Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
October 11, 2011
1:00 p.m. – 4:00 p.m.
American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota
ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING
ADVISORY PANEL
MEETING AGENDA
OCTOBER 11, 2011
Time
Agenda item
Presenters
Description/anticipated outcome
1:00
Welcome and
introductions
Bruce Alexander, PhD
Chair
Members and audience members are
invited to introduce themselves.
1:05
EHTB program and
legislation update
Jean Johnson, PhD
Program director
Jean will review new legislative direction
and work priorities for the state-funded
EHTB program for the 2012-13
biennium.
1:15
East metro PFC
follow-up study:
preliminary results
and analysis
Jessica Nelson, PhD
Carin Huset, PhD
Discussion item
Staff will review preliminary findings of
the follow-up investigation of changes in
PFC serum levels in the East Metro PFC
pilot project participants.
Panel members are invited to ask
questions and make recommendations
for next steps.
2:10
2:20
Biomonitoring
status updates
Information sharing
Break
Refreshments and Poster Viewing
MDH-EHTB staff share work recently
presented at national meetings
Updates are provided on these
biomonitoring topics in the panel
meeting materials. No presentation is
planned. Panel members are invited to
ask questions about any of these topics.
i
2:45
Tracking status
updates
Information sharing
Updates are provided on these Tracking
topics in the panel meeting materials.
No presentation is planned. Panel
members are invited to ask questions
about any of these topics.
2:50
Data portal
demonstration
Eric Hanson, MS
Information sharing
Demonstration of new interactive maps
on the Minnesota Public Health Data
Access portal.
3:25
Biomonitoring
planning
Barbara Scott
Murdock, MA, MPH
Discussion item
Staff will summarize results of the spring
2011 stakeholder interviews for planning
the targeted population exposure
tracking approach.
Panel members are invited to ask
questions, provide input and make
recommendations for next steps.
3:55
New business
Bruce Alexander, PhD
The chair will invite panel members to
suggest topics for future meetings.
4:00
Adjourn
Bruce Alexander, PhD
The chair will ask for a motion to
adjourn.
Next meeting:
Tuesday, December 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 SPECIFIC AGENDA ITEMS
Section overview:
East Metro PFC follow-up study:
preliminary results and analysis ......................................... 1
Section overview:
Environmental Public Health Tracking
and Biomonitoring posters ................................................... 13
Section overview:
Biomonitoring pilot program updates ................................... 17
Section Overview:
Tracking program updates .................................................... 21
Section overview:
MN EPHT launches new interactive maps ............................. 27
Section overview:
Strategic planning for targeted population
exposure tracking................................................................ 31
Section overview:
Other information ...........................................................41
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Section Overview: East Metro PFC follow-up study:
preliminary results and analysis
The original East Metro PFC Biomonitoring Pilot Project was conducted in 2008. The East Metro
PFC Biomonitoring Follow-up Project (PFC2) is measuring the two-year change in blood
concentrations of perfluorochemicals (PFCs) in residents of the East Metro who participated in
the 2008 project. The primary purpose of the project is to assess whether efforts to reduce
drinking water exposure to PFCs have been successful in reducing body burden in the
population.
At the October 2011 Advisory Panel meeting, staff will report on the preliminary results of the
Phase I analysis. They will present data on the distribution of the 2010 PFC concentrations and
compare them to the 2008 pilot project results and to concentrations in the US general
population in 2007-2008. They will discuss issues with interpretation of the data, both in
communicating results to the community and participants.
ACTION NEEDED: Panel members are invited to ask questions and provide advice and
suggestions on the PFC2 Project. In particular, we ask panel members to consider the following
questions:
Questions for the Advisory Panel
Are additional analyses recommended for this Phase 1 analysis?
How should MDH communicate to individual participants about whether differences
between their 2008 and 2010 concentrations are “real”? Should we incorporate
laboratory error into this assessment and, if so, how?
Please provide overall input on the interpretation and communication of results to
participants and the community.
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Overview
The East Metro PFC Biomonitoring Follow-up Project measured the concentration of
perfluorochemicals (PFCs) in serum of residents of the East Metro who participated in MDH’s
2008 pilot project. The primary purpose of the project is to assess whether efforts to reduce
drinking water exposure to PFCs have been successful in reducing body burden in the
population.
The 186 participants from 2008 who agreed to future contact were asked to participate. Of
these, 164 (88%) consented, filled out a questionnaire on possible sources of PFC exposure, and
provided a blood sample at the HealthEast Oakdale Clinic. Blood samples were collected
between November 2010 and February 2011.
MDH’s Public Health laboratory analyzed serum samples for 7 PFCs:
perfluorooctane sulfonate (PFOS)
perfluorohexanoic acid (PFHxA)
perfluorooctanoic acid (PFOA)
perfluorobutanoic acid (PFBA)
perfluorohexane sulfonate (PFHxS)
perfluoropentanoic acid (PFPeA)
perfluorobutane sulfonate (PFBS)
Laboratory methods used in 2010 and 2008 were identical, and detection limits were the same.
Preliminary results, Phase 1 analysis
The Phase 1 analysis described here presents the distribution of 2010 concentrations and
compares them to the general U.S. population and to concentrations from the 2008 pilot
project. The Phase 2 analysis will examine project questionnaire data on possible sources of PFC
exposure.
1. 2010 PFC concentrations. Table 1 presents the distribution of the 2010 PFC concentrations,
the 2008 pilot project concentrations, and concentrations in the US general population in 20072008 (measured in NHANES, the National Health and Nutrition and Examination Survey). PFOS,
PFOA, and PFHxS were detected in 100% of samples, whereas the remaining PFCs were less
frequently detected. Geometric mean (GM) concentrations of PFOS, PFOA, and PFHxS were
24.3, 11.3, and 6.4 g/L, respectively, and values were log-normally distributed (see histograms
in Figure 1). Concentrations in 2010, both GMs and upper percentiles, were lower than in 2008,
but not as low as those reported in NHANES. Because the remaining PFCs were detected less
frequently, it is more difficult to draw conclusions about changes in these. PFBA was detected in
21% of people in 2010 compared to 28% in 2008. In 2010, PFBS was detected in 7 people and
PFPeA in only 1 person; PFHxA was not detected in any participants.
Differences in 2010 PFOS, PFOA, and PFHxS concentrations by sub-group, shown in Table 2,
were similar to those seen in 2008. Men had higher concentrations of PFOS and PFHxS; this
difference was of borderline statistical significance for PFOA. Both age and residence length
were positively associated with all three PFCs. There were no statistically significant differences
by community, though levels in Oakdale tended to be slightly higher, and 3M employees had
higher PFHxS concentrations. These analyses are univariate and the different variables are not
adjusted for one another.
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2. Two-year change. PFOS, PFOA, and PFHxS concentrations declined over the two-year time
period between 2008 and 2010. Looking at the overall population GMs (Table 1), PFOS
concentrations declined by 32%, PFOA by 27%, and PFHxS by 24%. Looking at the individuallevel change (Table 3), PFOS concentrations decreased by an average of 26.4% (95% CI, -32.2 to 20.5%), PFOA by 21.2% (95% CI, -25.2 to -17.1%), and PFHxS by 12.9% (95% CI, -27.2 to 1.4%).
Viewed as the reduction in absolute values of the analytes, the two-year change was -15.6, -5.7,
and -3.4 g/L, respectively (all p-values < 0.0001).
Figure 2 graphically displays these differences, showing boxplots of log-transformed PFC
concentrations in 2008 (n=196) and 2010 (n=164), with a line representing the NHANES logtransformed GM. The two-year decline, both in central tendency and in upper values, is clear. It
is also apparent that concentrations in 2010 were not as low as those in NHANES.
Although concentrations in most participants declined, they stayed about the same in a smaller
group and, in a few cases, increased. Table 3 includes the range of percent and absolute change
over two years. One participant had very large percent increases for all three PFCs (400%
increase in PFOS, 97% in PFOA, and 1132% in PFHxS). It is important to note, however, that high
percentage change values do not always represent large changes in absolute values. The 1132%
increase in PFHxS, for example, represents a 4.2 g/L absolute change (from a low value of 0.4
g/L in 2008 to 4.6 g/L in 2010, which is still below the project GM).
Participants with lower 2008 concentrations, those with exposures closer to the U.S.
background and who may or may not have had significant drinking water exposure, had smaller
percent changes over the two-year period than those with higher 2008 concentrations.
Conversely, participants with the highest concentrations in 2008, those most likely to have been
highly exposed to contaminated drinking water, saw markedly larger reductions in serum
concentrations. This relationship was especially true for PFOS and PFHxS, and remained when
the individual with the outlier percent change values mentioned above was excluded from the
analysis.
Issues with data interpretation
In the overall population, GM concentrations of PFOS, PFOA, and PFHxS clearly decreased
between 2008 and 2010. The decrease ranged from 26% for PFOS to 13% for PFHxS. In some
individuals, particularly those with the highest concentrations in 2008, concentrations dropped
nearly by half. In a smaller number of individuals, however, concentrations stayed the same or
even increased (fairly significantly in a very small number of cases). This raises some
complications in interpreting and communicating results, particularly when it comes to
reporting results to individuals.
Various factors may explain why concentrations stayed the same or increased in some
participants. People have exposures to PFCs from sources other than drinking water, including
diet, use of stain-resistant products, etc. For those on well water, home filters may not
adequately remove PFCs from water if they are not properly maintained. Other sources of
exposure to PFCs in the East Metro environment such as consumption of home-grown
vegetables or local fish may exist. We hope that our Phase 2 analysis of information gathered on
the questionnaire will shed some light on these questions, but currently, we cannot say with
certainty why some individuals did not see a drop in PFC concentrations. It does seem that
these people were more likely to have had lower concentrations to begin with: that is, they may
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not have been highly exposed to contaminated drinking water in the first place, so the drinking
water improvements had less effect on their PFC concentrations.
A similar issue arises about the communication of results to participants: What is a “real”
change in an individual’s concentration? In addition to the variability and uncertainty of the
summary statistics presented in this update, there is also analytical uncertainty for the reported
analyte concentrations. MDH staff are exploring ways to incorporate laboratory uncertainty
into how we report changes in individual levels.
Next steps
Once results and interpretation from this Phase 1 analysis are final, we will report findings to
participants and the community. Participants will receive a letter with their individual results
and a short summary of initial project findings. MDH will conduct community meetings and
outreach to East Metro health care providers and local public health officials. We hope to
complete this in late fall/early winter 2011. After Phase 1 findings have been reported, we will
begin the Phase 2 analysis. We will also continue to review and evaluate studies on the
potential human health effects of PFC exposure and maintain website and other
communications.
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Table 1. PFC concentrations ( g/L)
GM
Median 75th %ile 95th %ile
Range
% detect (n)
PFOS
MN 2010 (n=164)
MN 2008 (n=196)
NHANES 07-08 (n=2100)
PFOA
MN 2010
MN 2008
NHANES 07-08
PFHxS
MN 2010
MN 2008
NHANES 07-08
PFBS
MN 2010
MN 2008
NHANES 07-08
PFBA
MN 2010
MN 2008
NHANES 07-08
PFPeA
MN 2010
MN 2008
NHANES 07-08
PFHxA
MN 2010
MN 2008
NHANES 07-08
24.3
35.9
13.2
26.5
41.0
13.6
41.6
58.0
21.0
68.2
96.0
40.6
1.6 - 234
3.2 - 448
*
100%
100%
*
11.3
15.4
4.1
12.2
15.5
4.3
22.8
29.0
5.9
51.2
64.0
9.7
0.9 - 110.5
1.6 - 177
*
100%
100%
*
6.4
8.4
2.0
7.1
8.9
2.0
11.2
15.0
3.5
28.2
34.0
9.8
0.2 - 154.2
0.3 - 316
*
100%
100%
*
N/A
N/A
<LOD
<LOD
<LOD
<LOD
<LOD
<LOD
<LOD
<LOD
<LOD
<LOD
<LOD - 0.3
<LOD - 0.2
*
4% (7)
3% (5)
*
N/A
N/A
*
<LOD
<LOD
*
<LOD
0.1
*
0.5
0.7
*
<LOD - 9.8
<LOD - 8.5
*
21% (34)
28% (55)
*
N/A
N/A
*
N/A
N/A
*
N/A
N/A
*
N/A
N/A
*
N/A
N/A
*
1% (1)
0%
*
N/A
N/A
*
N/A
N/A
*
N/A
N/A
*
N/A
N/A
*
N/A
N/A
*
0%
0%
*
* not reported in NHANES
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Table 2. 2010 PFC concentrations by sub-group ( g/L)
PFOS (GM) PFOA (GM) PFHxS (GM)
Gender
Women (n=91)
Men (n=73)
p-value*
20.1
30.9
0.0002
10.1
13.1
0.0702
5.3
8.0
0.0043
<45 (n=29)
46-59 (n=70)
>60 (n=65)
p-value**
Residence length (yrs)
<10 (n=31)
17.1
24.4
28.4
0.0078
7.9
10.7
14.1
0.014
3.9
5.9
8.6
0.0005
19.1
23.2
31.1
0.0105
8.2
10.5
16.1
0.0033
4.3
5.8
9.6
0.0004
26.3
12.0
6.6
22.5
10.7
6.1
0.1726
0.4164
0.5943
29.9
23.4
0.1207
11.1
11.4
0.9154
8.4
6.1
0.0245
Age group (yrs)
11-25 (n=86)
>26 (n=47)
p-value**
Community
Municipal - Oakdale (n=84)
Well water - Cottage
Grove/Lake Elmo (n=80)
p-value*
3M employment
Yes (n=26)
No (n=138)
p-value*
* t test on log values
** ANOVA on log values
Table 3. 2-year change in PFC concentrations (2010 - 2008)
PFOS
PFOA
PFHxS
Percent change
Absolute change ( g/L)
Mean
95% CI
Range
Mean
95% CI
Range
-26.4%* -32.2, -20.5
-89 - 400
-15.6*** -18.8, -12.3 -214 - 16.8
-21.2%* -25.2, -17.1
-80.3 - 144
-5.7***
-7.2, -4.3 -66.5 - 14.4
-12.9%**
-27.2, 1.4 -93.8 - 1132.4 -3.4***
-4.9, -1.9 -115.8 - 9.3
* p-value (different than 0) <0.0001
** p-value (different than 0) = 0.08
*** p-value (paired t test with log-transformed values) < 0.0001
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Figure 1. Histograms of 2010 PFC concentrations
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Figure 1. Histograms of 2010 PFC concentrations (continued)
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Figure 2. Boxplots of log-transformed PFC concentrations by year (2008 n=196, 2010 n=164)
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Figure 2. Boxplots of log-transformed PFC concentrations by year (2008 n=196, 2010 n=164)
[continued]
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Section Overview: Environmental Public Health Tracking
and Biomonitoring Posters
The following section provides short introductions to the posters that staff presented at the
recent National EPHT Conference held in September in Atlanta, GA.
ACTION NEEDED: Panel members need not take any formal action. They are invited to browse
the posters and to ask questions and provide comments during the break.
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Poster Session: Tracking and Biomonitoring
These posters were presented by MDH program staff at “Tracking in Action”, the National
Environmental Public Health Tracking Conference held in September 2011 in Atlanta, GA.
Poster 1: Evaluation
Blair Sevcik (MDH) presented “A Hierarchical Evaluation Process to Adopt New Content Areas
for Environmental Public Health Tracking (EPHT) in Minnesota”. The poster described
Minnesota’s evaluation process for adopting new content areas for EPHT. Because many states
have limited EPHT resources to adopt and maintain new content areas, Minnesota presented a
poster outlining our suggested evaluation process to our environmental public health partners
and other EPHT staff across the U.S. The poster described the objectives, key concepts, selection
criteria, and tasks/deliverables that staff consider for each phase in the four-phase evaluation of
new content areas. The successful piloting of Environmental Tobacco Smoke (ETS) Exposure as a
new content area for tracking in Minnesota served as an example of the evaluation. The poster
is titled:
Poster 2: Maps
In presenting the poster, “Visualization of Public Health Data in Maps: The Potential for
Misinterpretation,” Eric Hanson (MDH) explained that maps offer ways to view patterns and
trends in data and allow users to explore and analyze data. The poster illustrates examples of
how using an inappropriate classification method and failing to evaluate boundary changes over
time can cause inaccurate cartographic displays and analysis of data. The poster also
demonstrates the relationship between data confidentiality and geographic pattern
identification.
Best practices include having a firm understanding of the data and the purposes to be achieved
by mapping the data. In creating a choropleth map, a mapmaker needs to understand how each
classification method categorizes the analysis and interpretation of data and, in any particular
case, which classification method would be most appropriate for the map’s purpose.
Mapmakers must be aware of boundary changes that could alter comparisons, and map at the
smallest geographic unit that is both possible and appropriate for the
Poster 3: PFC Biomonitoring
Jessica Nelson (MDH) presented the poster, “Community Exposure to PFCs in Washington
County, Minnesota: The East Metro Perfluorochemical Biomonitoring Pilot Project,” which
described a project conducted by the EHTB program to measure PFC exposure in population
samples from two communities identified as likely to be exposed. The work was conducted
under a 2007 Minnesota law that established a pilot program to build MDH capacity for a state
biomonitoring program.
PFC groundwater contamination from nearby industrial waste disposal facilities was discovered
in Washington County, Minnesota, east of the Minneapolis-St. Paul metropolitan area ( “East
Metro”) in 2004. Wastes from PFC production and wastewater treatment were sent to disposal
sites in Washington County between 1956 and 1971. Groundwater remediation began in 2005,
but people living in the East Metro area before Jan 1, 2005 were exposed to PFCs through their
drinking water.
15
Biomonitoring showed that participants’ serum levels were 2 to 4 times higher than those
reported in NHANES samples collected in 2003-2004, but comparable to or lower than levels
found in other studies of communities exposed via drinking water. Past well water levels were
strongly correlated, but only partly explained variability in the blood serum levels, indicating
that other sources likely contribute to exposure in this population. A follow-up study was
recommended to measure changes in blood levels over time. Levels are expected to decline as a
result of remedial actions taken since 2005 to remove PFCs from drinking water in these
communities.
Poster 4: Environmental Phenols and Cotinine Biomonitoring
Jessica Nelson presented her poster, “Measuring Environmental Phenols and Cotinine in Urine
of Pregnant Minnesota Women: the Riverside Prenatal Biomonitoring Pilot Project,” which
reported results from a study of bisphenol A (BPA), four parabens, and cotinine in the urine of
66 pregnant women receiving prenatal care at two Minneapolis health clinics. Bisphenol A
(BPA) is used in polycarbonate plastic and the lining of food cans, and parabens are used in
products such as shampoo and lotion. Cotinine is an indicator of exposure to tobacco. Both are
measured in urine.
The project was ancillary to the Riverside Birth Study (RBS) conducted by researchers at the
University of Minnesota. It was funded under the 2007 Minnesota Environmental Health
Tracking and Biomonitoring law, which charged MDH to conduct four biomonitoring pilot
projects to inform the development of a statewide biomonitoring program. The law also
directed MDH to “conduct biomonitoring of pregnant women and minors on a voluntary basis,
when scientifically appropriate.”
Of the 122 women contacted about the pilot project, 66 provided a urine sample. Women were
from a range of income levels, and most were white. BPA levels were similar to U.S. women in
NHANES and to other studies that have measured BPA in pregnant women. Paraben levels were
lower than in U.S. women. Cotinine was detected in 15% of the women; 14% were classified as
active smokers.
The project showed that, in a small group of Minnesota women, exposures to environmental
phenols and tobacco were not elevated compared to other populations. It also provided some
evidence of disparities in exposure to parabens and BPA that deserve future attention. Finally,
MDH learned some useful lessons for future biomonitoring activities in Minnesota.
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Section Overview: Biomonitoring Pilot Program Updates
This section contains status updates on the topics below:
Biomonitoring Status Updates
Lake Superior Mercury in Newborns Biomonitoring Project
Riverside Prenatal Biomonitoring Project
Task Force to Develop Biomonitoring Content for the National EPHT Network
Abstract: Biomonitoring Finds Multiple Exposures in Disadvantaged Children
ACTION NEEDED: The Advisory Panel need take no formal action at this time. Panel members
are invited to ask questions or comment on any of these topics during the time designated on
the meeting agenda.
The Sexton et al. abstract is provided as background information of interest for the EHTB
biomonitoring program.
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Biomonitoring Status Updates
Lake Superior Mercury in Newborns Biomonitoring Project
The Minnesota Department of Health (MDH), in collaboration with state health departments in
Wisconsin (WI) and Michigan (MI), measured levels of mercury in the blood of infants born to
mothers living within these state’s respective land areas that drain water into Lake Superior (the
“Superior basin”). Use of newborn RDBS provided a convenient specimen that required no
further sample collection from individuals. The blood spots were analyzed for total mercury by
the MDH Public Health Laboratory.
Total mercury was measured in dried blood spots from over 1400 infants born during 2008
through 2010 to mothers residing in the US portion of the Lake Superior Basin. The study’s
purpose was to determine the range of mercury concentrations in these infants and to assess
feasibility of using dried blood spots from infants as an indicator of mercury exposure.
Preliminary findings reveal a wide range of total mercury concentrations measured in blood
spots from newborns in the US Lake Superior Basin. Further data analysis is now underway.
Some samples analyzed were above 5.8 µg/l, the US EPA Reference Dose (RfD) for
methylmercury (meHg). Preliminary results suggest a seasonal exposure pattern. Patricia
McCann from the Fish Advisory Program will present the full findings at the December Advisory
Panel meeting.
Riverside Prenatal Biomonitoring Pilot Project
Fact sheets for the Riverside Prenatal Biomonitoring Pilot Project have been sent to the
participants. Staff will continue communication efforts with stakeholders over the next few
months. The factsheets, plus a summary of the project, are now available online at
http://www.health.state.mn.us/divs/hpcd/tracking/biomonitoring/projects/riverside.html.
Task Force to Develop Biomonitoring Content for the National EPHT Network
Minnesota staff are actively engaged with a new national task force to develop biomonitoring
content for the national EPHT network. Jean Johnson co-chairs the task force which had its first
meeting at the EPHT meeting in September, 2011 in Atlanta, GA. At the meeting, MDH
epidemiologist, Jessica Nelson, gave a primer on accessing national biomonitoring data from the
National Health and Nutrition Examination Survey (NHANES). The CDC is proposing to display
national biomonitoring data measures for approximately 12 chemicals on the CDC EPHT data
portal. Several states, including Minnesota, are considering adding biomonitoring data to their
state portals.
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Biomonitoring Finds Multiple Exposures in Disadvantaged Children
This abstract below, from a recent paper, underscores some of the messages that staff heard
during stakeholder meetings designed to help the EHTB program plan a state biomonitoring
program. The reference is: Sexton K, Ryan AD, Adgate JL, Barr DB, Needham LL. 2011.
Biomarker measurements of concurrent exposure to multiple environmental chemicals and
chemical classes in children. J Toxicol Environ Health A.74(14):927-42.
Abstract
Concern is mounting that children from disadvantaged, low-income neighborhoods are likely to
be both more exposed to chemical hazards and more susceptible to related adverse health
effects. This article reports measurements of >75 individual biomarkers spanning 7
chemical/pollutant classes in blood and urine from more than 100 children living in a
socioeconomically disadvantaged and ethnically diverse area of south Minneapolis, MN. Results
indicate that a significant proportion of children in the study were at the high end of the
exposure distribution compared to national reference ranges for a variety of environmental
chemicals and/or their metabolites, including phthalates, organochlorine pesticides,
organophosphate pesticides, metals, polychlorinated biphenyls, and volatile organic
compounds. In addition, levels of cotinine in urine indicate that more than half the children
were regularly exposed to environmental tobacco smoke, with the upper 10th percentile
exposed to relatively high concentrations.
20
Section Overview: Tracking Program Updates
Tracking Status Updates
Evaluation Process for New Content Areas for Tracking
New Content Area for Tracking: Environmental Tobacco Smoke (ETS) Exposure
Population Characteristics as a New Content Area
Task Force to Develop Measures for Tracking Contaminants in Private Wells
Tracking Communications and Outreach
ACTION NEEDED: The Advisory Panel need take no formal action at this time. Panel members
are invited to ask questions or comment on any of these topics during the time designated on
the meeting agenda.
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Update: Minnesota Tracking Program
Evaluation Process for New Content Areas for Tracking
MN EPHT staff, Blair Sevcik, presented Minnesota’s evaluation process for adopting new content
areas for EPHT at the National EPHT Conference held in September in Atlanta, GA. Because
many states have limited EPHT resources to adopt and maintain new content, Minnesota
presented a poster outlining our suggested evaluation process to our environmental public
health partners and other EPHT staff across the U.S. The poster described the objectives, key
concepts, selection criteria, and tasks/deliverables that staff consider for each phase of the fourstep evaluation of new content areas. The successful piloting of Environmental Tobacco Smoke
(ETS) Exposure as a new content area for tracking in Minnesota served as an example of the
evaluation. The poster is titled: “A Hierarchical Evaluation Process to Adopt New Content Areas
for Environmental Public Health Tracking (EPHT) in Minnesota.”
New Content Area for Tracking: Environmental Tobacco Smoke (ETS) Exposure
The Advisory Panel voted to recommend to the Commissioner of Health that ETS Exposure be
adopted as a new content area for tracking in Minnesota (10 in favor; 1 opposed). ETS Exposure
has now moved into Phase 4: Implementation. Staff are currently drafting How-to Guides for
creating the new data and measures and working with the data steward (Minnesota Center for
Health Statistics) to implement this new content area on Minnesota Public Health Data Access
(MN EPHT’s web-based data access portal). The goal is to add static webpages describing ETS
Exposure data and measures during Project Year 3 (PY3), which ends June 30, 2012.
Population Characteristics as a New Content Area
Earlier this year, CDC implemented Population Characteristics as a new content area on the
National EPHT portal. The content area uses two indicators: demographics and socioeconomic
factors. Demographic measures include age (group), sex, and race/ethnicity. Socioeconomic
measures include poverty, health insurance coverage, median household income, and
education.
Minnesota is currently in Phase 1 of Minnesota’s evaluation of this new content area. Blair
Sevcik is identifying and evaluating data sources for Population Characteristics data and
measures, and exploring other measures that could be included on Minnesota Public Health
Data Access (MN EPHT’s web-based data access portal), in addition to those found on the
National EPHT portal. Staff will present on the progress of this new content area in future
Advisory Panel meetings, including a presentation of Phase 3: Recommendation.
Task Force to Develop Measures for Tracking Contaminants in Private Wells
Minnesota staff, Chuck Stroebel (MN EPHT) and Ed Schneider (EH) are participating in a new
national task force to develop data measures for tracking population exposure to certain
contaminants in private wells, such as arsenic. This work will be a continuation of work started
in Minnesota in 2010/2011 to inventory and evaluate available data sources in the state for
Tracking.
23
EPHT Communications and Outreach
MN EPHT communication activities focus on reaching staff throughout the Minnesota
Department of Health (MDH), other state agencies, and local public health agencies to introduce
or update them about:
The MN EPHT program and the Minnesota Public Health Data Access (MNPH Data
Access), the portal.
The MN EPHT partnership with CDC’s national tracking program;
The value of using MNPH Data Access and the CDC National Tracking Network.
Our goal is to increase our target audience’s knowledge of tracking and its enhancements, such
as mapping, and to promote the use of the portal in their work. In the coming months, we plan
to extend our outreach to policy makers and research librarians.
Despite the government shutdown (July 1–July 19), and the initial uncertainties about whether
the shutdown would occur and how long it would continue, we still completed the activities
listed below since our last report in May 2011. MN EPHT staff…
 Worked collaboratively with MDH Environmental Health staff to create bookmarks on
carbon monoxide poisoning and lead poisoning to distribute at the Minnesota State Fair.
The bookmarks also contain information about the MN EPHT portal.
 Submitted an article, “Environmental Tobacco Smoke Exposure Among Nonsmoking
Youth With Asthma in Minnesota,” to the MDH newsletter, Breathing Space.
 Planned for hosting exhibit booths at the School Nurses of Minnesota Conference in
November and the Association of Minnesota Counties in December 2011.
Presentations
Air Quality Forum: Working together to reduce pollution & enhance
public health: Presentation: Health Impacts of Polluted Air.
Free public lecture sponsored by the Minnesota American Lung
Association, in its Clean Air Choices Lecture series
Portal demonstration of childhood lead poisoning map and query for
the MDH Lead Program
Portal Demonstration for the MDH INHALE meeting
June 2011
Portal Demonstration for Northeast Data Planners, Duluth,
Minnesota
Webinar – Portal demonstration for Southeast and South central
region: Local Public Health and Public Health Nurse Consultants
Community Health Services Conference
Presentation: Investing in our Values and Vision -Making Data More
Available: Minnesota Public Health Data Access
CDC National Tracking Conference:
Presentation on usability testing of the MNPH Data Access portal
August 2011
24
June 2011
August 2011
August 2011
September 2011
September 2011
MN EPHT collaboration with CDC national and state tracking outreach efforts
MN EPHT communications staff, Mary Jeanne Levitt, serves on several CDC national tracking
marketing workgroups/subcommittees that develop education and outreach materials to
promote the national and state grantee tracking efforts. Mary Jeanne recently attended the
CDC Tracking Conference in September 2011, and she also co-chairs the Public Health
Environmental Practitioner workgroup, one of our important target audiences.
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;
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. 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.”
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26
Section Overview: MN EPHT Launches New Interactive
Maps
In September 2011, MN EPHT launched new interactive maps for asthma
hospitalizations and childhood lead poisoning (see Minnesota Public Health Data Access
at: https://apps.health.state.mn.us/mndata/). Local public health professionals and
others can use these maps to compare county and state data and to inform public
health planning and planning.
ACTION NEEDED: Panel members are invited to provide comments and suggestions on
the new interactive maps for asthma hospitalizations and childhood lead poisoning. We
also request panel members to suggest EPHT content areas of interest for near and long
term map/chart development for program year 3 (through July 31, 2012).
Members are encouraged to consider the following questions:
Do panel members have suggestions for enhancements or improvements to the
existing maps and charts for asthma hospitalizations and childhood lead
poisonings?
What audiences or groups (beyond local health professionals) would be
interested in these maps? What are good avenues for
outreach/demonstrations?
Which additional EPHT content areas of interest should MN EPHT consider for
map development in the future?
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MN EPHT Launches New Interactive Maps
In September 2011, MN EPHT launched new interactive maps for asthma hospitalizations and
childhood lead poisoning (see Minnesota Public Health Data Access at:
https://apps.health.state.mn.us/mndata/).
Local public health professionals and others can use these maps to compare county and state
data and to inform public health planning and planning. Maps and data can be used, for
instance, to assess local priorities for public health initiatives and evaluate program
effectiveness over time.
Maps and data on this portal can be downloaded in various formats for use in spreadsheets,
reports, and presentations. By summer 2012, MDH will implement new features on the site,
including an interactive glossary, users' guide, and maps and charts on additional health topics.
Currently, MN EPHT is working with the Minnesota Cancer Surveillance System and others to
assess new areas for map development in 2011-2012. One priority under consideration is to
develop maps of cancer incidence data for lung, colorectal, breast, and all cancers (combined)
by county; and mesothelioma by region.
Questions for the panel:
Do panel members have suggestions for enhancements or improvements to the
existing maps and charts for asthma hospitalizations and childhood lead poisonings?
What audiences or groups (beyond local health professionals) would be interested in
these maps? What are good avenues for outreach/demonstrations?
Which additional EPHT content areas of interest should MN EPHT consider for map
development in the future?
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30
Section overview: Strategic Planning for Targeted
Population Exposure Tracking
In spring 2011, EPHT staff began the planning for a state biomonitoring program. They met with
stakeholders (Table 1) and presented a summary update of the biomonitoring program,
highlighting the four pilot projects, results to date, and lessons learned in the pilots. Staff asked
a series of questions to elicit suggestions and recommendations for an ongoing state
biomonitoring program.
Three questions addressed target populations:
1) Which target populations are the most important, and why?
2) What criteria should the state use in selecting target populations for biomonitoring?
3) What population target would be most valuable for linking biomonitoring data with
other health outcome data?
In the pages that follow, we list recommendations that grew out of our stakeholder meetings
and discuss the target population of choice in light of stakeholders’ recommendations for target
populations and criteria for choosing target populations.
ACTION NEEDED: We invite panel members to provide input on the criteria identified by
stakeholder groups for selecting a target population for planning ongoing biomonitoring using a
targeted population exposure tracking approach.
In particular, we ask the panel members to respond to the following questions:
Do you agree with the criteria that are presented for selecting a target population?
What other criteria should we consider?
Which criteria are the most important in this first phase of exploration? Which are less
important?
What information does the advisory panel need to effectively make recommendations
about selecting a target population?
What additional information does the panel need in order to consider pregnant women as a
target population?
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32
Strategic Planning for Targeted Population Exposure Tracking:
Selecting a Target Population
Background
The MDH-EHTB Biomonitoring Pilot Program has been engaged in a strategic planning process
consistent with Minnesota Statutes Section 144.996, subd. 2(3) to “communicate findings to
the public, and plan ensuing stages of biomonitoring and disease tracking work to further
develop and refine the integrated analysis”. Recognizing that biomonitoring programs can serve
many different purposes and take many approaches, staff began in 2008-09 by hiring a
contractor and working closely with the Advisory Panel and agency experts to develop a clear
vision statement and program goals for a biomonitoring program that is consistent with the
MDH mission to protect and maintain the health of all Minnesotans.
In the next planning phase (2010), EHTB planning staff developed a comprehensive model for a
state biomonitoring program in Minnesota that identified three approaches for biomonitoring. If
implemented together, the three would achieve all program goals. Recognizing the fiscal
constraints of the program, the Advisory Panel and MDH Steering Committee recommended
that MDH-EHTB planning efforts for ensuing stages of biomonitoring be limited to only one of
the three approaches, a targeted population exposure tracking approach. The approach and
rationale for this decision was fully described in the 2011 EHTB Report to the Legislature.
Targeted population exposure tracking uses a systematic public health surveillance approach for
monitoring exposure, similar to the way public health agencies monitor the occurrence of
diseases in populations. It provides data that are useful for tracking trends, informing people
and communities about actions they can take to prevent exposure, and evaluating the efficacy
of public policies and actions.
Planning for this approach begins with the selection of a specific target population, followed by
selection of specific exposures of public health importance for that population. Since March,
2011, staff have been engaged in this next phase of planning and the development of
recommendations, reported below.
Strategic Planning for Targeted Population Exposure Tracking
During spring 2011, the biomonitoring team met with stakeholders that included academics,
local public health officers, representatives from two environmental advocacy groups, and
representatives of the Minnesota Medical Association’s Public Health Committee (Table 1).
We presented a summary update of the biomonitoring program to date, highlighting the four
pilot projects that we’d worked on, their results, and the lessons we’d learned in doing the
pilots. The presentation built on past strategic planning efforts and followed the
recommendation that an ongoing MDH biomonitoring program should focus on targeted
population exposure tracking. Among a series of questions, we asked stakeholders to help us
identify target populations. Three questions addressed target populations:
4) Which target populations are the most important, and why?
5) What criteria should the state use in selecting target populations for biomonitoring?
6) What population target would be most valuable for linking biomonitoring data with
other health outcome data?
33
Following the interviews, EHTB planning staff reviewed the notes and looked for themes that
emerged. The target populations most frequently named by stakeholders were young children,
communities of color, agricultural/rural communities, and pregnant women (Table 2). Important
criteria for selecting a target population most frequently cited by stakeholders were populations
with exposure associated with known, serious health implications (Table 3). Geographic
diversity and populations with “Minnesota-specific” exposures of concern were also named
more than once by stakeholders as important for selection.
Pregnant Women as a Target Population: Demonstrating Use of Criteria for Selection
This presentation demonstrates the use of several criteria for selecting a target population,
focusing on pregnant women as an example or “test population” for these criteria. A focus on
pregnant women would allow us to learn about exposures to the youngest children possible, the
highest priority for most stakeholders. Please note that the criteria do not address issues of
analyte selection or study design as these will be addressed in the next phase for selection and
planning which is a feasibility assessment.
Based on stakeholders’ recommendations we suggest that the Advisory Panel consider the
following primary criteria for selecting a target population:
Exposure factors:
o E1. The target population is likely exposed to chemicals that cause known
human health effects.
o E2.The target population is likely exposed to chemicals of concern in
Minnesota.
Demographic and geographic diversity:
o D1.The target population includes disadvantaged populations : poor people,
members of minority groups, people in polluted environments.
o D2.The target population includes geographic, rural/urban diversity across the
state.
Public health policy impacts:
o P1. Planned or recent change in public policy may affect exposure in the target
population.
o P2. Efficacy of public policy change can be measured in the target population
through exposure monitoring.
Information potential for individual results interpretation:
o I1. Appropriate reference or control population data exist for interpreting
biomonitoring results in the target population.
o I2. Clinic-based or risk assessment- –based reference values are useful for
interpreting individual results.
Demonstration: Selection of Pregnant Women
E1. Is there evidence that likely exposures in this target population are associated with known
health outcomes?
Yes. Public health science increasingly recognizes the influence of toxic exposures in utero on
children’s health. Exposure to toxic chemicals during fetal development can have important
34
effects on fetal anatomy, physiology, and function. During gestation and early childhood,
children undergo rapid growth and development, and these developmental processes are
particularly vulnerable to chemical toxicity.
Exposures that occur during gestation can have long lasting effects. In the 1960s and ‘70s,
recognition of fetal alcohol syndrome, thalidomide-related limb defects, and Minamata disease,
in which prenatal methylmercury exposure caused neurological damage, demolished the view
that the placenta protects the fetus from toxic exposures.
The effects of toxic exposure during development depend not only on the agent, the dose, and
the mechanism of action, but also on the developmental stage of the tissue of interest. Fetal
tissues undergoing rapid growth and morphological change are very vulnerable to toxic
exposures. Thalidomide exposure, for instance, caused severe limb defects in embryos exposed
during the first 33 days after fertilization, the critical period for limb development.1 An exposure
that happens before or after an organ develops generally does less damage than an exposure
that occurs during a period of rapid development.2 Chronic low-level exposures to such
toxicants as lead or mercury, however, can cause physiological and thus, functional damage.
The CDC publication, Preventing Lead Poisoning in Young Children3, notes, “The published
studies include a large body of literature establishing that lead is a developmental toxicant and
that harmful effects of lead on children’s development can occur without clinical signs,
symptoms, or abnormal routine laboratory test. In addition, a growing number of studies
suggest that blood lead levels prevalent in the general population are associated with
adverse health effects in adults and in the offspring of pregnant women.”
MDH’s web site on children’s environmental health4 points out that “the developing
brain is also sensitive to exposure to organic mercury (methylmercury).” In utero
exposure to methylmercury can affect the developing brain by "disrupt[ing] normal
patterns or neuronal migration and nerve cell histology."5
The National Children’s Study’s website identifies in utero through early childhood (up
to 3-5 years old) as the periods when children are most susceptible and when exposure
monitoring should be conducted. The Workshop to Identify Critical Windows of
Exposure for Children’s Health: Evidence from human and animal models resulted in a
series of papers published by scientific experts to consider what is known about early
exposure to environmental toxicants and their neurotoxic effects. Well known examples include
1
Hellerstedt WL, McGovern PM, Fontaine P, Oberg CN, Cordes JE. 2008. Prenatal Environmental Exposures and
Child Health. Minnesota Medicine, September 2008.
2
Rice D, Barone S. 2000. Critical periods of vulnerability for the developing nervous system: evidence from humans
and animal models. Environmental Health Perspectives 108, Suppl 3: 511-533. Based on a presentation at Workshop
to Identify Critical Windows of Exposure for Children’s Health: Evidence from humans and animal models, Cited in
http://www.nationalchildrensstudy.gov/about/organization/advisorycommittee/2003Sep/Pages/Hypothesis-6Development-and-Behavior.pdf
3
Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children. Atlanta: CDC; 2005.
4
Environmental Health Division, Minnesota Department of Health. Children’s Environmental Health: Background –
EH. URL: http://www.health.state.mn.us/divs/eh/children/background.html#ref
5
American Academy of Pediatrics, Committee on Environmental Health; RA Etzel, ed.; and SJ Balk, ed. Handbook of
Pediatric Environmental Health. American Academy of Pediatrics, 1999. Cited in (4) above.
35
lead, mercury, and PCBs. Outcomes can include sensory, intellectual, and cognitive deficits;
delayed development; and behavioral problems. Exposure to some neurotoxins during fetal
development reduces IQ,6 contribute to Attention Deficit Hyperactivity Disorder (ADHD), and
raise the risk for antisocial and delinquent behavior.7
Many of the studies of neurotoxicity from exposure to lead, methylmercury, and PCBs used
biomonitoring and assessed a newborn infant’s fetal exposure from its blood in the umbilical
cord. Because maternal blood correlates with cord blood at birth, biomonitoring during
pregnancy can enable us to estimate fetal exposures from the mother’s exposures.
E2. Is this target population likely exposed to chemicals of concern in Minnesota?
Yes. Two MDH biomonitoring pilot projects conducted biomonitoring in pregnant women
and/or newborns, and documented this population’s exposure to chemicals of interest in the
state.
D1. Does the target population include disadvantaged populations?
Yes. A target population of pregnant women could include women from diverse ethnic, racial
and economic subgroups such that exposure disparities could be quantified and tracked.
A recent paper by Sexton et al. 8 points out that “children from disadvantaged, low-income
neighborhoods are likely to be more exposed to chemical hazards and more susceptible to
related adverse health effects.” This study measured over 75 biomarkers of 7 chemical classes
in blood and urine from more than 100 children in an impoverished, ethnically diverse area of S.
Minneapolis. Compared to CDC’s 3rd National Report on Human Exposure to Environmental
Chemicals, these children had significantly higher blood and urine concentrations of biomarkers
for certain phthalates and organochlorine pesticides, blood lead and mercury, some PCBs, and
two volatile organic compounds (VOCs). More than half were exposed to environmental
tobacco smoke. From the standpoint of environmental justice, the authors noted, these
children also were experiencing major nonchemical stressors.
D2. Does the target population include geographic diversity and urban/rural diversity across
the state?
Yes. A target population of pregnant women could include women selected from various areas
in the state and could include comparisons of rural vs. urban exposures.
P1. Are there planned or recent changes in policy that may affect exposure in this
target population?
Yes. Current policy recommendations underscore the importance of understanding
children’s exposures and extend the concern to include prenatal exposures. The June
2011 report from the National Conversation on Public Health and Chemical Exposures
recommends that states protect children’s health “by requiring explicit consideration of
6
Rice D, Barone S. 2000. Op cit.
U.S. Environmental Protection Agency. America's Children and the Environment: Measures of Contaminants, Body
Burdens, and Illnesses, 2nd Edition. EPA 240-R-03-001, February 2003.
8
Sexton K, Ryan AD, Adgate JL, et alia. 2011. Biomarker Measurements of Concurrent Exposure to Multiple
Environmental Chemicals and Chemical Classes in Children. J. Toxicol & Environmental Health, Part A, 74:927-242.
7
36
children’s unique vulnerabilities, susceptibilities, exposures, and development stages (including
in utero)…”9
P2. Can the efficacy of current public policy or public health actions be measured in this target
population?
Yes. Biomonitoring pregnant women could enable MDH to establish baseline exposure levels in
the population, identify disparities in exposure, and implement and evaluate preventive efforts.
More than that, identifying and then preventing harmful exposures can improve the lives of
individuals and families, and in some cases, save the state economic costs in services and
productivity.
Current public health policies for preventing exposure to toxic chemicals for the developing child
in utero that could be evaluated include fish consumption advisories for pregnant women,
children/adult blood lead screening and prevention programs, work to prevent harmful
exposures in homes, air and water emissions monitoring and control programs, and product
controls (e.g., mercury in skin lightening creams). The work may further support industry
initiatives to promote green chemistry and economic sustainability.
I1. Are there appropriate reference or control population data for interpreting exposure
monitoring results in this target population?
Yes. The National Biomonitoring Program (part of NHANES) includes reference biomonitoring
data for pregnant women. Data are available through research publications and by special
analyses.
I2. Are clinic-based or risk assessment-based values available for interpreting exposure
monitoring results in this target population?
For some analytes (e.g. lead and mercury), there are clinic-based and/ or risk-assessment based
reference or threshold values useful for interpreting results.
Questions to the panel
1. Do you agree with the criteria that are presented for selecting a target population?
2. What other criteria should we consider?
3. Which criteria are the most important in this first phase of exploration? Which are less
important?
4. What information does the advisory panel need to effectively make recommendations
about selecting a target population?
5. What additional information does the panel need in order to consider pregnant women as a
target population?
9
Addressing Public Health and Chemical Exposures: An Action Agenda. Report of the National Conversation on
Public Health and Chemical Exposures. Leadership Council of the APHA, ASTHO, and NACCHO, facilitated by
RESOLVE. Sponsored by CDC and ATSDR: June 2011. URL: http://www.nationalconversation.us/actionagenda/downloads
37
Table 1. 2011 Stakeholder Meetings
Academics
Bruce Alexander (Environmental Health Sciences, UMN)
Jacobs, David & Suarez, Jose (Epidemiology, UMN)
McGovern, Pat (Environmental Health Sciences, UMN)
Spector, Logan; Nguyen, Ruby (Pediatric Epidemiology)
Toscano, Bill; Wattenberg, Elizabeth (Environmental Health Sciences)
Environmental Advocacy Groups
Healthy Legacy (3 constituencies represented: IATP, Preventing Harm MN, Clean Water Action)
MCEA (Minnesota Center for Environmental Advocacy. Allison Wolf, legislative liaison; Scott
Strand, director)
Local Public Health Officials
Local Public Health Association (Environmental Health Directors’ lunch)
Local Public Health Association Policy & Practices Committee (conference call)
Musicant, Gretchen (Minneapolis) and Pierce, Spencer (Washington County)
Minnesota Medical Association
Beth Baker, Mark Liebow (MMA Public Health Committee)
38
Table 2: Stakeholder Target Population Suggestions
Which target populations are most important?
Stakeholders’ suggestions
Children
o Children with learning deficits, precocious menarche, high insulin
o Babies/neonates
8 interviews
1 interview
3 interviews
Communities of color
o Somali
o Black*
o American Indian*
o Immigrant Mexican*
o Latino
6 interviews
3 interviews
1 interview
3 interviews
1 interview
1 interview (skin cream)
Agricultural communities
o Farm families
o Farmworkers
o Urban farmers
6 interviews
1 interview
1 interview
1 interview
Rural populations
o Communities w/ less public health infrastructure
o Suburban
Pregnant women
6 interviews
1 interview
2 interviews
5 interviews
Poor people
o Disenfranchised people
o EJ/underprivileged populations
o Food insecure
4 interviews
1 interview
1 interview
2 interview
Women of childbearing age
o Without medical care
o Pre-conception women
4 interviews
1 interview
1 interview
Populations affected by industrial pollution (point source)
o Living close to coal plants/other env hazards
4 interviews
1 interview
Workers
o Blue collar
3 interviews
1 interview
Populations that eat fish
o New immigrants
o American Indians
o Especially Metro lakes (non-white, low income)
3 interviews
1 interview
1 interview
1 interview
Skin cream users (Hg)
3 interviews
Old people
2 interviews
Breastfeeding women
1 interview
Populations affected by specific projects (mining, Central Corridor)
1 interview
Playground users
1 interview
Men
1 interview
Urban populations with pesticide exposure
1 interview
*These groups included as “vulnerable and difficult-to-reach minorities.”
39
Table 3. Stakeholder Criteria Suggestions for Choosing Target Populations
Exposure-related factors
Populations with exposures associated with known, serious health implications
Groups likely to have MN-specific exposure
Groups likely to be affected by exposure from major state industries
Groups with higher risk of exposure
Populations impacted by specific projects
5 interviews
2 interviews
1 interview
1 interview
1 interview
Connection to public policy
Groups where change in practice/technology may affect exposure
Groups that enable ability to answer: how are policies working?
Groups whose exposures could be reduced by policy change
1 interview
1 interview
1 interview
Demographic diversity
Geographic diversity
Age diversity
Ethnic diversity
Socioeconomic diversity
EJ communities
Groups less likely to have political influence
2 interviews
1 interview
1 interview
1 interview
1 interview
1 interview
Methodological issues
Must have control population
Different from NHANES
Willingness to participate
Reachable population
Known denominator
1 interview
1 interview
1 interview
1 interview
1 interview
40
Section Overview: Other information
These documents are included in this meeting packet as items that my be of interest to panel
members:
EHTB Advisory Panel 2012 meeting dates
EHTB Advisory Panel roster
EHTB Staff bios
EHTB statute
Meeting summary June 2011
Additional reference materials are available online at www.health.state.mn.us/tracking/
41
2012 Advisory Panel Meetings
Tuesday, March 13
1-4pm
Tuesday, June 12
1-4pm
Tuesday, Sept. 11,
1 – 4pm
Tuesday, Dec. 11
1-4pm
All meetings will be held from 1-4pm and will take place at
MDH’s Snelling Office Park location at 1645 Energy Park Drive.
42
ENVIRONMENTAL HEALTH TRACKING AND
BIOMONITORING
ADVISORY PANEL ROSTER
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
Thomas Hawkinson, MS, CIH, CSP
Toro Company
8111 Lyndale Avenue S
Bloomington, MN 55420
[email protected]
Statewide business org 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
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
Cathi Lyman-Onkka, MA
Preventing Harm Minnesota
372 Macalester Street
St. Paul, MN 55105
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
Home office
651-647-9017
[email protected]
Nongovernmental organization
representative
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
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
43
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
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
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
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
Vacant
Minnesota Senate appointee
44
Staff Biosketches
Wendy Brunner, MS, serves as surveillance epidemiologist for the MDH Asthma
Program since 2002, and joined the MN EPHT program on a part-time basis in fall 2009.
Previously, she worked on occupational respiratory disease studies for MDH. She has a
masters degree in Science and Technology Studies from Rensselaer Polytechnic Institute
and a masters degree in Environmental and Occupational Health from the University of
Minnesota. She is currently a doctoral student in the Division of Epidemiology and
Community Health at the University of Minnesota.
Eric Hanson, MS, is an Information Technology Specialist with the Environmental
Public Health Tracking program. His work is focused in Geographic Information Systems
(GIS), application development, cartography, data visualization, data management and
providing GIS technical assistance. He has a Masters degree in Geographic Information
Systems (GIS) and Masters Minor in Public Health from the University of Minnesota.
Jean Johnson, PhD, MS, is Program Director/Principal Investigator for Minnesota’s
Environmental Public Health Tracking and Biomonitoring Program. Dr. Johnson
received her Ph.D. and M.S. degrees from the University of Minnesota, School of Public
Health in Environmental Health and has 25 years of experience working with the state of
Minnesota in the environmental health field. As an environmental epidemiologist at
MDH, her work has focused on special investigations of population exposure and health,
including studies of chronic diseases related to air pollution and asbestos exposure, and
exposure to drinking water contaminants. She is currently the Principal Investigator on an
EPA grant to develop methods for measuring the public health impacts of population
exposure to particulate matter (PM) in air. She is also an adjunct faculty member at the
University of Minnesota School of Public Heath.
Mary Jeanne Levitt, MBC, is the communications coordinator with the Minnesota
Environmental Public Health Tracking program. She has a Masters in Business
Communications and has worked for over 20 years in both the public and non-profit
sector in project management of research and training grants, communications and
marketing strategies, focus groups and evaluations of educational needs of public health
professionals. She serves on 3 institutional review boards which specialize in academic
research, oncology research, and overall clinical research.
Paula Lindgren, MS, received her Master of Science degree in Biostatistics from the
University of Minnesota. She works for the Minnesota Department of Health as a
biostatistician, and provides statistical and technical support to the MN EPHT and
Biomonitoring programs for data reports, publications, web-based portal dissemination
and presentations in the Chronic Disease and Environmental Epidemiology section. Ms.
Lindgren has also received training in the area of GIS for chronic disease mapping and
analysis. In addition to her work for MN EPHT, she works for various programs within
Chronic Disease and Environmental Epidemiology including the Asthma program,
45
Center for Occupation Health and Safety, Minnesota Cancer Surveillance System, and
Cancer Control section.
Barbara Scott Murdock, MPH, is the Program Planner for the state Environmental
Public Health Tracking and Biomonitoring (EHTB) program, responsible for leading
strategic planning and communications with stakeholders and the EHTB Advisory Panel.
She is a biologist and public health professional by training and has over 30 years of
experience in writing and editing professional publications. Recently a grants
coordinator/writer for social science faculty at the University of Minnesota, she also
served as the biomonitoring project manager at the Minnesota Department of Health
(2001-2003); senior research fellow in the Center for Environment & Health Policy,
UMN School of Public Health (1995-2001); director of water and health programs at the
Freshwater Foundation (1991-1992); and founding editor of the Health & Environment
Digest, a peer-reviewed publication for environmental health and management
professionals in the US and Canada (1986-1992). She holds a BS in biochemistry from
the University of Chicago, an MA in zoology from Duke University, and an MPH from
the University of Minnesota.
Jessica Nelson, PhD, is an epidemiologist with the Minnesota Environmental Public
Health Tracking and Biomonitoring Program, working primarily on design, coordination,
and analysis of biomonitoring projects. Jessica received her PhD and MPH in
Environmental Health from the Boston University School of Public Health where her
research involved the epidemiologic analysis of biomonitoring data on
perfluorochemicals. Jessica was the coordinator of the Boston Consensus Conference on
Biomonitoring, a project that gathered input and recommendations on the practice and
uses of biomonitoring from a group of Boston-area lay people.
Jeannette M. Sample, MPH, is an epidemiologist with the Minnesota Environmental
Public Health Tracking program at the Minnesota Department of Health, working
primarily with the collection and statistical analysis of public health surveillance data for
EPHT. She also works on research collaborations with academic partners relating to
reproductive outcomes and birth defects. Prior to joining EPHT, she was a CSTE/CDC
Applied Epidemiology Fellow with the MDH Birth Defect Information System. Jeannette
received her Masters degree in epidemiology and biostatistics from The George
Washington University in Washington, DC.
Blair Sevcik, MPH, is an epidemiologist with the Minnesota Environmental Public
Health Tracking (EPHT) program at the Minnesota Department of Health, where she
works on the collection and statistical analysis of public health surveillance data for
EPHT. Prior to joining EPHT in January 2009, she was a student worker with the MDH
Asthma Program. She received her Master of Public Health degree in epidemiology from
University of Minnesota School of Public Health in December 2010.
Naomi Shinoda, MSPH, is an epidemiologist at the Minnesota Department of Health,
where she works on surveillance of carbon monoxide poisonings and conducts analyses
relating air pollution and adverse respiratory and cardiovascular health outcomes. She has
46
international work experience, most notably from her Peace Corps service as a science
and environmental educator at the Palau Environmental Quality Protection Board in the
Republic of Palau. Ms. Shinoda holds a M.S.P.H. degree in epidemiology from Emory
University and a B.S. in molecular biology and music from Yale University.
Dave Stewart MPH, is the Program Consultant for MDH’s Environmental Public Health
Tracking Program, where he oversees content development, layout, and design for the
MPH Data Portal. He also develops and delivers demonstrations and trainings of the
Web Portal for key data users and stakeholders. Dave has a Master of Public Health
degree with a concentration in Health Behavior and Health Education. Prior to working
at MDH, Dave worked at the Suicide Prevention Resource Center, providing technical
assistance to Federal Suicide Prevention Grantees on developing comprehensive suicide
prevention programs. He has experience in web development, training design, and health
program planning. Dave is also working on a community level collaboration with
Hennepin County.
Chuck Stroebel, MPH, is the MN EPHT Program Manager. In this capacity, he
provides day-to-day direction for program activities, including: (i) development and
implementation of the state network, (ii) development and transport of NCDMs and
metadata for the national network, and (iii) collaboration and communication with key
EPHT partners and stakeholders. Chuck received a Masters of Public Health in
Environmental Health Sciences from the University of North Carolina (Chapel Hill). He
has over 15 years of expertise in environmental health, including areas of air quality,
pesticides, climate change, risk assessment, and toxicology. In addition, Chuck played a
key role in early initiatives to build tracking capacity at the Minnesota Department of
Health. Currently, Chuck is a member of the IBIS Steering Committee (state network),
the MDH ASTHO Grant Steering Committee (climate change), and the Northland
Society of Toxicology. He also serves on the MN EPHT Technical and Communications
Teams.
Allan N. Williams, MPH, PhD, is an environmental and occupational epidemiologist in
the Chronic Disease and Environmental Epidemiology Section at the Minnesota
Department of Health. He is the supervisor for the MDH Center for Occupational Health
and Safety, which currently includes both the state-funded and federally-funded
Environmental Public Health Tracking and Biomonitoring programs. For over 25 years,
he has worked on issues relating to environmental and occupational cancer, cancer
clusters, work-related respiratory diseases, and the surveillance and prevention of workrelated injuries among adolescents. He has served as the PI on two NIOSH R01 grants
and as a co-investigator on four other federally-funded studies in environmental or
occupational health. He is also an adjunct faculty member at the University of Minnesota
School of Public Heath. He received an MA degree in Biology from Indiana University
and an MPH degree in Environmental Health and Epidemiology from the University of
Minnesota, and his PhD in Environmental and Occupational Health from the University
of Minnesota
47
Minnesota Department of Health (MDH)
Environmental Health Tracking & Biomonitoring
Advisory Panel Meeting Summary
June 7, 2011
Advisory panel members – Present: Bruce Alexander, Al Bender, Greg Pratt,
David DeGroote, Tom Hawkinson, Cathi Lyman-Onkka, Geary Olsen, Cathy VillasHorns, Lisa Yost
Advisory panel members – Regrets:
Fred Anderson, Lisa Heins Nesvold, Pat McGovern
MDH officials and staff: Jeanne Ayers, MJ Levitt, B. Sevcik, J. Sample, P. Rode, J.
Nelson, J. Johnson, C. Stroebel, M. Manning, P. Swedenborg, C. Huset, B. Murdock
Welcome and Introductions
Bruce Alexander, chair, convened the meeting. Barbara Scott Murdock introduced David
DeGroote, a new member of the advisory panel.
New Content Areas for Tracking in Minnesota
MN EPHT staff presented two new content areas for environmental health tracking in
Minnesota:
Environmental tobacco smoke exposure (ETS), a content area selected through a
rigorous, multi-phase process: exploration, feasibility, recommendation, and
implementation.
Arsenic in private wells, a content area in the exploration phase.
ETS as a new content area
In the March 2011 Advisory Panel Meeting, EPHT staff Blair Sevcik and Jeannette
Sample presented details of a refined selection process for new Minnesota-specific
content areas, using ETS Exposure. Because the panel had no quorum that day, a motion
to adopt ETS as a new content area was postponed. The first item of business for the June
2011 meeting was thus to vote on recommending ETS as a new content area for the
tracking program.
Blair Sevcik briefly reviewed the rationale for choosing exposure to environmental
tobacco smoke (ETS), as measured by surveys of youths and adults, as a new content
area for environmental health tracking. The rationale for choosing this content area,
detailed in the June 7, 2011 Advisory Panel Meeting book, arises out of data-driven
consideration of these factors:
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Phase I: Exploration
Prevalence (significant proportion of population exposed)
Causality (evidence that exposure causes disease)
Actionability (prevention/control programs, policies, regulations, personal
actions, government public health objectives)
Public health impact (population attributable risk; costs of treatments)
Feasibility (data sources, legal authority, protection of private data)
Phase II: Feasibility
Detailed feasibility (data quality, continuity, timeliness, & comparability; ability
to aggregate data at different geographic areas; low cost to obtain data)
Phase III:
Recommendations
Emerging issues (exposure trends)
Potential for information building (unknown exposure level or health outcomes)
Interest from other MDH programs
Outside interest/public concern
Balance among content areas (hazard/exposure and disease)
Discussion of ETS as a new content area
Geary Olsen asked whether cigarette smoking was a content area for Minnesota tracking,
and why ETS exposure should precede cigarette smoking. Blair said that adult cigarette
smoking is well documented in other databases, such as the Behavioral Risk Factor
Surveillance Survey (BRFSS), and that we propose to use ETS exposure differently, as
ETS exposure among non-smokers. In short, Bruce said, ETS is an involuntary exposure,
rather than a voluntary behavioral risk factor. As no one raised other questions, Greg
Pratt moved that the panel recommend to the Commissioner that the ETS Exposure
content area be adopted and implemented as part of the Tracking program. Eight panel
members voted in favor, joining two panel members who had voted yes in absentia. One
panel member voted against, and one could not be reached for a vote. The motion
passed.
Arsenic as a new content area
Jeannette Sample reviewed the Phase I (Exploration) information collected for
considering arsenic in private wells in Minnesota as new content for environmental
tracking. She noted that, although it is unclear whether MDH will have the resources to
continue this content area after July 1, 2011, staff time is available for this work if normal
resources are available. The prevalence of potential exposure is high. One million
Minnesotans have private wells, and 10.5% of new wells tested for arsenic since August
2008 exceeded the 10µg/L standard; 56% showed no detectable arsenic (Level of
Detection = 2µg/L). Some groundwater in Minnesota has arsenic levels at high as
150µg/L.
Evidence for causality is clear. Arsenic’s health effects depend on its chemical form,
route of exposure, dose, half-life in the body, and on the exposed person’s health.
Arsenic is not only a carcinogen, but can also cause non-carcinogenic problems. Fatal
arsenic doses are around 60,000 µg—far higher than natural concentrations in the
environment. But over time, daily consumption of lower levels of arsenic in drinking
49
water, combined with the arsenic found in foods, can produce harmful effects. Someone
who primarily drinks water containing 100µg/L over a lifetime can develop nervous
system disorders, diabetes, and some circulatory diseases. Levels below 100µg/L may
cause nervous system problems, skin problems, high blood pressure, and reduced
intelligence in children.
Actionability. Community water supply systems must meet the EPA drinking water
standard for arsenic (10µg/L). Minnesota has no enforceable standard for arsenic in
private wells, but beginning in 2008, MDH’s Well Management Program requires that all
new wells be tested for arsenic, and advises private well owners to reduce arsenic
exposure by drilling a new well, connecting to a community water system, or adding
water treatment systems with arsenic removal media. Reducing toxic arsenic exposure in
drinking water is among the Healthy People 2020 Environmental Health Objectives.
Publishing and mapping data for this new content area will support the creation of public
outreach programs, drilling and well-construction recommendations, and identify special
well construction areas. The MDH database does not catch older wells, but one MDH
study has measured how much well water people were drinking, and counties also gather
data on what people are drinking. Larry Souther said that MDH would like to get county
data so we could add data for older wells to the MDH database. Tom Hawkinson
commented that it might be good to find funding to get those data.
Larry reviewed the estimated public health impact of private wells with water containing
3µg/L arsenic. The estimated cancer risk is 3-10 additional lung or bladder cancers in a
population of 10,000. Health impacts of arsenic are found at levels below the EPA
standard of 10 µg/L. MCLs, but this standard is not based only on health impact but also
on the technical feasibility of removing the chemical from water, the analytical detection
limit, and the economic impact of regulating the contaminant.
Obtaining reliable well and arsenic data is feasible because the Minnesota Geological
Survey’s County Well Index, containing data on local wells’ depth, stratigraphy/geology,
and other factors, is joined with MDH’s Well Management database, which contains
arsenic data on all new wells drilled since 2008, though not on older wells. All of these
data are public.
Discussion of arsenic as a content area - Jeannette Sample, MDH EHTB, and Larry
Souther, MDH Environmental Health
In answering questions from Tom Hawkinson and Greg Pratt about arsenic’s geographic
distribution and whether arsenic in wells occurs naturally, Larry Souther explained that
arsenic’s occurrence and distribution is the result of glacial activity. In Minnesota,
arsenic occurs primarily in the Des Moines lobe in central and western Minnesota. This
layer of glacial till overlies an aquifer with high arsenic content; some aquifers at the
edge and below have lower levels. Although arsenic typically occurs in central and
western Minnesota, the CDC has found it throughout the state. Arsenic distribution in the
state is analogous to radon, Larry noted: one house may have arsenic in the well, and the
next may not. Jeannette added that Jim Lundy, in Environmental Health, said that the
arsenic content in well water depends both on geography and on the depth of the well.
50
When asked whether it would it make sense to have maps of the geographic areas, she
said that the tracking program plans to produce maps and graphs later during the
feasibility phase, and that arsenic in private wells is simply a hazard indicator, rather than
a measure of population exposure.
MDH tells well drillers where they are likely to find higher and lower arsenic levels. If a
well is intended to provide public water, MDH can rule out using a high arsenic aquifer.
For private wells, MDH informs citizens about choosing the best spots to drill a well and
advises them on ways to mitigate arsenic contamination. Arsenic mitigation is expensive,
Larry noted; ion exchange usually does not work well, but reverse osmosis removes
arsenic effectively.
The estimate of cancer cases from drinking arsenic in well water led to lively discussion.
Greg Pratt asked whether the public health impact estimate was based on someone
drinking well water all the time. Jeanette answered that the number came from the
National Research Council, which reviewed and revised EPA estimates, and was based
on a standard risk assessment assumption, in which someone drinks 2 liters/day for a
lifetime. Greg Pratt clarified the estimate, saying that the estimate calculation is based on
a population of 10,000 that is exposed at that concentration. Moreover, Greg added, from
a population perspective in Minnesota, this estimated number is not significant compared
to overall cancer risk, but for exposed individuals, it is important. Lisa Yost agreed,
adding that anyone who uses the estimate must make sure that people understand the
denominator [so they realize that the denominator population is all exposed at that level].
Al agreed, noting that because the extrapolation of a health risk statement to cancer in a
community is always difficult, we must be careful how we articulate statements of risk.
Lisa added, if you find many wells at the 100 level (50 to 100 range), and it seems that
you might, it would be important to include this content in Tracking.
Geary Olsen asked about how a private well owner would test for arsenic. Who pays for
it? And whose data is it? What disclosure must an owner do if the water contains more
than 10µg/L? In short, are the data public or private? Larry answered that land owners
who hire a well tester pay for the tests themselves and own the data. If MDH tests the
well, the data become public data coming from the well. If the Department of
Agriculture tests it under certain programs, then it’s private data. Real estate sales do not
require disclosure of the sample results, but if someone sells the land, the seller must
disclose that wells are on the property, whether they are open or sealed. Often, the sale is
contingent on the buyer having samples tested and making sure that local water is
available.
At the end of the discussion, Bruce Alexander suggested that the team spend more time
on actionability of arsenic information in the Phase II planning.
Tracking Updates
Chuck Stroebel enhanced the Tracking Update in the panel book with a short report of
the May 26 public launch of the Minnesota Public Health Data Access (MNPH Data
Access), an electronic gateway to Minnesota health and environment data. MNPH Data
Access is part of a national initiative led by the Centers for Disease Control and
51
Prevention (CDC) to close the information gap in what is known about the impact of
environmental hazards on public health.
Local public health professionals, the public, and others can use MNPH Data Access to
gather information about health and environment trends over time, and to query state and
county-level data in Minnesota about diseases and illnesses, such as asthma, cancer and
heart attacks. MNPH Data Access currently includes data on ten topics: air quality,
asthma, heart attacks, childhood lead poisoning, carbon monoxide poisoning,
reproductive outcomes, cancer, birth defects, drinking water quality, and chronic
obstructive pulmonary disease. This summer, MNPH Data Access will add new data and
tools, including GIS maps.
Minnesota, along with 22 states and New York City, receives CDC grant funding to
improve what is known about the environment's impact on public health by building state
tracking networks.
CDC Biomonitoring Communications Evaluation Project
Jean Johnson introduced Claudia Vousden, a communications researcher from CDC.
Claudia joined the meeting by phone to present findings from a case study of the
communications efforts in the PFC pilot biomonitoring study in Minnesota. The section
overview and study abstract in the Panel book outline the study’s purpose, background,
methods, results, and conclusions. Jean showed the PowerPoint during the
teleconferenced presentation.
Key stakeholders in the study and intended audiences for the communications plan,
included:
State legislators
Other state and local government agencies
Industry
Environmental advocacy groups
Members of affected communities
Study participants
Health care providers
The study’s initial communication goals were to:
Increase awareness of the study plan
Increase understanding of the study’s purpose and limitations
Tell people how to find more information
To engage people to
 Collaborate or offer suggestions
 Encourage healthcare providers to participate in information sessions
 Encourage community members to take part in the study
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The key messages were:
 The study’s purpose is to characterize exposure to PFCs in the population.
 The study won’t provide information about relationships between PFCs and
current or future health effects.
Additional communication needs included:
Demonstrating to legislators how the PFC study would meet constituents’ needs
and how biomonitoring can be useful to future policy decisions.
Engaging healthcare providers in interpreting biomonitoring results, making
advice about reducing or avoiding exposure available to patients, and addressing
questions about health effects.
Explaining to community members and environmental advocates why the study
 Excluded children
 Limited the number of study participants
 Selected a random sample from the study population
With the release of the pilot biomonitoring results, the communication goals focused,
first, on telling individuals and their communities their PFC levels and emphasizing that
the health implications of these levels are neither known nor understood. Other major
goals were to fulfill the legislative mandate and demonstrate the value of PFC
biomonitoring to public health.
Responses to the communication efforts were largely favorable: constituent calls to
legislators dropped significantly, and most study participants said they understood that
the results could not predict current or future health effects. But they—and their
legislators—were still unhappy with the lack of information about health effects.
Nevertheless, study participants valued the follow-up biomonitoring study and
communication.
The lessons for public health
Transparency, openness, and availability are key to facilitating communication, but
public health staff must reinforce the message that measurement of exposure is not a
health study at every step. Moreover, they must realize that communities expect follow
up and continuing communication beyond the study. One person said, “I look forward to
communications from the State of Minnesota on any updates on the facts of what they
find. I feel some level of comfort knowing that the State has an eye on what’s
happening… and that level of concern…”
Nevertheless, study participants still wonder whether exposure will affect their future
health, and struggled to understand the fact sheets and letters that accompanied their
results. As a study participant said about the letter, “It’s very informative, but it doesn’t
tell me anything… it strikes me that these… are written by very well meaning people
who talk about this every day with other people who understand it… When they try to
write for the general public, they write like they are writing to their co-workers… and
that’s the problem.”
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Biomonitoring Updates
PFCs and Lake Superior Mercury
The East Metro PFC Biomonitoring Follow up (PCF2) Project Update and the Lake
Superior Mercury in Newborns Project are described in the Panel book. In a further
update to the PFC2 study, Jessica Nelson explained that the current plan is to send
individual results in a letter to study participants this summer, before the next Advisory
Panel meeting. Participants will also receive their 2008 result and the NHANES results.
The other option is to wait until the next meeting, but people are anxious to know their
results. Al Bender asked whether the participants’ exposures are falling. Jean Johnson
replied that we don’t have the results from the lab yet. Jessica added that we can’t send
out the results until we are sure we have the right numbers. Panel members discussed
whether it would be good to use a study group geometric mean or median to give
participants a sense of where they stood in relation to the other participants. Geary Olsen
questioned what the MDH response might be if the press asked for more information.
The panel agreed that it would be best if the individual findings could be sent to the
participants with geometric means or other measures that would enable participants to
compare their results with the rest of the group, not just with NHANES.
Riverside Prenatal Biomonitoring Pilot Project
Jessica Nelson introduced Logan Spector, associate professor in Pediatric Epidemiology,
University of Minnesota, and then presented an overview of this pilot project, which was
ancillary to Logan’s larger research study. She briefly reviewed the rationale for the
study (measurement of cotinine, a biomarker for tobacco exposure, and environmental
phenols, used in plastics and personal care products), methods, and data collection, and
then presented preliminary summary results for cotinine, bisphenol A (BPA), and four
parabens.
Jessica reviewed the data in Tables 1-3 in the panel book. Table 1 describes the
characteristics of the pilot project population. The 66 participants were spread relatively
similarly across the income spectrum from 10 people (15%) with incomes below
$10,000/year, through 11 people in the $80,000 to $100,000/year income range and 16
participants in the highest range, >$100,000. Most participants were white (70%), while
the rest of the participants self-identified as non-white: black/African American (12%),
Hispanic/Latina (6%), Asian (6%), and Other (Eastern European, South African, Russian
Jewish, 5%).
Limits of detection (LOD) in cotinine. In reviewing the cotinine data, Jessica raised a
concern. The LOD for urinary cotinine in this group was 20 ng/ml, but other studies have
shown that non-smokers who live with a smoker have a lower geometric mean: 11.4
ng/mL. The pilot study results thus could identify 9 women who were active smokers,
using the MedTox definition (cotinine + nicotine > 200ng/mL), and one as either a light
smoker or as exposed to ETS. The other 56 women (85% of the group) had no detectable
urinary cotinine, but because the LOD was above mean ETS exposure levels, it is
possible that some non-smoking Riverside women were exposed to ETS.
54
Overall, the percentage of the women who were classified as active smokers (14%) was
similar to the percentage found in other studies, the 1999-2006 NHANES (13%) and the
MN PRAMS survey (13.8%). Women with lower household incomes were more likely
to have detectable cotinine.
Table 2 shows results for the environmental phenols (BPA, methyl paraben (MePb),
propyl paraben (PrPb), and ethyl and butyl parabens), adjusted and not adjusted for
creatinine, a measure of urine dilution. Jessica also showed the panel a graphical way of
displaying the biomonitoring data based on research done at UC Berkeley and the Silent
Spring Institute on how to communicate results most effectively to participants in
community studies. Overall, despite the limitations of a small pilot study, BPA levels in
these women were similar to those found in NHANES and other studies that measured
BPA in pregnant women. Levels of MePb and PrPb found in this project were lower than
those found in NHANES. Table 4 in the Panel book lists findings from NHANES and
other studies.
Jessica then discussed differences in phenol levels by income and race/ethnicity. Table 3
displays the geometric means for BPA, MePb, and PrPb in three income ranges
(<$20,000/year, $20-80,000/year, >$80,000/year) and for non-white vs. white ethnicity.
She also showed bar graphs with these results.
These graphs illustrate higher BPA and MePb levels in low income women compared to
middle and higher income women, though the sample size was small and the results not
statistically significant. For MePb and PrPb, and particularly for MePb, levels were
higher in non-white women compared to white women. Jessica showed results from a
paper on parabens in NHANES 2003-2004 that found similar differences by
race/ethnicity, with Non-Hispanic Blacks having markedly higher levels than NonHispanic Whites. Mexican Americans also had higher levels than Non-Hispanic Whites.
Limitations of the study
Small size (66 pregnant women out of 122 who were told about the study)
Study did not meet its goal to recruit three racial/ethnic groups equally (initial
goal was to recruit 30 women in three ethnicities: African American, white,
Hispanic)
Women identified as “non-white” in analysis by income and race/ethnicity
represented several different ethnic/racial backgrounds
Urine samples were self-collected at home (each woman provided one spot urine
sample), which increased the variability among women
Limits of detection (LOD) limited some conclusions that could be drawn, both for
cotinine and environmental phenols
Because of the chemicals’ short half-lives in the body, these analytes show
substantial variability
Questions for Advisory Panel Discussion
Do Panel members agree with the data analysis and interpretation presented? Are
additional analyses recommended?
55
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?
Do Panel members agree with the following approaches to data analysis?
1. 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?
Analysis of non-detect values. Jessica asked panel members for advice in handling non-
detection values in the environmental phenols data. Different studies use different
approaches in assigning a value to biomonitoring measurements below the limit of
detection (LOD). The most common approach, used by NHANES, is to use LOD/sqrt210;
other investigators use LOD/2. Because the LODs for 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 1µg/L; the LOD in NHANES is
0.4µg/L. The BPA geometric mean (GM) presented in Table 2 differs according to
which non-detect value is used: with LOD/sqrt2, GM = 2.5µg/g; with LOD/2, GM =
2.2µg/g; with the NHANES non-detect value, GM = 1.7µg/g. These preliminary analyses
used LOD/2.
Greg Pratt strongly recommended against censoring the data. Instead, he advocated using
all of the data, including data below LOD. He recommended a software program
(ProUCL) designed for low detect data and suggested using statistical tests and methods
for calculating central tendencies and best fit. He also suggested displaying the data with
box charts, which can indicate confidence limits, medians, quartiles, and other measures.
Al Bender suggested non-parametric tests for analyzing <LOD data (Kolmogorov–
Smirnov, Wilcoxon). Lisa Yost commented that the Minnesota Department of
Agriculture often has to use data that are < LOD. In this case, laboratory chemist Carin
Huset said, the lab did not report data below LOD for the phenols because the urine
samples were complex and difficult, and the signal-to-noise ratio in the samples was too
high.
Geary Olsen commented that the approach (LOD/2 or LOD/sqrt2) does not matter as
long as the difference is less than the LOD. Both simply use a constant.
Exclusion based on creatinine values. Because urine varies in concentration, laboratories
typically report the creatinine concentration in urine to allow analysts to adjust for
dilution. Creatinine, a normal constituent in urine, is a metabolic product of muscle
tissue. Some analyses exclude samples with creatinine values below a certain level, such
as 20mg/dL.11 The reasoning is that low creatinine values may inflate results because the
analyte is divided by creatinine for the creatinine-adjusted concentration. Results from
10
Square root of 2.
Wolff et al. Prenatal phenol and phthalate exposures and birth outcomes. Environ Health Perspect. 2008
Aug;116(8):1092-7.
11
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two participants, for example, have BPA <LOD, but have very different creatinineadjusted concentrations: Participant A (creatinine=10) = 5.0µg/g; participant B
(creatinine=116) = 0.43µg/g. Low creatinine values inflate the adjusted results.
The preliminary analyses did not exclude the five participants with creatinine <20 mg/dL,
and panel members agreed with that decision.
Presentation of results by income and race/ethnicity. The panel raised no objections to
reporting these results. Lisa and Bruce recommended that appropriate caveats be made
clear about the study’s small size, and about such factors as variations in the samples as a
result of the chemicals’ short half-life in the body.
Further biomonitoring for these or other compounds in this population. Given the high LOD
for cotinine, Bruce commented that he couldn’t see the point of testing for cotinine if the
lab can’t get a lower LOD; [with this LOD] it isn’t possible to detect exposure to ETS.
Greg said it is hard to draw conclusions because of the pilot study’s small sample size.
One would need to look at a larger sample size and lower LOD.
Geary Olsen said that one reason the project chose Riverside was to get minority
populations, yet the pilot project had trouble recruiting them. He asked whether a
different method might get better recruitment in that population. Logan Spector, PI of
the larger University of Minnesota Riverside Birth Study (RBS), explained that the pilot
was a sub-set of the main study population, and only women who were willing to have to
have future contact were sent information about the pilot project. He believes that if the
project had only asked women in a clinic for a spot urine sample, participation would
have been better.
Logan also addressed specific barriers to recruiting Somali women, one of the aims of the
larger RBS. These included a lack of adequate recruiting staff, the patriarchal culture, and
functional illiteracy (oral tradition).
Phase II Strategic Planning for an MDH Biomonitoring Program
Barbara reviewed current strategic planning for an MDH biomonitoring program. Phase
II builds on earlier Phase I planning that established the vision, framework, long-term
goal, and approach to biomonitoring. Phase II asks stakeholders to identify priorities for
study. Ultimately, it will lead to a plan for an ongoing biomonitoring program at MDH
that includes several specific and potentially fundable initial projects. Using a standard
set of questions, the biomonitoring planning team began meeting with key stakeholders in
April. Stakeholder meetings will continue this summer, depending on resources.
To date, the staff have met with faculty members at the University of Minnesota, local
advocacy groups, and environmental directors in the LPHA (Local Public Health
Association) and the LPHA’s Committee on Policy and Practice (Table 1). These
stakeholders have suggested target populations, priority chemical classes, sources for
funding, and health outcomes of interest (Table 2). Suggested potential funders,
collaborations, and partnerships are in Table 3.
57
Table 1. Stakeholder Meetings
UMN Academic Stakeholders
Health & Environmental Advocacy Groups
LPHA
Environmental Health Sciences
Bruce Alexander
Pat McGovern
UMN Epidemiology
David Jacobs
Jose Suarez
Ruby Nguyen
Pediatric Epidemiology
Logan Spector
Healthy Legacy
Kathleen Schuler, IATP; Healthy Legacy
co-leader
Kim LaBo, Clean Water Action; Healthy
Legacy organizer
Julia Earl, Preventing Harm Minnesota;
Healthy Legacy member
Minnesota Center for Environmental Advocacy
Scott Strand, director
Allison Wolf, legislative liaison
Staff
Environmental health
directors
Committee on Policy &
Practice
Table 2. Stakeholder Suggestions
Target populations
Pregnant women, infants,
& children
Disadvantaged populations
Fish-eating populations
Rural/agricultural
populations
Men
Priority chemicals & data needs
Health outcomes
MN Chemicals
Endocrine disrupting chemicals
Pesticides
Heavy metals
MN reference data
NHANES-like data specific to MN
Assessment of exposure-reducing policies
Other data needs
MN data should be published in peerreviewed journals
Reproductive health
Developmental
disabilities
Neurobehavioral
disabilities (e.g.,
autism)
Allergies
Table 3. Potential Funders, Collaborations, and Partnerships
Potential funders
NIEHS (Partnerships for Environmental
Public Health, if available)
Foundations interested in health (e.g.,
Robert Wood Johnson Foundation)
CDC (if grants available)
Potential Collaborators or Partners
Research projects at UMN
Follow up or collaboration on existing studies
NCS (National Children’s Study sub-programs)
Food Safety Act (focuses on microbial contaminants;
could address pesticides)
TIDES (The Infant Development & Environment Study)
Health plans/foundations (BCBS, Health Partners Fdn)
Discussion
Criteria for identifying specific target populations
Greg Pratt suggested that the biomonitoring program focus on vulnerable & at risk
populations. To resolve the question of how to set vulnerability or risk factor criteria, he
suggested using cumulative levels and effects analysis, which attempts to take account of
all exposures and effects analysis of known hazards, plus the health status of the
community. The MPCA developed ways to assess the cumulative levels of
environmental hazards and their effects on communities at Representative Karen Clark’s
58
behest. [The MPCA link to “Cumulative Impacts Air Permitting in South Minneapolis
is:” http://www.pca.state.mn.us/index.php/air/air-permits-and-rules/air-permits-andforms/air-permits/cumulative-impacts-air-permitting-in-south-minneapolis.html. A
background document reviews hazard/exposure/health indicators for the community and
includes demographics and data sources at http://www.pca.state.mn.us/index.php/viewdocument.html?gid=14030 ].
Lisa Yost suggested that the criteria used in selecting new content areas for tracking offer
a good model, as they ask for data on such factors as prevalence, causality, actionability,
and detectability. Cathi Lyman-Onkka cautioned that the program should not decide to
investigate an area simply because it’s easy to obtain the data.
Geary Olsen raised a concern that people interested in biomonitoring may not appreciate
the relationship between absorption and clearance of chemicals in the body, particularly
clearance of chemicals at low-level concentrations in the body. He pointed out that an
individual or a specific population may have physiological characteristics
(pharmacokinetics, toxicokinetics) that affect clearance of certain chemicals. He
recommended looking at Matthew Longnecker’s work for a discussion of
pharmacokinetics. [Longnecker is in the biomarker epidemiology group at NIEHS].
Bruce noted that the choice of target populations will drive which partnerships and
collaborations are possible. Cathi advised MDH to look at questions that we identify as
being important to ask and to take available funding into account.
David DeGroote asked whether the Advisory Panel can take a more proactive approach
to choosing a population, rather than waiting for a community to push for it. Noting that
MDH identified three biomonitoring approaches (statewide population exposure tracking,
targeted population exposure tracking, and special investigations in response to public
concerns), he asked what the special investigations involved. Barbara said that the PFC
and arsenic pilot studies were examples, as legislators in those communities were very
aware of public concern about the exposures. David asked, which communities would
we choose in such situations? In the case of concern over pregnant mothers who eat fish
that contain high mercury levels, is there enough interest in the community to drive the
study, or do the Advisory Panel and MDH decide? Al commented that we have
significant areas of concern other than the fears of specific communities, but
acknowledged that, often, sociology drives the decision.
Legislative Update
Jean Johnson gave the legislative update. Although funding cuts and a government
shutdown loom, she said that the EHTB program is still planning for the future. One
possibility is that the legislature will fund the biomonitoring program only to finish the
PFC pilot, although we all recognize that there are other significant areas of concern.
The tracking program currently has CDC funding.
The meeting adjourned at 4:00 PM.
Finalized August 22, 2011
59
ENVIRONMENTAL HEALTH TRACKING AND
BIOMONITORING STATUTE
$1,000,000 each year is for environmental health
tracking and biomonitoring. Of this amount,
$900,000 each year is for transfer to the
Minnesota Department of Health. The base
appropriation for this program for fiscal year
2010 and later is $500,000.
144.995 DEFINITIONS;
ENVIRONMENTAL HEALTH TRACKING
AND BIOMONITORING.
(a) For purposes of sections 144.995 to
144.998, the terms in this section have the
meanings given.
(b) "Advisory panel" means the
Environmental Health Tracking and
Biomonitoring Advisory Panel established under
section 144.998.
(c) "Biomonitoring" means the process by
which chemicals and their metabolites are
identified and measured within a biospecimen.
(d) "Biospecimen" means a sample of human
fluid, serum, or tissue that is reasonably
available as a medium to measure the presence
and concentration of chemicals or their
metabolites in a human body.
(e) "Commissioner" means the commissioner
of the Department of Health.
(f) "Community" means geographically or
nongeographically based populations that may
participate in the biomonitoring program. A
"nongeographical community" includes, but is
not limited to, populations that may share a
common chemical exposure through similar
occupations, populations experiencing a
common health outcome that may be linked to
chemical exposures, populations that may
experience similar chemical exposures because
of comparable consumption, lifestyle, product
use, and subpopulations that share ethnicity, age,
or gender.
(g) "Department" means the Department of
Health.
(h) "Designated chemicals" means those
chemicals that are known to, or strongly
suspected of, adversely impacting human health
or development, based upon scientific, peerreviewed 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, peerreviewed studies of humans, animals, or cells
have demonstrated that the chemical is known or
reasonably anticipated to adversely impact
human health.
(j) "Environmental health tracking" means
collection, integration, analysis, and
dissemination of data on human exposures to
chemicals in the environment and on diseases
potentially caused or aggravated by those
chemicals.
144.996 ENVIRONMENTAL HEALTH
TRACKING; BIOMONITORING.
Subdivision 1. Environmental health
tracking. In cooperation with the commissioner
of the Pollution Control Agency, the
commissioner shall establish an environmental
health tracking program to:
(1) coordinate data collection with the
Pollution Control Agency, Department of
Agriculture, University of Minnesota, and any
other relevant state agency and work to promote
the sharing of and access to health and
environmental databases to develop an
environmental health tracking system for
Minnesota, consistent with applicable data
practices laws;
(2) facilitate the dissemination of aggregate
public health tracking data to the public and
researchers in accessible format;
(3) develop a strategic plan that includes a
mission statement, the identification of core
priorities for research and epidemiologic
surveillance, and the identification of internal
and external stakeholders, and a work plan
describing future program development and
addressing issues having to do with compatibility
with the Centers for Disease Control and
Prevention's National Environmental Public
Health Tracking Program;
(4) develop written data sharing agreements as
needed with the Pollution Control Agency,
Department of Agriculture, and other relevant
state agencies and organizations, and develop
additional procedures as needed to protect
60
individual privacy;
(5) organize, analyze, and interpret available
data, in order to:
(i) characterize statewide and localized trends
and geographic patterns of population-based
measures of chronic diseases including, but not
limited to, cancer, respiratory diseases,
reproductive problems, birth 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.
61
(b) Following the conclusion of the pilot
program, the commissioner shall:
(1) work with the advisory panel to assess the
usefulness of continuing biomonitoring among
members of communities assessed during the
pilot program and to identify other communities
and other designated chemicals to be assessed
via biomonitoring;
(2) work with the advisory panel to assess the
pilot program, including but not limited to the
validity and accuracy of the analytical
measurements and adequacy of the guidelines
and protocols;
(3) communicate the results of the pilot
program to the public; and
(4) after consideration of the findings and
recommendations in clauses (1) and (2), and
within the appropriations available, develop and
implement a base program.
Subd. 3. Participation. (a) Participation in the
biomonitoring program by providing
biospecimens is voluntary and requires written,
informed consent. Minors may participate in the
program if a written consent is signed by the
minor's parent or legal guardian. The written
consent must include the information required to
be provided under this subdivision to all
voluntary participants.
(b) All participants shall be evaluated for the
presence of the designated chemical of interest as
a component of the biomonitoring process.
Participants shall be provided with information
and fact sheets about the program's activities and
its findings. Individual participants shall, if
requested, receive their complete results. Any
results provided to participants shall be subject
to the Department of Health Institutional Review
Board protocols and guidelines. When either
physiological or chemical data obtained from a
participant indicate a significant known health
risk, program staff experienced in
communicating biomonitoring results shall
consult with the individual and recommend
follow-up steps, as appropriate. Program
administrators shall receive training in
administering the program in an ethical,
culturally sensitive, participatory, and
community-based manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that
address the science and practice of
biomonitoring to be utilized and procedures for
changing those protocols to incorporate new and
more accurate or efficient technologies as they
become available. The commissioner and the
advisory panel shall be guided by protocols and
guidelines developed by the Centers for Disease
Control and Prevention and the National
Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up
counseling and support; and communicating
findings to participants, communities, and the
general public. The informed consent used for
the program must meet the informed consent
protocols developed by the National Institutes of
Health;
(3) educational and outreach materials that are
culturally appropriate for dissemination to
program participants and communities. Priority
shall be given to the development of materials
specifically designed to ensure that parents are
informed about all of the benefits of
breastfeeding so that the program does not result
in an unjustified fear of toxins in breast milk,
which might inadvertently lead parents to avoid
breastfeeding. The materials shall communicate
relevant scientific findings; data on the
accumulation of pollutants to community health;
and the required responses by local, state, and
other governmental entities in regulating toxicant
exposures;
(4) a training program that is culturally
sensitive specifically for health care providers,
health educators, and other program
administrators;
(5) a designation process for state and private
laboratories that are qualified to analyze
biospecimens and report the findings; and
(6) a method for informing affected
communities and local governments representing
those communities concerning biomonitoring
activities and for receiving comments from
citizens concerning those activities.
(b) The commissioner may enter into
contractual agreements with health clinics,
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
62
serve without compensation but shall be
reimbursed for travel and other necessary
expenses incurred through performance of their
duties. Members appointed by the commissioner
are appointed for a three-year term and may be
reappointed. Legislative appointees serve at the
pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner
shall appoint eight members, none of whom may
be lobbyists registered under chapter 10A, who
have backgrounds or training in designing,
implementing, and interpreting health tracking
and biomonitoring studies or in related fields of
science, including epidemiology, biostatistics,
environmental health, laboratory sciences,
occupational health, industrial hygiene,
toxicology, and public health, including:
(1) at least two scientists representative of
each of the following:
(i) nongovernmental organizations with a
focus on environmental health, environmental
justice, children's health, or on specific chronic
diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a
representative of the University of Minnesota.
(b) Two citizen panel members meeting the
scientific qualifications in paragraph (a) shall be
appointed, one by the speaker of the house and
one by the senate majority leader.
(c) In addition, one representative each shall
be appointed by the commissioners of the
Pollution 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
63
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
64