittees that develop education and outreach materials to promote the
national and state grantee tracking efforts. In addition,
Staff recently attended the CDC Tracking Workshop in April 2011 and participated in
training on a variety of topics, including Plain Language writing.
MN EPHT staff now co-chair the Public Health Environmental Practitioner workgroup,
one of our important target audiences.
The EPHT PowerPoint presentation template is under going through final review for
approval and should be released in summer 2011.
MN EPHT Outreach materials developed since March 2011 report to Advisory Panel

MN Tracking Network bookmark
Plans for 2011


Seminars available via webinar to a broader audience;
Needs assessment survey of local public health staff to help guide our communications
and outreach;
18



Development of the state tracking data portal: Minnesota Public Health Tracking
Network;
Development of a MN EPHT 101 as a recorded webinar presentation;
Printed materials to inform people about the data portal.
CDC email list
The National Environmental Public Health Tracking Network sends program announcements to
an email list service. If you would like to keep abreast of major developments at the national
level (e.g., new data sets added to the national network) via the CDC’s email list, please go to
http://ephtracking.cdc.gov/showAbout.action. In the right-hand column under Resources, click
on “Join our List-serv.”
19
Tracking Updates: CDC Tracking Content Initiatives
May 2011
The CDC recently asked state Tracking grantees to submit proposals for new Tracking content
initiatives. Currently, the CDC has established 10 content workgroups for the development and
implementation of tracking data in the following core content areas:
Reproductive/birth outcomes
Birth defects
Cancers
Carbon monoxide poisoning
Hospitalizations (respiratory and heart disease outcomes)
Blood lead
Drinking water quality (public water supply data )
Air quality (particulate matter and ozone monitoring)
Pesticides (hazard and health outcomes)
Climate change
The CDC received 10 proposals from grantees and after initial review, 5 proposals were
presented and discussed at a meeting of the state principal investigators and program managers
(PI/PM) on April 25, 2011. Proposals for new tracking content centered on a statement of
public health concern or need, relevance to Tracking program goals, potential leadership and
interested parties, available data sources, and potential deliverables. All proposed activities
were to fit within a 12-month timeframe. The five proposals still under consideration for future
tracking content development are:
Radon
Private wells (arsenic)
Biomonitoring
Occupational indicators (adult blood lead, mesothelioma, occupational asthma, and
pesticide exposure)
NASA aerosol data for estimating particulate matter exposure in data linkages
State PI/PMs have recommended all five content initiatives for consideration by the CDC. A
decision by the CDC to move forward with support for this work is pending. Other new content
development is proposed within the existing 10 content workgroup teams for continued work in
the year ahead. MDH EPHT staff and partners will participate in these national workgroups and
new initiatives as resources allow.
20
SECTION OVERVIEW:
CDC Biomonitoring
Communications Evaluation
Project
Background
Investigators at the CDC Public Health Laboratory and Westat (contractor) have conducted a
formative evaluation study to learn more about communicating biomonitoring information to
target audiences that use, interpret, or communicate about biomonitoring data. The Minnesota
East Metro PFC pilot project communities of Oakdale, Lake Elmo, and Cottage Grove, are part of
this research effort as “affected communities.” In collaboration with MDH EHTB biomonitoring
program staff, CDC identified several key audiences for biomonitoring information in the
community, including PFC biomonitoring project participants, public health officials, community
advocacy organizations, healthcare providers, the business community, legislators, and the
media. Individual interviews with these audiences were conducted from August 2010 through
January 2011. The project is intended to gather information that will benefit MDH/Minnesota
as well as CDC in developing future biomonitoring communications.
Jean Johnson will introduce CDC investigator Claudia Vousden, who will present (by telephone)
the methods and findings of the case study in our East Metro PFC study community. Project
results will be presented at the Council of State and Territorial Epidemiologists annual
conference in June 2011. The case study provides empirical evidence of the need for and value
of integrating strategic communication planning, implementation, and evaluation into the
broader planning of biomonitoring studies.
Please see the presentation abstract in this section of the panel meeting materials for more
information.
ACTION NEEDED: No action on this item is necessary. After the presentation, Panel
members are invited to ask questions and provide input on future biomonitoring
communications with affected communities. In particular, members will be asked to
consider the questions:
How important is communications planning, implementation, and evaluation in overall
design and implementation of ongoing state biomonitoring activities?
Are there any specific recommendations for improving state biomonitoring
communications in the future?
21
CSTE 2011 Annual Meeting
Communicating biomonitoring study results: A case study on one state’s experience
Background
In their 2006 report, Human Biomonitoring for Environmental Chemicals, the National Research Council
describes communicating biomonitoring results as the most challenging issue facing the field, yet critical
to the accurate interpretation and use of biomonitoring data. The dearth of research in this area has
hindered progress toward filling the gap in knowledge about how to communicate effectively about
biomonitoring and the results of biomonitoring studies with lay audiences and others outside the field.
In 2008-09, the Minnesota Department of Health conducted a biomonitoring study among residents of
two communities in the Minneapolis-St. Paul metropolitan area who were exposed to
perfluorochemicals through contamination of their drinking water. This study provided the Centers for
Disease Control and Prevention’s National Biomonitoring Program with a case for documentation of the
process, characteristics and effects of strategic communication implemented to support a community
based biomonitoring study.
Methods
This case study research used qualitative methods to explore and describe communication practices
before, during and after a biomonitoring study through collection and analysis of primary and secondary
data. A review of documents and archival records contributed to an understanding of the context of the
study and chronology of events. In-depth interviews with key informants provided insight into the
knowledge, attitudes, perceptions and responses of the target audiences that participated or had vested
interest in the local biomonitoring study and its findings. These informants included participants in the
community based biomonitoring study, state public health officials, state legislators, advocates and
industry representatives. The data was analyzed using a descriptive framework based on chronologic
and thematic organization, classification and presentation of the case.
Results
The primary data collected from over 20 in-depth interviews combined with the data from secondary
sources supported development of a narrative that describes a biomonitoring communication process
generally characterized as collaborative and open and the variable responses of key audiences to the
local biomonitoring study communication activities, messages and materials.
Conclusions
The case study provides empirical evidence of the need for and value of integrating strategic
communication planning, implementation, and evaluation into the broader planning of biomonitoring
studies. The study also highlights how communication needs across key audiences can vary and the
importance of understanding and addressing such variations during development and implementation
of communication plans. This case study contributes to the formation of a database for future
comparison and theory building for development of best practices in biomonitoring communication.
22
SECTION OVERVIEW: Biomonitoring Updates
Updates for the following projects describe progress in program areas that are not part
of today’s agenda or that might alert panel members to material that will be discussed
in greater depth in a future meeting.
Status reports in this section include…
The East Metro PFC Biomonitoring Follow-up (PFC2) Project Update
The Lake Superior Mercury in Newborns Project Update
ACTION NEEDED: Currently, no action is needed. Panel members are invited to ask
questions or comment on these projects during the time listed on the meeting agenda.
23
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24
Biomonitoring Update: East Metro PFC Biomonitoring
Follow-up (PFC2) Project Update
Project summary
May 12, 2011
The East Metro PFC Biomonitoring Follow-up Project will measure the two-year change in blood
levels of 7 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.
Status
Participant recruitment and sample collection are complete. One hundred sixty-four people (out
of 186 contacted, or 88%) consented, filled out the study questionnaire, and provided a blood
sample. All serum samples were collected from the HealthEast Oakdale Clinic, where
participants’ blood was drawn, and delivered to the MDH Public Health Laboratory.
Laboratory analysis is underway. This has not gone as quickly as expected because of issues with
the instruments being used, but the problems have been resolved and results are expected this
summer.
Timeline
Pending continued funding for this project, the current plan is to communicate individual results
to participants as soon as laboratory analysis is complete. The results letter will include the
participant’s 2008 and 2010 levels, and will say that overall study results will be communicated
in a subsequent mailing. Participants will be given the opportunity to speak with a physician
working with the study, and staff will provide seminars for healthcare providers in the area.
Overall study results will be presented at the September meeting of the Advisory Panel. After
receiving feedback from the Panel, results will be communicated to participants and to the
community at large via a community factsheet and public meetings. A journal article and/or
technical report will also be written.
25
Biomonitoring Update: Lake Superior Mercury in
Newborns Project
February 2011
Recruitment:
Participant recruitment 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. We expect mercury analysis
to be complete by the end of May. One partial batch of samples remains to be analyzed. This
batch will be completed following final internal MDH PHL quality review of the completed
samples.
Status Details:
Data analysis and reporting will be complete by September 30, 2011.
Some of the measured mercury concentrations in blood spots in our study were higher than
expected. A second, higher, calibration curve was developed and we have revised our SOP to
include running these samples using this second calibration curve. Additional time was needed
to complete the re-analysis of these high samples. Given this and the maternity leave of a key
staff member, our mercury analyst, a no-cost extension of our grant period to September 30,
2011 was requested from EPA.
26
SECTION OVERVIEW:
Riverside Prenatal Biomonitoring
Pilot Project
Recruitment, sample collection, and laboratory analysis have all been completed for the
Riverside Prenatal Biomonitoring Pilot Project. Staff presented preliminary results for cotinine to
the Advisory Panel in June 2010.
At this meeting, staff will provide an overview of the project, laboratory methods, and project
population, and will review results for cotinine. Staff will present preliminary results for
environmental phenols. In accordance with Minnesota Statutes 144.996, the Advisory Panel is
asked to make recommendations related to interpreting the results, communicating findings to
the public, and planning follow-up stages of biomonitoring work (if any).
The following item is included in this section of the meeting materials:
Riverside Prenatal Biomonitoring Pilot Project: Preliminary Results
ACTION NEEDED: At this time, no formal action is needed by the Advisory Panel. Panel
members are invited to ask questions or provide input. In particular, Panel members are
asked to respond to the following questions:
Do Panel members agree with the data analysis and interpretation presented?
Are additional analyses recommended?
For the community factsheet, staff proposes to present results for
environmental phenols by income and race/ethnicity, with appropriate caveats
about the small sample size. Given that the data are consistent with NHANES
findings, do Panel members consider this acceptable?
1. Do Panel members agree with the following approaches to data analysis?
For measurements <LOD, assign a value of LOD/2
2. Include participants with creatinine <20 mg/dL
Based on these pilot project findings, is further biomonitoring for environmental
phenols and cotinine recommended in this community (pregnant women)?
Should MDH continue biomonitoring work with this target population for a
different set of chemicals or a different specimen type?
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PRELIMINARY RESULTS
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Riverside Prenatal Biomonitoring Pilot Project: Preliminary Results
May 12, 2011
Overview and data collection
This pilot project measured certain chemicals in the urine of pregnant women who delivered at
Fairview Riverside Hospital in Minneapolis. Chemicals included environmental phenols, used in
plastics and personal care products, and cotinine, an indicator of exposure to tobacco. The
project was ancillary to the Riverside Birth Study (RBS) conducted by Dr. Logan Spector at the
University of Minnesota.
Women who had consented to the RBS and agreed to future contact received information about
the project. Those who indicated interest were given a urine collection kit. Participants
collected and froze a single urine sample, which was delivered via courier to the MDH Public
Health Laboratory (PHL). MedTox Laboratory analyzed samples for cotinine, and the PHL
analyzed samples for environmental phenols. The environmental phenol values presented
below are total concentrations, i.e., free plus conjugated species. MDH received variables of
interest from the RBS, including age, ethnicity, income, and pre-pregnancy height and weight.
Differences in log-transformed environmental phenol concentrations by demographic factors
were assessed with two-sample t tests and ANOVA. Samples and data provided to MDH were
de-identified.
Preliminary Results
Study population. Sixty-six women agreed to participate and provided a urine sample. Table 1
presents participants’ demographic characteristics.
Cotinine. Ten women (15%) had detectable levels of cotinine in their urine, with levels ranging
from 129 ng/mL to over 1400 ng/mL. Nine women (14%) would be classified as active smokers
using the MedTox definition (cotinine plus nicotine > 200 ng/mL), and one as exposed to
secondhand smoke (<= 200 ng/mL). Fifty-six women (85%) did not have detectable cotinine in
their urine. The LOD was 20 ng/mL. Women with lower household incomes were more likely to
have detectable cotinine, though findings are limited by the small sample size.
Environmental phenols. Table 2 shows the distribution of analytes, with and without adjustment
for creatinine to account for dilution of the urine sample. Bisphenol A (BPA) was detected in the
urine of 56% of women, methyl paraben in 94%, propyl paraben in 85%, ethyl paraben in 44%,
and butyl paraben in 11%. (Because of a difference in LODs, these percent detections are not
directly comparable to NHANES.)
Differences in concentrations by income level and race/ethnicity are displayed in Table 3.
Concentrations, particularly of BPA and methyl paraben, were highest in the lowest income
group, though these results are limited by the small sample size and not statistically significant
28
PRELIMINARY RESULTS
PLEASE DO NOT CITE OR DISTRIBUTE
(p > 0.05). Concentrations were higher in non-white than white women, with results statistically
significant for methyl and propyl paraben. Methyl paraben levels were 3.5 times higher in nonwhite than white women (p = 0.01). Because the sample size was small, we combined all nonwhite racial/ethnic groups, including people who self-identified as Black/African American,
Hispanic, Asian, and other groups.
Comparison to other studies
According to U.S. data from 1999-2006 NHANES, 13% of pregnant women were active smokers,
as determined by self-reported information and blood levels of cotinine. In Minnesota, 13.8% of
pregnant women with babies born in 2008 were estimated to have smoked during pregnancy, as
measured by self-reported information from the Minnesota Pregnancy Risk Assessment
Monitoring Survey (MN PRAMS) and birth certificates. Results from this project are comparable.
Average BPA levels in Riverside project women were similar to those in U.S. women (pregnant
and non-pregnant) measured by NHANES in 2007-2008 (2.2 compared to 2.4 g/g). Paraben
levels were lower than in NHANES. An analysis of NHANES data from 2003-2004 found
disparities in paraben levels by race/ethnicity that were similar to those seen in this project.
Other studies have measured BPA in pregnant women, with average levels ranging from 1.7
g/g in Cincinnati and the Netherlands to 4.1 g/g in Norway. Very few studies have measured
parabens in pregnant women. Table 4 displays a summary of results from other studies.
Issues with data analysis
1. Non-detect values. Different approaches are used in assigning a value to biomonitoring
measurements below the limit of detection (LOD). The most common approach, used by
NHANES, is to use LOD/sqrt2; other investigators use LOD/2. Because the LODs for certain
chemicals (BPA, propyl paraben, and butyl paraben) in this project are higher than in
NHANES, the non-detect values assigned are different. An example is BPA: The LOD in this
project is 1 g/L; the LOD in NHANES is 0.4 g/L. The BPA GM presented in Table 2 differs
according to which non-detect value is used: with LOD/sqrt2, GM = 2.5 g/g; with LOD/2,
GM = 2.2 g/g; with the NHANES non-detect value, GM = 1.7 g/g. These preliminary
analyses used LOD/2.
2. Exclusion based on creatinine values. Some analyses exclude participants whose creatinine
values are below a certain level, such as 20 mg/dL.11 The reasoning is that low creatinine
values may inflate results because the analyte is divided by creatinine for the creatinineadjusted concentration. For example, two participants have BPA <LOD, but have very
different creatinine-adjusted concentrations: Participant A (creatinine=10) = 5.0 g/g;
participant B (creatinine=116) = 0.43 g/g. These preliminary analyses did not exclude the
five participants with creatinine <20 mg/dL.
11
Wolff et al. Prenatal phenol and phthalate exposures and birth outcomes. Environ Health Perspect. 2008
Aug;116(8):1092-7.
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PRELIMINARY RESULTS
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Timeline for project completion
Factsheets summarizing results have been drafted, and will be completed once results are final.
These will be mailed with a letter to project participants, and results will be presented to
healthcare providers at the Fairview Women’s Clinic. Depending on continued funding,
outreach will be conducted to other stakeholder groups such as Healthy Legacy, city and county
public health officials, maternal and child public health nurses, and the tobacco prevention
community. Also depending on funding, we will write a technical report and/or article about the
project.
30
PRELIMINARY RESULTS
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Table 1 Project population (n=66)
Age
mean (sd)
19-27
28-31
32-41
Annual household income
< $10,000
> $10,000 - < $20,000
> $20,000 - < $40,000
> $40,000 - < $60,000
> $60,000 - < $80,000
> $80,000 - < $100,000
> $100,000
N
29.8 (5.4)
20
23
23
%
30%
35%
35%
10
6
9
8
6
11
16
15%
9%
14%
12%
9%
17%
24%
46
8
4
4
70%
12%
6%
6%
3
1
5%
2%
55
10
83%
15%
Race/ethnicity
White
Black/African American
Hispanic/Latino
Asian
Other (E. European, South
African, Russian Jewish)
East Indian
Birthplace
US
Outside US
Pre-pregnancy BMI
Table 2. Distribution
phenols
meanof
(sd)environmental
26 (6.2)
Bisphenol A
Methyl paraben
Propyl paraben
Ethyl paraben
Butyl paraben
<25 (normal)
39
59%
25 - <30 (overweight)
15 Unadjusted
23% ( g/L)
LOD
% > 30 (obese)
12
18%
( g/L) detect GM
Median
IQR
Min
1
56%
1.6
1.6
0.5 - 3.5
0.5
1
94%
53.8
84
15.5 - 186
0.5
1
85%
10.1
13.8
1.8 - 35.7
0.5
1
44%
*
<LOD
<LOD - 4.0
0.5
1
11%
*
<LOD <LOD - <LOD
0.5
* Not calculated: proportion of results <LOD too high to provide valid result
31
Creatinine-adjusted ( g/g)
Max
25.5
1760
552
373
36.3
GM
2.2
73.3
13.8
*
*
Median
2.4
110.9
18.1
1.6
0.6
IQR
0.6 - 5.3
30 - 247.5
2.9 - 60.9
<LOD - 5.0
<LOD - 1.4
Min
0.2
0.4
0.4
0.3
0.2
Max
46.9
1157.9
363.2
384.5
45.9
PRELIMINARY RESULTS
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Table 3. GM concentrations by income and race/ethnicity
BPA (GM) MePb (GM) PrPb (GM)
g/g
g/g
g/g
creatinine creatinine creatinine
Income
<$20,000 (n=16)
$20-80,000 (n=23)
>$80,000 (n=27)
p-value (ANOVA on log values)
3.5
1.6
2.1
0.23
120.9
54.9
69.7
0.39
17.9
9.6
16.1
0.48
White v. non-white
Non-white (n=20)
White (n=46)
3.3
1.8
181.7
49.4
27.5
10.2
p-value (t test on log values)
0.1
0.01
0.04
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PRELIMINARY RESULTS
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Table 4. Other studies of BPA, parabens in pregnant women
LOD
( g/L)
ND
approach
Unadjusted
GM ( g/L)
third
trimester
0.4
LOD/2
2.2
389
3 samples:
16 wks, 26
wks, birth
0.4
LOD/sqrt2
16 wks = 2.0
26 wks = 1.8
birth = 1.3
16 wks = 1.7
26 wks = 2.0
birth = 2.0
16 wks = +90
26 wks = +90
birth = 87
60
third
trimester
0.4
LOD/2
1.52
1.95
80
10 pools,
110
women
17-18
wks?
0.26
LOD/sqrt2
2.81
4.11
87
unknown
0.4
LOD/sqrt2
2.52
2.04
404
third
trimester
0.36
100
after 20
wks
0.26
LOD/sqrt2
1.08
1.67
82
0.4
LOD/sqrt2
2.4
2.8
93**
MePb = 123
+
EtPb = nr
PrPb = 23.9
BuPb = 1.1
MePb = 100
EtPb = 88
PrPb = 98
BuPb = 90
MePb = 99**
EtPb = 42
PrPb = 93
BuPb = 47
Year
collected
Population
N
Casas 2011*
2004-2008
Pregnant women in
INMA Project in Spain
120
Braun 2010*
2003-2006
Cantonwine 2010
2001-2003
Citation
Ye 2009
2004
2003-2004
Wolff 2008*
1998-2002
Ye 2008
2004 - 2006
Calafat 2008
2003-2004
Casas 2011*
Calafat 2010
2004-2008
2005-2006
Pregnant women in
HOME study in
Cincinnati
Pregnant women in
ELEMENT study in
Mexico City
Pregnant women in
MoBa study in
Norway
Pregnant women in
NHANES
Pregnant women in
Children's EH Study in
NYC
Pregnant women in
Generation R study in
the Netherlands
Women in NHANES
Pregnant women in
INMA Project in Spain
Women in NHANES
1288
120
1278
Timing in
pregnancy
BPA
NA
Parabens
third
trimester
NA
MePb = 1
EtPb = 1
PrPb = 0.2
BuPb =0.2
MePb = 1
EtPb = 1
PrPb = 0.2
BuPb = .2
LOD/2
LOD/sqrt2
MePb = 191
EtPb = 8.8
PrPb = 29.8
BuPb = 2.4
MePb = 104
+
EtPb = nr
PrPb = 20.4
BuPb = 0.9
% detect
91
1.3
* Median values are reported, not GMs
** For BPA and all parabens, % detect are for whole population, not just women
+
nr = not reported, due to the fact that the proportion of values below LOD was too high to provide a valid result
33
Adjusted GM
( g/g)
91
PRELIMINARY RESULTS
PLEASE DO NOT CITE OR DISTRIBUTE
Questions for Advisory Panel discussion
1. Do Panel members agree with the data analysis and interpretation presented? Are
additional analyses recommended?
2. For the community factsheet, staff propose to present results for environmental
phenols by income and race/ethnicity, with appropriate caveats about the small
sample size. Given that the data are consistent with NHANES findings, do panel
members consider this acceptable?
3. Do Panel members agree with the following approaches to data analysis:
a) For measurements <LOD, assign a value of LOD/2
b) Include participants with creatinine <20 mg/dL
4. Based on these pilot project findings, is further biomonitoring for environmental
phenols and cotinine recommended in this community (pregnant women)?
5. Should MDH continue biomonitoring work with this target population for a different
set of chemicals or a different specimen type?
34
SECTION OVERVIEW:
Strategic Planning for an MDH
Biomonitoring Program
Background
During 2010, the EHTB staff conducted strategic planning to develop a framework for
biomonitoring based on the findings and recommendations gleaned from the biomonitoring
pilot program, as directed under Minnesota state law (Minn. Stat. 144.997, sub-div. 2). Staff
and management from MDH developed recommendations in consultation with the Advisory
Panel. To date, MDH has adopted a statement of vision, program goals, and the framework for
development of targeted strategies to achieve the recommended goal.
The vision describes Minnesota’s biomonitoring program as having the capacity to accurately
and efficiently measure and track exposures in people from the environment, and to protect
public health by improving the understanding of risk and disease so that Minnesotans will lead
healthier lives and live in safer environments.
The long-term goal of Minnesota’s ongoing biomonitoring program is to monitor the distribution
of exposure to designated chemicals in the environment among the general population of
Minnesota and communities within the population, so as to…
Track trends in exposure over time.
Identify exposure disparities and sub-populations that are vulnerable to exposure.
Assess the need for public health interventions.
Evaluate the effectiveness of statewide and community-level interventions and policies
that are implemented to reduce exposure.
The planning identified three main approaches to biomonitoring:
Statewide population exposure tracking;
Targeted population exposure tracking; and
Special investigations in response to local events, concerns, and threats.
In consultation with the Advisory Panel, MDH decided to focus on biomonitoring in targeted
populations, with special investigations, if needed and funded, in response to local threats and
community concerns.
Strategic Planning for Biomonitoring Phase II
The next phase of strategic planning aims to gather stakeholder recommendations for target
populations and suggestions for funding, partnerships, and collaborations. The objective is to
identify target population categories, data gaps, categories of chemicals, and suggestions for
funding sources, partnerships, and collaborations.
ACTION NEEDED: No action is needed on this item. We invite the panel to ask questions,
provide input on the request, and consider these questions:
What criteria should we use to narrow down suggestions for target populations?
What funding mechanisms, partnerships, or collaborations can you suggest?
35
Phase II Planning
Earlier EHTB development of the vision and goals for a state biomonitoring program had
identified systematic biomonitoring of targeted populations as the most cost-effective route to
achieving the program vision and goals including measurement of baseline exposure data in a
targeted segment of Minnesota’s population, and identifying disparities and highly exposed
groups within the targeted population.
Goals and Objectives of Phase II Planning
The immediate objectives are to share with stakeholders the lessons learned from our
pilot program, and to gather advice about target populations, high priority chemical
classes, gaps in knowledge, and ideas for funding sources, partnerships, and
collaborations. This information will be used to inform continued development of the
strategic plan for ongoing biomonitoring in Minnesota.
The intermediate objectives are to develop a detailed strategic plan focused on specific
target populations and analytes; explore potential partnerships and collaborations; and
develop and submit proposals.
The long-term objective is to obtain funding to monitor one or more specific target
populations for a short list of chemical analytes of interest in Minnesota.
The long-term goal is to protect public health by improving the understanding of risk
and disease so Minnesotans can lead healthier lives and live in safer environments
(Program Vision statement).
Methods
We developed a concise summary of the Biomonitoring Program achievements to date to share
with stakeholders, plus a set of questions to ask each stakeholder or stakeholder group. We
also developed a PowerPoint presentation to show larger stakeholder groups what the program
has achieved over the last four years.
We’ve asked stakeholders the following questions:
1)
2)
3)
4)
5)
6)
7)
8)
How would state biomonitoring data help you in your work?
Which target populations are the most important, and why?
What criteria should the state use in selecting target populations for biomonitoring?
What population target would be most valuable for linking biomonitoring data with
other health outcome data?
What data gaps do you see in the biomonitoring realm (in general)?
Can you suggest any funding sources or partnerships MDH should pursue?
In thinking about the projects or programs that you work on (current and upcoming),
are there areas of collaboration that we might explore?
What biomonitoring information would be useful for your programs or projects?
To date, we have met with representatives from three key stakeholder groups:
1. Academic scientists
2. Health and environmental advocacy groups
3. Local Public Health
36
We have gathered recommendations from six UMN faculty members and will be scheduling a
meeting and interview with the seventh academic stakeholder.
We have met with representatives from three stakeholder groups affiliated with Healthy Legacy,
which represents interests that include healthcare, citizens with disabilities, environmental
justice, and environmental health. Healthy Legacy’s steering committee comprises
representatives from six advocacy groups: IATP, Clean Water Action, Preventing Harm
Minnesota, MPIRG, LDA Minnesota, and the Women’s Environmental Institute at Amador Hill.
We are trying to arrange a meeting with representatives from MCEA (Minnesota Center for
Environmental Advocacy), an organization that was instrumental in promoting Minnesota
Statutes 144.995-144.998, which has funded the EHTB program to date.
On May 19, we presented our program and questions at the LPHA environmental health
directors Networking Lunch during the Local Public Health Association membership meeting;
later in the month, we took part in a conference call with members of the LPHA’s Policy &
Practices Committee.
Outcomes to Date
The stakeholders with whom we’ve met so far see both a need for, and benefits from, an
ongoing biomonitoring program. We’ve received suggestions for
Target populations
Major classes of chemicals of concern
Health outcomes of interest
Needs for Minnesota biomonitoring data
Suggestions for possible partnerships, collaborations, or funding sources so far include:
NIEHS (Partnerships for Environmental Public Health, if available)
NCS (National Children’s Study sub-programs)
Food Safety Act (focuses on microbial contaminants; could address pesticides)
TIDES (The Infant Development & Environment Study)
Health insurance companies/foundations (BCBS, HP Foundation)
Foundations interested in health (e.g., Robert Wood Johnson Foundation)
Program Value
Biomonitoring measures exposure as the concentration of environmental chemicals that get
into people’s bodies from all sources (e.g., air, water, foods, consumer products). Thus,
biomonitoring reduces the uncertainties that public health practitioners face with standard
exposure assessment formulas for making public health decisions.
With more accurate exposure data, public health scientists can conduct studies of whether and
how environmental chemicals can influence health and sensitive systems, such as reproductive
or cognitive functions. With improved scientific evidence, public health advocates legislators
and community leaders can promote evidence-based policies for protecting the health of
communities.
37
Although the Minnesota EHTB program may lose a significant portion of state funding in
FY2012, continued Phase II planning for biomonitoring through July 2012 will likely be
supported through a national Environmental Public Health Tracking program initiative.
The challenge of ongoing funding at the state and federal level may be resolved when
the utility of biomonitoring to public health is well enough known and understood by
the public to attract bi-partisan support.
Please see the timeline on the next page.
38
Biomonitoring Strategic Planning TimeLine
Milestones
Interview stakeholder s to obtain guidance on target populations,
chemicals, data gaps, & funding sources/partnerships/collaborations.
Stakeholders include academics, key health & environmental
advocacy groups, LPHAs, legislators, policymakers, professional
organizations/associations, state agencies
1) Academic stakeholders
Logan Spector & Ruby Nguyen
Bruce Alexander
Pat McGovern
Bill Toscano
David Jacobs & Jose Suarez
2) Advocacy groups
a) Healthy Legacy affiliates
Clean Water Action
IATP
Preventing Harm Minnesota
b) MCEA
LPHA
Environmental Health directors meeting
Conference call with Policy & Practice Committee
Interview 3-4 Additional Stakeholders/Groups (TBD)
Summary Report of Recommendations
Present to Advisory Panel
Funding Searches
Exploration of partnerships or collaborations
Preparation of funding proposals
Chemical Selection
Population Sampling Strategy
Communications strategy; laboratory methods
39
Anticipated date of
completion
August 2011
Apr 19
Apr 20
May 6
TBA
June 6
May 4
May 26
May 19
May 25
July 31
August 22
September 13
June ‘11→ July ‘12
July ‘11 → July ‘12
Sept ‘11→ July 2012
December 2011
March 2012
June 2012
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40
SECTION OVERVIEW: Other Information
These documents are included in this meeting packet as items that may be of interest to panel
members:
March 2011 Meeting Summary
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/.
41
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42
Summary of the Minnesota Department of Health (MDH)
Environmental Health Tracking & Biomonitoring
Advisory Panel Meeting
March 8, 2011 1-4 p.m.
Advisory panel members – Present:
Greg Pratt, (chair), Fred Anderson, Alan Bender, Pat McGovern, Cathy Villas-Horns.
Advisory panel members – Regrets:
Bruce H. Alexander, Jill Heins Nesvold, Beth Baker, Cathi Lyman-Onkka, Thomas
Hawkinson, Geary Olsen, Lisa Yost.
Welcome and Introductions
Greg Pratt, serving as chair for Beth Baker, convened the meeting. Jean Johnson
introduced Barbara Scott Murdock, who will serve as program planner, replacing
Michonne Bertrand.
Tracking Update
Chuck Stroebel and David Stewart reviewed the development of the MN DATA secure
portal.
Chuck framed his discussion of the development of the portal in terms of four 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?
Goals are
To provide secure access to EPHT data for authorized users;
To meet a July 31 deliverable to CDC
To develop and pilot a system for sharing data among authorized EPHT users.
Target audiences for the secure portal include
Public health professionals in the EPHT network
Researchers and public health professionals in state and local agencies
Researchers at universities
Issues and challenges
CDC requirements are poorly defined
Few states have secure portals
State standards for identity management are in development
The timeline for Phase 1 is tight (July 31, 2011)
43
Phase 1 includes developing standards, procedures, and data dictionaries that allow users
to look at available data and request access. Finally, it involves evaluating what users
want in the way of tools and access to data. Phases 2 and 3 will use the information
collected above to enhance and expand the portal..
Dave Stewart demonstrated the draft portal design on MDH’s web-test server. The login
is on the right side of the screen; users must establish a valid need for access. The data
steward also must approve the user’s access to the requested data in accordance with
applicable laws that govern data use and practices. MN EPHT is developing an internal
process and criteria for vetting such requests.
Access agreement with data users. Hard copy would be submitted with terms &
conditions for users. For now, the focus is on gathering information from potential users
to see what they need and want. MN EPHT will evaluate resource constraints and need
for access to determine whether it can meet data requests. Security is the key element;
Chuck and Dave are working with ISTM and the MDH Chief Information Security
Officer on password policies; permission settings at file level (users will be allowed
access only to certain files); and tracking of users’ activities for audits. In addition, MN
EPHT will work with ISTM to plan implementation of the anticipated state standards for
identity management. Local public health staff in the Metro area who work with datasets
will meet with Chuck & Dave to identify their needs and wishes. CDC will evaluate the
system in 2011-12.
Alan Bender questioned the use of the word ―secure,‖ concerned that the term suggests
that private information would be on the website.
Further discussion about how portal users could get data on the secure portal clarified the
issue. Staff anticipate that professional users (researchers or state or local health
professionals) may want to request unsuppressed data from MN EPHT and the data
steward for research or public health practice purposes. Unsuppressed data is private
data, subject to the MN Government Data Practices Act, and could contain information
that might identify an individual. Staff noted that the MDH Legal Unit is reviewing a
terms and practices document that is intended to serve as a contract, and that users would
know what their responsibilities and obligations are for protecting the data in accordance
with the law. Each user given access would be limited to the dataset requested and could
gain access to other datasets only by requesting another dataset and signing another
contract.
Preparing custom data sets for the secure portal could become burdensome to MN EPHT.
Pat McGovern suggested assessing the burden in the pilot phases. Because students might
be interested in using the data for field projects, she suggested that enabling students to
use the data would build an audience of professionals over time. User fees might be
reasonable.
44
Chuck stated that MN EPHT would follow the current model at MDH, in which MDH
asks the data stewards to answer requests that MN EPHT is unable to fulfill. Greg Pratt
asked about the CDC’s secure portal. The presenters said that only approved staff can see
and review their own state data on CDC’s portal. Wisconsin and Missouri also have
secure portals. The term secure is CDC’s use. Pat McGovern suggested developing a list
of key terms and their definitions.
Environmental Tobacco Smoke Exposure as a New Content Area for
Tracking
Jeannette Sample reviewed the criteria and selection process used to identify new content
areas for Tracking in Minnesota (pp 9-11) and Blair Sevcik presented Phase III of the
selection process for ETS Exposure as a new content area (pp 15-22). The data sources
used were the Youth Tobacco Survey (YTS) and the Adult Tobacco Survey (ATS).
The advisory panel first considered the questions for consideration list on page 7. Alan
Bender noted that the first two questions are related: Whether the data are informative at
only the state-level depends on what inferences you want to draw. One can point out
what the limits are in the data, and you want precision of estimates to support inferences.
If users want county-level or metro vs. non-metro information, the statewide data won’t
support that. For other questions, these data will suffice. The panel agreed that having
state-level data only, as long as it was reliable and representative, was a good place to
start.
Pat McGovern asked whether the datasets gave any idea of how long people were
exposed and whether one can get a sense of a dose-response relationship. Blair answered
that the Youth Tobacco Survey questions do include an estimated of the number of days
in the past week that the respondent was exposed to ETS but that the Adult Tobacco
Survey questions are yes/no questions and would not allow an ―exposure-response‖
association to be calculated.
Greg Pratt asked whether these surveys were randomly sampled and representative, and
whether the data were weighted. Pete Rode (Center for Health Statistics, MDH),
representing the data steward, responded that the data come from randomly sampled
populations in Minnesota and that both data sources were population-based and randomly
sampled. Moreover, the CDC questions for the Youth Tobacco Survey have been
reviewed, and the Center for Health Statistics is confident that the questions are reliable.
The questions from the Adult Tobacco Survey expand on a core bank of CDC questions
and draw from Behavioral Risk Factor Surveillance System (BRFSS) questions, although
no special reliability studies have been done. Pete is confident of the ATS data because
he is confident of the survey contractor (Westat) but no special studies have been done on
reliability or validity.
Although the surveys ask what county people live in, Pete doesn’t think we have
sufficient data to be confident of smoking rates within a county, but probably can be
45
confident about adult smoking rates within a region. The project has surveyed the metro
area vs. non-metro.
Fred Anderson asked about the intent behind tracking these measures, given that ETS
exposure is trending downward and that we have public initiatives to reduce smoking. Pat
McGovern noted that because laws can change (e.g., can be repealed), it would be good
to have monitoring data to track the effects of any changes.
Greg asked what the prevalence of active smoking is in these groups and whether that
should be included as a measure in this new content area. In response to panel
discussion, Pete noted that tracking ETS exposure in nonsmokers could determine
whether declining exposure in nonsmokers reflects declining prevalence of smoking
(already documented in tobacco reports) or whether it is related to new policies designed
to reduce exposure in nonsmokers. He added that it would be informative for the
Tracking program to look at this subpopulation of nonsmokers rather than behavioral risk
factors, such as smoking status. Pete Rode pointed out that we have data on the
prevalence of smoking and on ETS exposure among smokers, already published by the
Center for Health Statistics and the Tobacco Prevention and Control Program, both at
MDH. Jeannette noted that the CDC national EPHT program wants to add behavioral
risk factors from Behavioral Risk Factor Surveillance System (BRFSS) survey data.
The group considered a motion to recommend the new content, but had no quorum, so
Pat McGovern moved to query everyone by email, Al Bender seconded the motion, and
all agreed. The group then amended the motion to ask everyone to vote for or against
recommendation to the Commissioner of Health that ETS Exposure be adopted as a new
content area for Tracking in Minnesota by email by March 22.12
Jean Johnson then asked whether the panel had any comments on the process of
selection. One panel member asked what would happen if the Advisory Panel did not
recommend this content area. Jean and Jeannette responded that MDH would write up
the reasons why the panel did not recommend a new content area be adopted and would
send the report to the Steering Committee, who would make the final decision. Al
Bender also pointed out that staff will not terminate a content area without consulting the
Advisory Panel.
Section Overview:
Project Year 3 Proposal for Tracking and Biomonitoring
Jean Johnson reviewed the program goals:
1. Develop a strong environmental public health tracking system based on
the collection and analysis of high-quality data.
2. Ensure that environmental public health data are accessible and used.
12
Later, because of a question from a panel member and a question from a member of the Chamber of
Commerce, staff conferred with panel chair Beth Baker, and the decision about the ETS content area was
postponed to the June 7 meeting, when more panel members would be present to confer and vote.
46
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.
4. Build collaborations that enhance environmental public health tracking in
Minnesota.
She then showed a PowerPoint that listed content for new measures added.
Plan to propose new areas to add to the tracking list
ETS if the Advisory Panel so recommends;
Important covariates include behavioral risks (e.g., smoking prevalence data) and
population demographics. Having these will allow MDH staff to look at trends
and demographic factors, such as poverty, that put people at risk.
Asthma and chronic obstructive pulmonary disease (COPD)
Additional cancers (15 cancers have been added in the portal), and the program
proposes to add all 36 cancers for which data are routinely published by the state
cancer registry.
Air quality data: particulate monitoring data (air quality) & are working with the
PCA on the use of continuous monitoring air quality data
New drinking water & blood lead measures will be added as the CDC adds them
Climate change measures, as adopted by CDC
Possible new data sources
National Air Toxics Assessment (NATA) data
Pesticide sales data, NHANES biomonitoring data, pesticide poisonings (Poison
Control Center data)
Radon in homes
Child health
Chuck Stroebel reported on proposed activities for goals 2 and 3. For goal 2, the EPHT
program supplies metadata in reports. Staff are enhancing the program’s portal, adding
new or updated data to existing data, and will add maps for cancer (MN cancer
surveillance) and demographic information. The staff plan to add blood lead and asthma
maps in July, to evaluate GIS platforms, and to develop a glossary of terms and a users’
guide. For the secure portal, they will implement enhancements based on what the CDC
requires in a secure portal and add custom data sets.
For goal 3, the staff offer portal demonstrations for groups, presentations and displays at
conferences, and a brown bag seminar series for state agency staff on such topics as the
health effects of climate change, air quality, and other environmental issues. They will
expand presentations to broader areas as available. The program website will offer
updates and webinars. Staff will evaluate EPHT communications and program activities
to see if people are in fact using the portal and the data.
Jean Johnson updated progress toward goal 4. The EPHT program plans to continue
current collaborations with the following groups:
47
The American Lung Association (COPD & asthma outcomes),
The University of Illinois-Chicago research collaboration,
The Hennepin County EPA Care Grant to study the Hiawatha Light Rail corridor
for contamination and health issues,
The Center for Occupational Health grant (CDC/NIOSH funded) to develop
occupational parameters for dissemination over the MN DATA portal.
The local Public Health Association of MN,
The MDH climate change committee, and
The MPCA air monitoring division.
In addition, the program proposes to collaborate in the future with Wisconsin and Iowa
on tracking radon, private well monitoring, and, possibly, biomonitoring, with the MDH
Office of Statewide Health Improvement, which studies obesity & tobacco use, & with
the Child Health Initiative to look at sources to track child health.
Discussion
Jean asked the panel whether they had any other priorities to suggest and ideas for how
MN might supplement CDC’s work. Greg asked Chuck Stroebel about how much of the
portal is public, and how much of it will be secure. Chuck explained that the primary
emphasis has been on the public portal, to make as much data public as possible. Staff
will limit effort on the secure portal until they can get advice and feedback from potential
users of the secure portal about applications and content, which would determine the final
proportions.
Pat McGovern suggested a possible collaboration on the child health initiative. The
National Children’s Study (NCS) in Ramsey County is in the pilot phase. As it moves
into the main phase in 2012, it would be interesting if some of the MN child health
outcomes followed are the same as the NCS outcomes of interest. Doing this might add
value and cost efficiency for both groups.
Al Bender noted that the last two years of the project call for strong epidemiologic input
and involvement, as there will be pressure from users to correlate findings from the
exposure side with the disease side, which could have severe consequences for the state.
He observed that the recommendation of the Pew Report was to examine ecologic
associations and to increase the dialog about the role of the environment in disease
burden. This approach has the potential to consume a lot of energy on issues that have
little or no plausibility—and this will increase the time and resources burden [on health
departments].
Jean noted that MN EPHT is currently engaged in two ―linkage‖ projects: one with the
University of Illinois (linking agrichemicals in drinking water with child health
outcomes) and the other is linking MPCA air pollution data with monitoring of
respiratory and cardiovascular disease outcomes. Al Bender noted that linkages can be of
two kinds: ecological correlation and the kind of studies that follow a group of people
and link their individual outcomes to other datasets. The first is much more prone to the
ecological fallacy. It’s important to draw a distinction between the two kinds of
48
correlations. Chuck noted that the linkage of health outcome data with demographic data
is a useful one for examining health disparities.
Fond du Lac (FDL) Biomonitoring Project (ATSDR-funded 3-year study)
David Jones and Rita Messing (MDH) presented the project, described on pp 39-43 in the
background book. The project is funded by the CDC/Agency for Toxic Substances and
Disease Registry. The focus is on looking at the body burden of contaminants in the
Great Lakes in populations near Areas of Concern (AOCs). The ATSDR is funding three
state agencies: MDH, the MI Dept of Community Health, and the NY Dept of Health.
The objectives are to see which contaminants people are exposed to, to compare these
with other populations (NHANES data), and to determine pathways of exposure. The
analytes include a list of chemicals specified by ATSDR, plus chemicals of local concern
to Minnesota’s study group. MDH chose the FDL tribe of Native Americans as a highly
exposed population of interest in MN, because members of the group eat traditional diets,
use more foods from the region, have vulnerable community members, and assign a
greater cultural value to their traditional foods. Ultimately, the goal is to develop a public
health action plan at the end of the study.
MDH will include omega-3 fatty acids to quantify the benefits of fish consumption. The
PIs will also measure some clinical parameters, in part to offer participants some direct
benefit (for identifying diabetes, for example). They plan to measure height, weight, and
blood pressure as part of the physical to get a sense of participants’ risk for CVD and
diabetes and will also get the participants’ lipid content and triglycerides to offer some
direct benefit to the participants.
Rita Messing noted that the study is not research; it is meant only to characterize
exposures in this population and not to contribute to generalizable knowledge. If the
biomonitoring results show high levels of lead, cadmium, mercury or arsenic, MDH staff
know how to interpret these results and will tell the participants about them. Because
people are concerned about risks from eating traditional foods, if we find that the
exposures are low, that will be a benefit to the community. MDH will work with the
FDL health services and will share the project report with the community and with the
advice committee in the community. This public health action plan is unique to the
project and will give something back to the community.
Discussion
Al Bender said that he understood why the project is taking clinical information, but that
taking clinical information raises a number of issues. Relevant questions include: What
are the implications of offering clinical findings? What this will mean for the Tennessen
warning given to participants? Who will review the results? What does one say about
MDH’s responsibility if the study found something bad? Will the results be reported to
the participant’s physician or to the participant? Is a physician involved in the study to
help people understand their results? What does one say to a participant about MDH’s
49
responsibility, once one has clinical information about an individual? Do all participants
have access to the Indian Health Service?
Rita Messing referred to the slide that described how the study participants will be
chosen: they must be members or descendents of members of an Indian tribe, a
designation that, according to local sources, appears to cover nearly everyone in the FDL
community. FDL human services are available to almost all of the people in the
community through a clinic in Cloquet or Duluth. She said that individual results will
probably be reported to the individual. And, although project procedures are still in
development, the PIs will probably structure the informed consent procedure to specify
that, if clinically relevant results for metals or other clinical information are found in the
samples, they will contact the individuals and make medical advice available. The PIs
will put a system in place for early notification and physician consultation about any
exposures above health guidelines, as they learn about them. They will try to get the
participant to get to the physician. Al Bender noted that this issue must be considered
carefully because it is MDH’s responsibility to get information back consistent with the
Tennessen warning.
Al Bender asked whether anyone is helping to choose the clinical parameters, since
markers such as liver enzymes can be helpful. Rita Messing said that the investigators
had decided the parameters themselves (cholesterols and triglycerides). The project
includes no parameters related to alcohol or drug consumption, but the investigators
would try to get someone to a physician if they found evidence of problems. Pat
McGovern suggested contacting Jean Forester at UMN, who has worked with the FDL;
Pat would be willing to facilitate the contact. She also suggested snowball recruiting if
the PIs have trouble recruiting.
Asked whether the investigators planned surveys to find out how much fish people eat
and other variables, the investigators replied that they are developing the questions now,
and will discuss the survey with the project’s Advice Council (in Fond du Lac) to learn
about consumption of fish and other traditional foods, basic demographics, and other
characteristics, including occupational histories. There are actually two contaminated
sites near the community. The major contaminants of concern to ATSDR at those sites
are the polyaromatic hydrocarbons (PAHs), so the study is measuring 1, hydroxypyrene,
an indicator of PAH exposure, a major concern in the superfund sites in the AOC. The
PIs will also measure cotinine to estimate tobacco use. They plan to speciate Hg (to see
whether it is elemental or methyl Hg) so they can better understand its sources and
toxicity. They will also measure Se, Cd, PFCs, phenols (partly because of a plan to treat
pilings with phenols), and toxaphene, which is of concern in Lake Superior. They do not
plan to measure dioxins and furans because one needs too much blood for analysis.
Because fish advisories are based on total PCBs, the project will measure total PCBs. In
response to a question from Pat McGovern, the PIs said that, because the study is not a
research study, it has no control population, but the data will be compared to the
NHANES dataset and with the other study populations (MI, NY).
50
Greg asked about the difficulty of recruiting. Rita answered that participants will get an
incentive – probably of $50, but the PIs are debating a 2nd $50 incentive because the
survey is getting long, and the study may ask for 7 tubes of blood from each person.
Al Bender inquired about the cost of the lab work. Rita Messing estimated that the study
has about $1.5 million for lab work for 500 people (about $3000/person); the project will
do only one blood draw per person. The PIs do not intend to save the serum. They will
destroy the samples when they’re through with them, because they believe the tribe will
not want to have their samples saved. The study will keep the personal identifiers so the
PIs can go back to the people for more, if necessary.
East Metro PFC Biomonitoring Follow-up Project (PFC2) Update
Jessica Nelson and Carin Huset presented a brief update on the PFC2 project. Jessica
reviewed the goals of the project and reported on participant recruitment and sample
collection, which are now complete. Of the 186 participants contacted for PFC2, 164
gave a blood sample; this participation rate is 88% of those contacted, and 84% of
participants in the 2008 study (10 of whom declined contact for future studies). The 22
non-participants fell into different categories: three returned the consent and
questionnaire but did not give a blood sample; seven declined to participate in PFC2 but
were willing to answer a short phone survey re: residential, water use, and occupational
history; 12 did not respond.
Carin discussed an issue that arose with the serum samples received from the clinic. She
showed a series of photos documenting that, while most serum tubes were yellow in
color, in some cases, tubes from the same individual were different colors (i.e. three
yellow and one orange/pink tube). This indicates that hemolysis occurred during sample
preparation. In a more limited number of cases, all tubes from an individual were pink or
orange, indicating hemolysis during blood collection or sample preparation. Carin reexamined samples from 2008, which displayed a similar range of colors; the difference
was that all tubes from an individual were the same color. Carin contacted different
sources for input. Antonia Calafat (CDC) said they have not observed problems with
method performance due to pink samples, though no systematic study has been done.
Based on the photos Carin sent, Charles Dodson (CDC) said that, based on the colors
observed, the quality of samples would not be a problem. Nathan Kendrick (MDH PHL)
said that there does not appear to have been significant hemolysis and that the samples
would still be usable for their purposes. Carin thus concludes that the samples are usable.
She will analyze only the yellow tubes when an individual’s samples have multiple
colors. But the multiple-color tubes offer an opportunity to do an analysis comparing PFC
concentrations in yellow v. orange/pink serum samples from the same individuals.
Carin and Jessica asked the Panel for feedback on whether staff have addressed this
concern sufficiently or if there are outstanding questions. Jessica added that staff received
an email from Panel member Geary Olsen, who could not attend the meeting. He
commented that the serum color issue is likely related to hemolysis, and that it would be
useful to consider if differences were a function of clinic, medical
technician/phlebotomist, or amount of time from blood collection to storage in a freezer.
51
Jessica stated that only one clinic was used in this project (in contrast to the 2 clinics used
in 2008), that information was not collected on technician/phlebotomist, and that staff
assume that the clinic followed the standard protocol re: sample processing and freezing.
Alan Bender recommended that staff write up the issue thoroughly, but that it seems to
have been reported with due diligence. Greg Pratt recommended re-analyzing samples
from 2008 as a quality control check. Carin responded that this is something to consider,
though she is confident of the QA/QC measures in place. Still, if there were a difference
in results, it would not be clear which were correct.
Updates
Panel members had no questions about the updates on biomonitoring and tracking
projects in the background book.
The meeting was adjourned.
Finalized May 13, 2011
52
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.
53
As of April 2011
Bruce Alexander, PhD
University of Minnesota School of Public
Health
Environmental Health Sciences Division
MMC 807 Mayo
420 Delaware Street SE
Minneapolis, Minnesota 55455
612-625-7934
[email protected]
At-large representative
David DeGroote, PhD
St. Cloud State University
740 4th Street South
St. Cloud, MN 56301
320-308-2192
[email protected]
Minnesota House of Representatives
appointee
Thomas Hawkinson, MS, CIH, CSP
Toro Company
8111 Lyndale Avenue S
Bloomington, MN 55420
[email protected]
Statewide business org representative
Fred Anderson, MPH
Washington County
Department of Public Health and
Environment
14949 62nd St N
Stillwater MN 55082
651-430-6655
[email protected]
At-large representative
Jill Heins Nesvold, MS
American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota 55103
651-223-9578
[email protected]
Nongovernmental organization
representative
Alan Bender, DVM, PhD
Minnesota Department of Health
Health Promotion and Chronic Disease
Division
85 East 7th Place
PO Box 64882
Saint Paul, MN 55164-0882
651-201-5882
[email protected]
MDH appointee
54
Cathi Lyman-Onkka, MA
Preventing Harm Minnesota
372 Macalester Street
St. Paul, MN 55105
Gregory Pratt, PhD
Minnesota Pollution Control Agency
Environmental Analysis and Outcomes
Division
520 Lafayette Road
St. Paul, MN 55155-4194
651-757-2655
[email protected]
MPCA appointee
Home office
651-647-9017
[email protected]
Nongovernmental organization
representative
Cathy Villas-Horns, MS, PG
Minnesota Department of Agriculture
Pesticide and Fertilizer Management
Division
625 Robert Street North
St. Paul, Minnesota 55155-2538
651-201-6291
[email protected]
MDA appointee
Pat McGovern, PhD, MPH
University of Minnesota School of Public
Health
Environmental Health Sciences Division
MMC Mayo 807
420 Delaware St SE
Minneapolis MN 55455
612-625-7429
[email protected]
University of Minnesota representative
Lisa Yost, MPH, DABT
Exponent, Inc.
15375 SE 30th Pl, Ste 250
Bellevue, Washington 98007
Local office
St. Paul, Minnesota
651-225-1592
[email protected]
At-large representative
Geary Olsen, DVM, PhD
3M Medical Department
Corporate Occupational Medicine
MS 220-6W-08
St. Paul, Minnesota 55144-1000
651-737-8569
[email protected]
Statewide business organization
representative
Vacant
Minnesota Senate appointee
55
GLOSSARY OF TERMS USED IN ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
Biomarker: According to the National Research Council (NRC), a biomarker is an indicator of a change or an
event in a human biological system. The NRC defines three types of biomarkers in environmental health, those
that indicate exposure, effect, and susceptibility.
Biomarker of exposure: An exogenous substance, its metabolites, or the product of an
interaction between the substance and some target molecule or cell that can be measured in an
organism.
Biomarker of effect: A measurable change (biological, physiological, etc.) within the body
that may indicate an actual or potential health impairment or disease.
Biomarker of susceptibility: An indicator that an organism is especially sensitive to
exposure to a specific external substance.
Biomonitoring: As defined by Minnesota Statute 144.995, biomonitoring is the process by which chemicals
and their metabolites are identified and measured within a biospecimen. Biomonitoring data are collected by
analyzing blood, urine, milk or other tissue samples in the laboratory. These samples can provide physical
evidence of current or past exposure to a particular chemical.
Biospecimen: As defined by Minnesota Statute 144.995, biospecimen means a sample of human fluid, serum,
or tissue that is reasonably available as a medium to measure the presence and concentration of chemicals or
their metabolites in a human body.
Community: As defined by Minnesota Statute 144.995, community means geographically or
nongeographically based populations that may participate in the biomonitoring program. A nongeographical
community includes, but is not limited to, populations that may share a common chemical exposure through
similar occupations; populations experiencing a common health outcome that may be linked to chemical
exposures; populations that may experience similar chemical exposures because of comparable consumption,
lifestyle, product use; and subpopulations that share ethnicity, age, or gender.
Designated chemicals: As defined by Minnesota Statute 144.995, designated chemicals are those chemicals
that are known to, or strongly suspected of, adversely impacting human health or development, based upon
scientific, peer-reviewed animal, human, or in vitro studies, and baseline human exposure data. They consist of
chemical families or metabolites that are included in the federal Centers for Disease Control and Prevention
studies that are known collectively as the National Reports on Human Exposure to Environmental Chemicals
Program and any substances specified by the commissioner after receiving recommendations from the advisory
panel in accordance with the criteria specified in statute for the selection of specific chemicals to study.
Environmental data: Concentrations of chemicals or other substances in the land, water, or air. Also,
information about events or facilities that release chemicals or other substances into the land, water, or air.
56
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.
57
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.
58
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 populationbased 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
59
ACRONYMS USED IN ENVIRONMENTAL HEALTH TRACKING &
BIOMONITORING
ACGIH
ATSDR
American Conference of Governmental Industrial Hygienists
Agency for Toxic Substances and Disease Registry, DHHS
CDC
Centers for Disease Control and Prevention, DHHS
CERCLA
Comprehensive Environmental Response; Compensation and Liability Act (Superfund)
CSTE
Council of State and Territorial Epidemiologists
DHHS
US Department of Health and Human Services, including the US Public Health Service,
which includes the CDC, ATSDR, NIH and other agencies
EPA
US Environmental Protection Agency
EHTB
Environmental Health Tracking and Biomonitoring (the name of Minnesota Statutes
144.995-144.998 and the program established therein)
EPHI
Environmental Public Health Indicators
ICD
International Classification of Diseases
IRB
Institutional Review Board
MARS
Minnesota Arsenic Study, conducted by MDH in 1998-1999
MDA
Minnesota Department of Agriculture
MDH
Minnesota Department of Health
MN DATA
Minnesota Data Access for Tracking & Assessment
MN EPHT
Minnesota Environmental Public Health Tracking
MNPHIN
Minnesota Public Health Information Network, MDH
MPCA
Minnesota Pollution Control Agency
NCDM
Nationally Consistent Data & Measures
NCEH
National Center for Environmental Health, CDC
NCHS
National Center for Health Statistics
60
NGO
Non-governmental organization
NHANES
National Health and Nutrition Examination Survey, National Center for Health Statistics
(NCHS) in the CDC
NHEXAS
National Human Exposure Assessment Survey, EPA
NIOSH
National Institute for Occupational Safety and Health, CDC
NIEHS
National Institute of Environmental Health Sciences, NIH
NIH
National Institutes of Health, DHHS
NLM
National Library of Medicine, NIH
NPL
National Priorities List (Superfund)
NTP
National Toxicology Program, NIEHS, NIH
PFBA
Perfluorobutanoic acid
PFC
Perfluorochemicals, including PFBA, PFOA and PFOS
PFOA
Perfluorooctanoic acid
PFOS
Perfluorooctane sulfonate
PHL
Public Health Laboratory, MDH
PHIN
Public Health Information Network, CDC
POP
Persistent organic pollutant
SEHIC
State Environmental Health Indicators Collaborative
Revised February 24, 2011
61
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.
studies of humans, animals, or cells have
demonstrated that the chemical is known or
reasonably anticipated to adversely impact human
health.
(j) "Environmental health tracking" means
collection, integration, analysis, and dissemination of
data on human exposures to chemicals in the
environment and on diseases potentially caused or
aggravated by those chemicals.
144.995 DEFINITIONS; ENVIRONMENTAL
HEALTH TRACKING AND
BIOMONITORING.
(a) For purposes of sections 144.995 to 144.998,
the terms in this section have the meanings given.
(b) "Advisory panel" means the Environmental
Health Tracking and Biomonitoring Advisory Panel
established under section 144.998.
(c) "Biomonitoring" means the process by which
chemicals and their metabolites are identified and
measured within a biospecimen.
(d) "Biospecimen" means a sample of human fluid,
serum, or tissue that is reasonably available as a
medium to measure the presence and concentration of
chemicals or their metabolites in a human body.
(e) "Commissioner" means the commissioner of the
Department of Health.
(f) "Community" means geographically or
nongeographically based populations that may
participate in the biomonitoring program. A
"nongeographical community" includes, but is not
limited to, populations that may share a common
chemical exposure through similar occupations,
populations experiencing a common health outcome
that may be linked to chemical exposures,
populations that may experience similar chemical
exposures because of comparable consumption,
lifestyle, product use, and subpopulations that share
ethnicity, age, or gender.
(g) "Department" means the Department of Health.
(h) "Designated chemicals" means those chemicals
that are known to, or strongly suspected of, adversely
impacting human health or development, based upon
scientific, peer-reviewed animal, human, or in vitro
studies, and baseline human exposure data, and
consists of chemical families or metabolites that are
included in the federal Centers for Disease Control
and Prevention studies that are known collectively as
the National Reports on Human Exposure to
Environmental Chemicals Program and any
substances specified by the commissioner after
receiving recommendations under section 144.998,
subdivision 3, clause (6).
(i) "Environmental hazard" means a chemical or
other substance for which scientific, peer-reviewed
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
62
chronic diseases including, but not limited to, cancer,
respiratory diseases, reproductive problems, birth
defects, neurologic diseases, and developmental
disorders;
(ii) characterize statewide and localized trends and
geographic patterns in the occurrence of
environmental hazards and exposures;
(iii) assess the feasibility of integrating disease rate
data with indicators of exposure to the selected
environmental hazards such as biomonitoring data,
and other health and environmental data;
(iv) incorporate newly collected and existing
health tracking and biomonitoring data into efforts to
identify communities with elevated rates of chronic
disease, higher likelihood of exposure to
environmental hazards, or both;
(v) analyze occurrence of environmental hazards,
exposures, and diseases with relation to
socioeconomic status, race, and ethnicity;
(vi) develop and implement targeted plans to
conduct more intensive health tracking and
biomonitoring among communities; and
(vii) work with the Pollution Control Agency, the
Department of Agriculture, and other relevant state
agency personnel and organizations to develop,
implement, and evaluate preventive measures to
reduce elevated rates of diseases and exposures
identified through activities performed under sections
144.995 to 144.998; and
(6) submit a biennial report to the chairs and
ranking members of the committees with jurisdiction
over environment and health by January 15,
beginning January 15, 2009, on the status of
environmental health tracking activities and related
research programs, with recommendations for a
comprehensive environmental public health tracking
program.
Subd. 2. Biomonitoring. The commissioner shall:
(1) conduct biomonitoring of communities on a
voluntary basis by collecting and analyzing
biospecimens, as appropriate, to assess environmental
exposures to designated chemicals;
(2) conduct biomonitoring of pregnant women and
minors on a voluntary basis, when scientifically
appropriate;
(3) communicate findings to the public, and plan
ensuing stages of biomonitoring and disease tracking
work to further develop and refine the integrated
analysis;
(4) share analytical results with the advisory panel
and work with the panel to interpret results,
communicate findings to the public, and plan ensuing
stages of biomonitoring work; and
(5) submit a biennial report to the chairs and
ranking members of the committees with jurisdiction
over environment and health by January 15,
beginning January 15, 2009, on the status of the
biomonitoring program and any recommendations for
improvement.
Subd. 3. Health data. Data collected under the
biomonitoring program are health data under section
13.3805.
144.997 BIOMONITORING PILOT
PROGRAM.
Subdivision 1. Pilot program. With advice from
the advisory panel, and after the program guidelines
in subdivision 4 are developed, the commissioner
shall implement a biomonitoring pilot program. The
program shall collect one biospecimen from each of
the voluntary participants. The biospecimen selected
must be the biospecimen that most accurately
represents body concentration of the chemical of
interest. Each biospecimen from the voluntary
participants must be analyzed for one type or class of
related chemicals. The commissioner shall determine
the chemical or class of chemicals to which
community members were most likely exposed. The
program shall collect and assess biospecimens in
accordance with the following:
(1) 30 voluntary participants from each of three
communities that the commissioner identifies as
likely to have been exposed to a designated chemical;
(2) 100 voluntary participants from each of two
communities:
(i) that the commissioner identifies as likely to
have been exposed to arsenic; and
(ii) that the commissioner identifies as likely to
have been exposed to mercury; and
(3) 100 voluntary participants from each of two
communities that the commissioner identifies as
likely to have been exposed to perfluorinated
chemicals, including perfluorobutanoic acid.
Subd. 2. Base program. (a) By January 15, 2008,
the commissioner shall submit a report on the results
of the biomonitoring pilot program to the chairs and
ranking members of the committees with jurisdiction
over health and environment.
(b) Following the conclusion of the pilot program,
the commissioner shall:
(1) work with the advisory panel to assess the
usefulness of continuing biomonitoring among
members of communities assessed during the pilot
program and to identify other communities and other
designated chemicals to be assessed via
biomonitoring;
(2) work with the advisory panel to assess the pilot
program, including but not limited to the validity and
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
63
the appropriations available, develop and implement
a base program.
Subd. 3. Participation. (a) Participation in the
biomonitoring program by providing biospecimens is
voluntary and requires written, informed consent.
Minors may participate in the program if a written
consent is signed by the minor's parent or legal
guardian. The written consent must include the
information required to be provided under this
subdivision to all voluntary participants.
(b) All participants shall be evaluated for the
presence of the designated chemical of interest as a
component of the biomonitoring process. Participants
shall be provided with information and fact sheets
about the program's activities and its findings.
Individual participants shall, if requested, receive
their complete results. Any results provided to
participants shall be subject to the Department of
Health Institutional Review Board protocols and
guidelines. When either physiological or chemical
data obtained from a participant indicate a significant
known health risk, program staff experienced in
communicating biomonitoring results shall consult
with the individual and recommend follow-up steps,
as appropriate. Program administrators shall receive
training in administering the program in an ethical,
culturally sensitive, participatory, and communitybased manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that address
the science and practice of biomonitoring to be
utilized and procedures for changing those protocols
to incorporate new and more accurate or efficient
technologies as they become available. The
commissioner and the advisory panel shall be guided
by protocols and guidelines developed by the Centers
for Disease Control and Prevention and the National
Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up counseling
and support; and communicating findings to
participants, communities, and the general public.
The informed consent used for the program must
meet the informed consent protocols developed by
the National Institutes of Health;
(3) educational and outreach materials that are
culturally appropriate for dissemination to program
participants and communities. Priority shall be given
to the development of materials specifically designed
to ensure that parents are informed about all of the
benefits of breastfeeding so that the program does not
result in an unjustified fear of toxins in breast milk,
which might inadvertently lead parents to avoid
breastfeeding. The materials shall communicate
relevant scientific findings; data on the accumulation
of pollutants to community health; and the required
responses by local, state, and other governmental
entities in regulating toxicant exposures;
(4) a training program that is culturally sensitive
specifically for health care providers, health
educators, and other program administrators;
(5) a designation process for state and private
laboratories that are qualified to analyze
biospecimens and report the findings; and
(6) a method for informing affected communities
and local governments representing those
communities concerning biomonitoring activities and
for receiving comments from citizens concerning
those activities.
(b) The commissioner may enter into contractual
agreements with health clinics, community-based
organizations, or experts in a particular field to
perform any of the activities described under this
section.
144.998 ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
ADVISORY PANEL.
Subdivision 1. Creation. The commissioner shall
establish the Environmental Health Tracking and
Biomonitoring Advisory Panel. The commissioner
shall appoint, from the panel's membership, a chair.
The panel shall meet as often as it deems necessary
but, at a minimum, on a quarterly basis. Members of
the panel shall serve without compensation but shall
be reimbursed for travel and other necessary
expenses incurred through performance of their
duties. Members appointed by the commissioner are
appointed for a three-year term and may be
reappointed. Legislative appointees serve at the
pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner shall
appoint eight members, none of whom may be
lobbyists registered under chapter 10A, who have
backgrounds or training in designing, implementing,
and interpreting health tracking and biomonitoring
studies or in related fields of science, including
epidemiology, biostatistics, environmental health,
laboratory sciences, occupational health, industrial
hygiene, toxicology, and public health, including:
(1) at least two scientists representative of each of
the following:
(i) nongovernmental organizations with a focus on
environmental health, environmental justice,
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.
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(c) In addition, one representative each shall be
appointed by the commissioners of the Pollution
Control Agency and the Department of Agriculture,
and by the commissioner of health to represent the
department's Health Promotion and Chronic Disease
Division.
Subd. 3. Duties. The advisory panel shall make
recommendations to the commissioner and the
legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based on
sound science and practice, and that will advance the
state of public health in Minnesota;
(3) specific chronic diseases to study under the
environmental health tracking system;
(4) specific environmental hazard exposures to
study under the environmental health tracking
system, with the agreement of at least nine of the
advisory panel members;
(5) specific communities and geographic areas on
which to focus environmental health tracking and
biomonitoring efforts;
(6) specific chemicals to study under the
biomonitoring program, with the agreement of at
least nine of the advisory panel members; in making
these recommendations, the panel may consider the
following criteria:
(i) the degree of potential exposure to the public or
specific subgroups, including, but not limited to,
occupational;
(ii) the likelihood of a chemical being a carcinogen
or toxicant based on peer-reviewed health data, the
chemical structure, or the toxicology of chemically
related compounds;
(iii) the limits of laboratory detection for the
chemical, including the ability to detect the chemical
at low enough levels that could be expected in the
general population;
(iv) exposure or potential exposure to the public or
specific subgroups;
(v) the known or suspected health effects resulting
from the same level of exposure based on peer-
reviewed 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=2007&sn=0&num=57
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