Minnesota Department of Health
Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting
December 13, 2011
1:00 p.m. – 4:00 p.m.
ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING ADVISORY PANEL MEETINGAGENDA
DECEMBER 13, 2011
Time Agenda item Presenters Description/anticipated outcome 1:00 Welcome and introductions Bruce Alexander Chair Members and audience members are invited to introduce themselves. 1:05 Designing MN Public Health Data Access to Meet Audience Needs Tracking Updates Dave Stewart Discussion item 1:30 Panel members are invited to ask questions and make recommendations for next steps. Information sharing. No presentation. 1:35 Lake Superior Patricia McCann Mercury in Newborns: Project Results 2:10 2:20 Break Lake Superior Jean Johnson Mercury in Newborns project: EHTB Follow up i
Updates on these Tracking program topics are in the meeting materials. Panel members are invited to ask questions about these topics. Discussion item. Presentation of data and analyses from the Lake Superior Mercury in Newborn biomonitoring project. Panel members are invited to ask questions and make recommendations regarding interpretation and communication of these results with the public. Refreshments Discussion item. The panel will be invited to discuss a set of follow‐up questions and topics for further investigation needed to inform EHTB recommendations for future mercury biomonitoring. 3:05 Strategic planning: EHTB and the National Children’s Study Barbara Scott Murdock, Patricia McGovern Discussion item Following Barbara Murdock’s review of the suggested criteria for selecting target populations, Pat McGovern will present biomonitoring plans of the National Children’s Study (NCS) with respect to mercury and other chemicals. Panel members will be asked to respond to the question: How could Minnesota’s EHTB program potentially complement information collected in Minnesota by the NCS in the future? 3:45 Biomonitoring Updates 3:55 New business Jessica Nelson Information sharing. An update of the status of the East Metro PFC Biomonitoring Follow‐up project. 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, March 13, 2012, 1‐ 4 PM American Lung Association 490 Concordia Avenue St. Paul, Minnesota ii
TABLEOFCONTENTS
Agenda ......................................................................................................................... i Table of Contents ........................................................................................................ iii MATERIALSRELATEDTOSPECIFICAGENDAITEMS
Section overview: Section overview: Section overview: Section Overview: Section Overview: Section overview: Section overview: Designing MN Public Health Data Access to Meet Audience Needs ............................................................. 1 MN EPHTracking Updates ....................................................... 5 Lake Superior Mercury in Newborns ..................................... 11 Lake Superior Mercury in Newborns: Questions and Next Steps for EHTB ....................................... 21 Strategic Planning: EHTB and the National Children’s Study ...................................................... 27 Biomonitoring Updates ......................................................... 33 Other information ................................................................. 37 iii
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SectionOverview:DesigningMNPublicHealthDataAccesstoMeet
AudienceNeeds
The MN Public Health Data Access (Portal) offers electronic access to high quality data and information that can be used in the state’s public health program development, policymaking, and program evaluation. To date, staff have tailored the portal primarily to meet the needs of local public health department staff through usability testing, interviews, and other formal and informal qualitative assessments. This presentation describes and demonstrates how staff work with priority audiences to generate feedback for improving the portal’s content and usability. ACTION NEEDED: Panel members are invited to provide comments and suggestions on the portal staff’s approach to assessing audience needs. We ask panel members to consider the questions below. 1) What other audiences might be potential users of the portal? 2) What other state‐specific topic areas might be useful to our priority audiences? 3) What new data displays (e.g., map views, map overlays, zip code‐level data, etc.) might we investigate? 1
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DesigningMNPublicHealthDataAccesstoMeetAudienceNeeds
A primary goal of the MN Public Health Data Access (Portal) is to offer electronic access to high quality data and information that can be used in program development, policymaking, and program evaluation in Minnesota. Local health departments, for example, can use these resources to identify data gaps, assess priorities, develop programs and policies, and evaluate the effectiveness of interventions. To achieve this goal, staff must tailor the Portal to address the specific needs of various organizations and individuals and the barriers that prevent them from using the Portal effectively. A series of key informant interviews with members of the National Association of County and City Health Officials (NACCHO) identified one major barrier: some local health departments have few or no full‐time epidemiologists on staff, and this affects their ability to evaluate and use data. The EPHT program has thus developed the Portal so it addresses the needs of our priority audiences and minimizes barriers to meeting those needs. How we present and package data and information on the Web depends highly on such audience characteristics as:  Job roles (e.g., health educator, program manager, researcher, etc.)  Level of expertise in epidemiology and statistics  Organizational resources (e.g., computer specifications, Internet browsers, desktop software, internet connection speed, etc.)  Proficiency with web technology and desktop applications To create a website tailored to audience needs, the EPHT program follows a strategic communications process. This ensures that the Portal:  Addresses specific audiences.  Has clear objectives for its audiences (i.e., what the Portal will help its audiences accomplish).  Has undergone usability testing and revisions based on audience feedback.  Is evaluated continually to address priority audiences’ changing needs. The EPHT program investigates the needs of its priority audiences, but to date, has primarily tailored the Portal to Minnesota’s local public health departments. Activities to assess what priority audiences require include both formal and informal qualitative assessments of user needs, such as usability testing, meetings and conversations with external (e.g., regional data user groups) and internal (e.g., MDH Office of Performance Improvement) stakeholders, and Portal demonstrations (e.g., Local Public Health Association, Community Health Conference). Usability testing involves one‐on‐one interviews with members of priority audiences, in which testers ask participants to tackle specific tasks on the web site (example: You would like to see the age‐adjusted rate of asthma hospitalizations in Renville County for 2003‐2005. How would you do this?) Testers then observe participants as they try to complete the tasks, asking follow‐
up questions along the way. The goal of usability testing is to assess: 1) how easily participants locate information, and 2) whether they think the messages within the web site are clear and understandable. 3
During stakeholder meetings and Portal demonstrations, facilitators assess audience needs by asking questions of the groups (example: What additional topic areas would you find useful on the Portal? What additional features would help you in your job?) At the December meeting, the EPHT program will share highlights of comments and suggestions from local health departments in Minnesota and ask the Advisory Panel to address the questions below. To view the portal, see: https://apps.health.state.mn.us/mndata/ Questions: 1) What additional audiences might be potential users of the Portal? 2) What state‐specific topic areas might be useful to our priority audiences? 3) What new data displays (e.g., map views, map overlays, zip code‐level data, etc.) might we investigate? 4
SectionOverview:MNEnvironmentalPublicHealthTracking(MN
EPHT)Updates
This section contains updates on the topics below: Cancer Query Cancer Maps National EPHT Network Launches New Content Area: Developmental Disabilities Reproductive and Birth Outcomes Query Air Quality Query 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 in the meeting agenda. 5
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6
TrackingUpdates
Cancer Query MN EPHT has developed a new query for cancer incidence data on MNPH Data Access. Users can find data on the incidence of several types of cancer:  All cancer types combined  Acute lymphocytic leukemia (ALL)  Acute myeloid leukemia (AML)  Bladder cancer  Brain and other nervous system cancer  Breast cancer (female only)  Chronic lymphocytic leukemia (CLL)  Leukemia  Lung and bronchus cancer  Mesothelioma  Non‐Hodgkin lymphoma  Thyroid cancer Users will be able to query state‐level data over the past 20+ years (since 1988) and county‐level data for the past 15 years, in 5‐year increments (1994‐2008). The query enables users to stratify these cancer incidence data by sex and, in some cases, age group. Childhood cancer data are available for 5 types of cancer at the state level. MN EPHT rolled out the new cancer query in November 2011. You can view it at: https://apps.health.state.mn.us/mndata/cancer_query Cancer Maps MN EPHT is developing new interactive maps for cancer incidence data on MN Public Health Data Access. Users will be able to access data on the incidence of 4 types of cancer:  All cancer types combined  Breast cancer (female only)  Lung and bronchus cancer  Mesothelioma Users will be able to view incidence data at the county level in three 5‐year increments (2004 – 2008, 1999 – 2003, and 1994 – 1998), with the exception of mesothelioma (which will be available at the regional level). The data will also be broken down into male, female, and both sexes combined for all types of cancer except for breast cancer, which will be displayed by age group (0‐49 years and 50+ years). The cancer interactive maps will have similar functionality to the asthma hospitalization and childhood lead poisoning maps currently on the MN Public Health Data Access website. MN EPHT plans to have the maps in production by January 2012. 7
National EPHT Network Launches New Content Area: Developmental Disabilities The National EPHT Network is preparing to launch a new content area, developmental disabilities, in December 2011. Measures include: (1) the prevalence of autism at age 8 (data source: Autism and Developmental Disabilities Monitoring Network), and (2) children receiving services or interventions for developmental disabilities (data source: Individuals with disabilities Education Act). Minnesota currently has no public health surveillance system for developmental disabilities. While related data on children receiving services or interventions is available for Minnesota and other states, these data cannot inform us about the true prevalence of developmental disabilities (e.g., autism spectrum disorder). MN EPHT is informing MDH programs and others who may receive inquiries from the public or media about the data that will be available through the National EPHT Network. MN EPHT has a high interest in improving surveillance for developmental disabilities in Minnesota; however, significant data gaps remain. To view the new content area, view the National EPHT Network in December: http://ephtracking.cdc.gov/showHome.action Evaluation Process Posted on the Web New information about Minnesota’s Evaluation Process for selecting new state‐specific content areas is now on the MN EPHT program website. The material includes information about the four phases of the process, criteria and questions, purpose of the process, and input provided. The site presents the template document needed to evaluate a new content area, plus a summary of evaluation criteria for Minnesota’s new Environmental Tobacco Smoke (ETS) content area. See the “Evaluation Process for Adopting New Content Areas” webpage at: http://www.health.state.mn.us/divs/hpcd/tracking/evaluationprocess/ Reproductive & Birth Outcomes Query A data query for the Reproductive & Birth Outcomes content area was launched in October 2011, including county‐level data. Indicators include:  Total fertility rate  Infant mortality (including Perinatal, Neonatal, Post‐neonatal, and Infant Mortality options)  Low birth weight o Term low birth weight o Very low birth weight  Prematurity o Premature birth (<37 weeks gestation) o Very premature birth (<32 weeks gestation)  Sex ratio Users can query Reproductive & Birth Outcome data in Minnesota for Birth Years 2000‐2009. Queries can be stratified by maternal age group and maternal race/ethnicity. You can view the data query at: https://apps.health.state.mn.us/mndata/reproductive_query 8
Air Quality Query A data query for the Air Quality content area was launched in October 2011, including county‐
level data. Indicators include measurements of fine particles (PM2.5) and ozone in outdoor air. Users can query monitor data (in counties with air monitors) or modeled data (estimated levels in all counties based on Hierarchical Bayesian modeling techniques). The following years are available: Ozone  Monitor data: 2000‐2010 o Person‐days above standard o Number of days above standard  Modeled data: 2001‐2006 o Number of days above standard Fine particles  Monitor data: 2001‐2010 o Annual average concentration o Person‐days above standard o Percent days above standard  Modeled data: 2001‐2006 o Annual average concentration You can view the Air Quality data query at: https://apps.health.state.mn.us/mndata/air_query 9
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SectionOverview:LakeSuperiorMercuryinNewborns
The Lake Superior Mercury study conducted by the Fish Consumption Advisory Program at 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 Lake Superior Basin”). This project used residual dried blood spots (RDBS) from newborns. Results reveal a wide range of total mercury concentrations in blood spots from newborns in the US Lake Superior Basin. Results suggest a seasonal exposure pattern and thus support a fish consumption exposure pathway. ACTION NEEDED: Panel members are asked to consider the following question for discussion by the panel concerning ongoing work by the EHTB program in follow‐up to this project. Panel members are asked to consider the following question: 1. What do you suggest for communicating the results to the public and to health providers? 11
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MercuryLevelsinBloodfromNewbornsintheLakeSuperiorBasin
Overview 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 states’ respective land areas that drain water into Lake Superior (the “Superior basin”). This project utilized residual dried blood spots (RDBS) from newborns. Use of newborn RDBS provided a convenient specimen that did not require further sample collection from individuals. The Newborn Screening (NBS) Programs in MI, MN, and WI collected a sample from newborn residual blood specimens (by punching disks from the dried blood spot on the submitted filter paper). The blood spots were analyzed for total mercury by the MDH Public Health Laboratory. Total mercury was measured in dried blood spots from 1465 infants born during 2008 through 2010 to mothers residing in the US portion of the Lake Superior Basin. The purpose of this study 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. Most mercury exposure occurs through consumption of fish, either sport‐fish or commercially available fish. Measuring total mercury concentrations in newborns’ blood within the Superior basin helped to characterize this population’s exposure to mercury. The data collected will assist public health departments in targeting health protective outreach and advice on fish consumption. Methods Residual DBS from babies born to mothers on the U.S. side of the Lake Superior Basin (residents of MI, MN and WI) were tested for total mercury. Two 3‐mm punches from filter paper containing dried blood were analyzed from each participant for total mercury by ICP‐MS. The ZIP code of the mother’s residence was used to identify eligible blood spot specimens. The geographic boundary of the Lake Superior Basin was defined by watershed boundary data obtained from Natural Resources Research Institute (NRRI 1999). ZIP codes within this boundary were identified using ESRI data (ESRI 2005). ZIP codes with less than one percent land mass within the basin were not included in this study. Figure 1 shows the Lake Superior Basin and ZIP code boundaries within MI, MN and WI. Enrollment ran from November 2008 through May 2010 in Minnesota, February 2009 through July 2009 in Wisconsin, and May 2009 through Oct 2009 in Michigan. The only overlapping time period for births in all three states was May though July of 2009. Specimens were anonymized. Only specimen identification number (ID), year of birth, month of birth, sex state, and for MN urban or non‐urban residence data were provided to MDH Environmental Health Division staff. Only specimen ID, which included the state of collection, was provided to the the MDH PHL. There were differences in specimen collection procedures used by each state. MN and WI both started collecting potential participants on a particular date and ended when the quota was reached. MI selected from days that had the most specimens meeting the ZIP code criteria. Written, informed consent was required before the MN Newborn Screening Program could release residual specimens for use in this study. Mothers were contacted a few weeks after their infant’s birth and asked for their written, informed consent. The written communications from 13
MDH informed the mothers that the specimens (if meeting eligibility criteria) would be de‐
identified. The mothers were instructed that, during and after the research study, MDH would not inform them if their babies’ specimen was actually included in the study, of the individual findings, or of the anonymized aggregate findings. Instead, MDH will generate reports and other communications for scientific audiences and disseminate the aggregate results in a non‐targeted manner. In MN ZIP codes were categorized as urban or non‐urban. Due to the lower number of specimens collected it was not possible to meet the criteria for anonymity (five males and five females per varible) and retain a breakdown of urban/non‐urban ZIP codes in WI and MI. Percent urban and percent rural data for each MN ZIP code was obtained from the U.S. Census. In this study will be considered non‐urban if the census defined it as less than 65% urban. This cut‐off was determined following review of maps and using qualitative community information. The number of specimens collected per state was originally designed to be based on the percentage of births in the Lake Superior basin by state. Monthly and annual number of births from 2005 and 2006 were reviewed for MI, MN and WI. Due to changes in the storage, custody, and cost per specimen of the Michigan residual blood spots the number of specimens from Michigan was reduced. Results A wide range of total mercury concentrations was measured in blood spots from newborns in the US Lake Superior Basin. Forty three percent of the specimens were below the method detection limit (MDL) of 0.7 µg/l. Eight percent of the specimens analyzed were above 5.8 µg/l; the US EPA Reference Dose (RfD) for methylmercury (Figure 2). About one percent (14 of 1465) of specimens were above 58 µg/l; the Benchmark Dose Limit (BMDL) used by EPA in developing the RfD. This is lower 95th confidence interval of the estimated dose where there is a doubling of the number of children with a test response at the 5th percentile of the population. Thirteen of the fourteen specimens above the BMDL were from MN. Overall, mercury concentrations were higher in the MN specimens. Using Tukey's test for differences by pairs of means, mercury concentrations in MN specimens are statistically significantly different from WI and MI specimens, but WI and MI are not different from one another. Results suggest a seasonal exposure pattern and therefore support a fish consumption exposure pathway. Births in summer months were higher than other seasons, particularly in MN (Figure 3). Fall and Spring are the only seasons not different from one another; all other seasons are different (overall population & MN only). No association was seen between mercury concentration and sex or urban versus non‐urban residence. Differences by birth season, state, and birth month were determined using ANOVA on log‐transformed mercury concentration. Tukey's test for differences was used to determine differences between particular pairs of means. Differences by gender and residence were assessed using t tests on log‐transformed mercury concentration. Comparison to other published results Published data on levels of mercury in newborn blood spots is not available for comparison. Chaudhuri et al 2009 published an analytical method for measuring mercury in blood spots but did not provide a summary or details on results from mercury analysis of blood spots. The best available comparison is mercury measured in umbilical cord blood. Published cord blood concentrations are in the range of results from this study. Concentrations up to 735 µg/l 14
are reported from “normal deliveries” (Murata et al., 2007; Tsuchiya et al., 1984). Although there is considerable variability in the relationship, a linear correlation between cord blood and maternal blood has been shown in most studies, with an average ratio of cord blood to maternal blood of 1.7 reported (Stern, 2005; Stern et al., 2003). Given the ratio of cord blood mercury to maternal blood mercury (cord blood mercury > maternal blood mercury) a direct comparison of these results to adult concentrations is not appropriate. Sources of Exposure/Form of Mercury The form of mercury was not determined in this study. Both elemental and organic forms of mercury easily cross the placenta (EPA 1997a). For most people, fish consumption is thought to be the major route of human exposure to mercury (EPA 1997b). Other possible sources of exposure include dental amalgams and ritual/ homeopathic uses of mercury containing products. Cord blood inorganic mercury has been reported to increase with number of maternal amalgams (Ask et al., 2002). Murata et al 2007 examined studies that measured both meHg and total Hg. Mean HgTotal/HgmeHg ranged from ~1 to 2.5 (this is the ratio of the means, the ratio for individuals could be much higher), which suggests that other forms of mercury may be in fetal blood. Conclusions and Recommendations This study provides evidence of mercury exposures above the EPA RfD in the U.S. Lake Superior Basin. The form of mercury is not known. Follow‐up studies are needed to determine source(s) of exposure. Increased public outreach and communication is needed to ensure the public has information that promotes eating fish that are low in mercury. Potential Follow‐up studies Exposure pathways need to be investigated. Blood spots could be screened, for total mercury as in this study, followed by contact with parent(s) for babies with high levels to investigate potential exposures, and speciation of mercury of mother’s and baby’s blood. In addition to exposure investigation there is a need to correlate infant blood spot mercury with cord blood and maternal mercury. Since mercury binds to red blood cells hematocrit/hemoglobin should be also be measured to standardize results. Are RDBS a useful biomarker of fetal exposure to mercury? Due to limited availability of blood spots leftover after newborn screening, only two 3mm discs were used for mercury analysis in this study. This increased the MDL and limited characterization of low end of the exposure distribution. Mercury analysis of blood spots is not a routine method; refinements could be made to improve the method. The method is useful for characterizing the high end of the exposure distribution and as a screen for follow‐up exposure investigation. In order to know the form of mercury a method for speciation needs to be developed. However it is unlikely that there will consistently be enough residual blood to speciate mercury. Speciation could be included when additional blood can be collected such as in follow‐up after initial screening. From a policy perspective there is uncertainty regarding future restrictions on use of RDBS for public health research. 15
References Ask, K., A. Åkesson, et al. (2002). "Inorganic Mercury and Methylmercury in Placentas of Swedish Women." Environmental Health Perspectives 110(5): 523. Chaudhuri SN, Butala S, Ball RW, Braniff CT, 2009. Pilot study for utilization of dried blood spots for screening of lead, mercury and cadmium in newborns. J Expo Sci Env Epid 19, 298‐
316 doi:10.1038/jes.2008.19 ESRI. 2005. ESRI® Data & Maps. ESRI, Redlands, California, USA Murata, K., M. Dakeishi, et al. (2007). "[Usefulness of umbilical cord mercury concentrations as biomarkers of fetal exposure to methylmercury]." Nippon Eiseigaku Zasshi 62(4): 949‐
959. NRRI. 1999. Watershed Boundary for Lake Superior. Natural Resource Research Institute (NRRI), Duluth, Minnesota. http://www.nrri.umn.edu/lsgis/index.htm Stern, A. H. (2005). "A revised probabilistic estimate of the maternal methyl mercury intake dose corresponding to a measured cord blood mercury concentration." Environ Health Perspect 113(2): 155‐163. Stern, A. H. and A. E. Smith (2003). "An assessment of the cord blood:maternal blood methylmercury ratio: implications for risk assessment." Environ Health Perspect 111(12): 1465‐1470. Tsuchiya, H., K. Mitani, et al. (1984). "Placental Transfer of Heavy Metals in Normal Pregnant Japanese Women." Archives of Environmental Health 39(1). U.S. EPA. 1997a. Mercury study report to Congress. Vol. V. Health effects of mercury and mercury compounds. U.S. EPA, Office of Air Quality Planning and Standards and Office of Research and Development. EPA‐452/R‐97‐007. U.S. EPA. 1997b. Mercury study report to Congress. Vol. IV. An assessment of exposure to mercury in the United States. U.S. EPA, Office of Air Quality Planning and Standards and Office of Research and Development. EPA/452/R‐97‐006. 16
Figures
Figure 1. Lake Superior Basin Lake Superior Basin
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Figure 2. Figure 3. Mercury Concentration by Season
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Table 1. Participants: Data and Demographics 19
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SectionOverview:LakeSuperiorMercuryinNewborns:
QuestionsandNextStepsforEHTB
Recent state legislation directs the EHTB program to “complete the environmental public health tracking and biomonitoring analysis related to mercury monitoring in Lake Superior and disseminate the results.” Preliminary results from the Lake Superior Basin Mercury study conducted by the Fish Consumption Advisory Program at MDH answers an important question about the range of total mercury exposure that is likely occurring among newborns in the Lake Superior community. It also raises a number of questions that are likely to be asked by the public, policy‐makers, and public health officials when these results are disseminated. In this section, Advisory Panel members are asked to consider and recommend next steps for the EHTB program in completing the assessment of mercury exposure in this population, addressing these important questions, and meeting program goals. In 2008, the EHTB program goals of the mercury pilot project as presented to the Advisory Panel were to: 1) Characterize exposure in the population; and 2) Assess the feasibility and utility of a novel method that uses newborn blood spots for mercury biomonitoring. Follow‐up investigation that builds upon this initial study is needed for the EHTB program to fully meet the project goals, and, ultimately, to inform future mercury biomonitoring. For discussion, panel members are asked to consider a set of questions that are likely to be asked by program stakeholders and recommend additional work that the EHTB program at MDH could do within existing resources to address these questions. Follow‐up questions about the project fall into four topic areas: a. Can we do more to identify sources of exposure? b. Can we improve interpretation of the data from newborn spots? c. Can we assess the validity and technical feasibility of the laboratory method and disseminate it to others? d. Can we address ethnical concerns and minimize the impact of informed consent on participation in future projects? Included in this section is a brief explanation of the questions we anticipate will be asked by EHTB stakeholders, a current response, and questions for the panel about follow‐up recommendations. ACTION NEEDED: Panel members are asked to consider the following questions for discussion about ongoing work by the EHTB program (within available resources) in follow‐up to this project. Panel members may choose to discuss the questions at this meeting, or they may request more information and/or defer the discussion to a future meeting. Panel members may also suggest additional questions raised by this project for discussion and possible follow‐up. Panel members are asked to consider and discuss the following questions for future EHTB investigation: 21
Questions for Discussion: 1) Sources of Exposure. Should further biomonitoring be conducted in this Lake Superior population to investigate the sources of exposures? 2) Interpretation of the Result. Should EHTB conduct or seek to collaborate with other interested partners in a follow‐up study of paired specimens to determine the ratio of total mercury in newborn blood spots to maternal and cord blood? 3) Interpretation of the Result. Should EHTB conduct biomonitoring using newborn blood spots in a comparison population? In a representative sample of all Minnesota newborns to serve as a reference population? 4) Laboratory Method. Should the EHTB program support the further assessment and documentation of the method by the MDH Public Health Laboratory for the purpose of disseminating the method or making a recommendation? 5) Informed Consent. Should the EHTB program seek to develop consensus on the best methods for obtaining informed consent for future use of newborn blood spots as a biomonitoring specimen? 6) Informed Consent. Given the informed consent requirements currently in law, should the EHTB program seek to inform elected representatives of the costs and benefits of biomonitoring for public health surveillance in order to inform future decision‐making? 22
LakeSuperiorMercuryinNewbornsStudy:
QuestionsandNextStepsforEHTB
The recently completed Lake Superior Basin Mercury study conducted by the Fish Consumption Advisory Program at MDH answers an important question about the range of total mercury exposure occurring among newborns in the Lake Superior community. It clearly indicates that while most newborn exposures are within a “safe” range, in a small subset of the population, some exposures are occurring above accepted safe levels. It also demonstrates a seasonal pattern, which points towards fish consumption as likely the greatest contributor to the exposure. This provides valuable information to further inform and target fish consumption advice for pregnant women and women of child‐bearing age. The study also raises a number of important questions for the EHTB program that relate directly to the stated EHTB goals of the mercury pilot project, which were to: 1) Characterize exposure in the population, and 2) Assess the feasibility and utility of a novel method that uses newborn blood spots for mercury biomonitoring. Follow‐up investigation is needed, both to build on this initial study so the EHTB program can meet the project goals, and, ultimately, to inform future mercury biomonitoring and exposure tracking. The following discussion is framed in response to a set of questions that program stakeholders are likely to ask about this study and about mercury biomonitoring generally. It also poses questions for the panel to consider in terms of follow‐up work that the EHTB program could do to address these questions. Questions fall into four basic topics: a) sources of exposure, b) interpretation of the data, c) validity and technical feasibility of the laboratory method, and d) ethical concerns and informed consent. A. Questions about the Sources of Exposure: While fish consumption likely explains the seasonal patterns in the data, what sources of exposure explain the extremely high values that are observed? And which species of mercury exposure are occurring at these levels, methyl‐mercury or elemental mercury? EHTB Response: Further investigation, including detailed follow‐up interviews with mothers of newborns with elevated levels, is needed to answer this question. But because specimens were anonymized in the laboratory, such follow‐up is not possible. A repeat study with consent for follow‐up contact would be needed to shed light on this question. Collection of newborn cord blood or maternal blood would be needed for speciation because newborn blood spots are too small. A literature review is recommended to determine whether other similar studies have answered this question sufficiently and whether those results might be generalizable to this population. Future panel discussion question: Should further biomonitoring be conducted in this Lake Superior population to investigate the sources of exposures? B. Questions about the Interpretation of the Data: Are exposures in the Lake Superior basin unusual? How do these exposures compare to similar measurements made in other 23
populations of newborns? Is the EPA reference dose (based on cord blood and hair samples) the best value for interpreting the finding and providing guidance for further action? EHTB Response: No published data have been located for studies of mercury using newborn blood spots, and no other comparison group of newborns has been monitored in Minnesota. Therefore, it is not possible to draw meaningful comparisons with other studies or populations in the state. Only the state of Utah has conducted a similar study, and EHTB staff are working with the investigator to discuss comparison of the findings and methodology. Most published studies of biomonitoring for mercury in newborns has been based on cord blood or estimated from maternal blood. Studies have identified a ratio of umbilical cord to maternal blood mercury concentrations in the range of 1.5 to 2.0 (measured in mother‐infant paired specimens). The CDC National Biomonitoring Program does not measure newborn exposures, but publishes data on measures of total mercury in whole blood among children ages 1‐4 and women of child‐
bearing age. A sample of these results is shown in Table 1. A recent study examined mercury levels in pregnant women recruited as part of a pilot for the National Children’s Study. The study, which used a non‐representative sample of the target population, showed that mercury levels (geometric mean=0.580 µg/l) were low, compared to the 2005‐06 National Biomonitoring Program results for women age 16‐49 (geometric mean = 0.920). To date, no study has measured the ratio of newborn blood spot mercury to either maternal blood or cord blood. It is unknown how well measurement using this novel method compares with measurements made using these other standard methods. A small pilot study, comparing mercury levels from paired mother‐infant specimens of maternal blood, cord blood, and newborn blood spot, is needed to better inform comparison of the findings from newborn blood spots to other published studies and to the EPA reference dose. Discussion questions for the panel: 1. Should EHTB conduct or seek to collaborate with other interested partners in a follow‐
up study of paired specimens to determine the ratio of total mercury in newborn blood spots to maternal and cord blood? 2. Should EHTB conduct biomonitoring using newborn blood spots in a comparison population or in a representative sample of all Minnesota newborns to serve as a reference population for future biomonitoring? C. Questions about the validity and technical feasibility of the laboratory method: Is biomonitoring using newborn blood spots the best method for tracking newborn exposure to mercury in the future? Will MDH PHL recommend and disseminate the method to other state public health laboratories? EHTB Response: The use of dried blood spots for monitoring mercury exposure is relatively new, though many other states are considering this specimen type for this purpose. Newborn blood spots are collected by newborn screening programs in all states and are tested for a range of heritable conditions or congenital disorders. The residual spots are stored by the laboratories, though laws governing informed consent, storage, and research use of specimens for purposes other than newborn screening vary widely from state to state. In Minnesota, residual spots potentially could offer a convenient and stable specimen for biomonitoring of newborn 24
exposures, provided that legal requirements are met and parents have given their informed consent. As described by former MDH lab director, Louise Liao, when this project was proposed in 2008, the method protocols developed by the MDH Public Health Laboratory and the Utah Department of Health incorporate rigorous controls to both minimize and measure variability due to storage conditions, filter paper lots, heterogeneity across the spot and across the paper, the recovery of mercury from the filter paper, and other sources of uncertainty. The accuracy and precision of the measurements have been well characterized. However, until a novel method meets the standards defined in federal regulations, including standards for proficiency testing, verification of the procedures, and a defined clinical reference value, the testing results can be used for research only and not for medical management. In order to make recommendations for future use of this method and to disseminate information with other states, a detailed assessment and documentation of the methodological considerations by the MDH Public Health Laboratory is needed. It should address the current status of this method with respect to the technical difficulties encountered, the standards for validation in federal regulations, and the practical considerations of resources expended in analyzing the specimens for this project’ relative to other specimen types. Question for the panel: Should the EHTB program support the further assessment and documentation of the method by the MDH PHL for the purpose of disseminating the method or making a recommendation? D. Question regarding ethical concerns and informed consent: How did the requirement for informed consent affect the outcome of the mercury biomonitoring pilot project? What have we learned about the informed consent process for use of newborn screening blood spots in Minnesota that may be useful to others? How would we recommend improving the process? EHTB Response: The issue of whether informed consent should be required before laboratories can use newborn screening specimens for “research” purposes has been highly controversial, and state laws vary widely in regulating this use. In Minnesota, a recent ruling by the State Supreme Court determined that the specimens are protected under the 2006 Genetic Privacy Act as “genetic information,” and further restricts their use such that the state cannot store blood specimens for additional public health research without parental consent. Environmental health scientists in Minnesota and in other states view residual newborn screening blood spots as a convenient biomonitoring specimen for environmental public health surveillance of exposures to mercury, and potentially other chemicals. Yet it is not widely understood how the restrictions that require informed consent will affect the validity and inferences that can be drawn for characterizing population exposure. Requiring consent is likely to cause participation to fall to levels that could make the data unreliable, and possibly even misleading. In the Lake Superior pilot project, participation fell to less than 50% and all births with risk factors (sick baby, deceased sibling, congenital anomalies, very low birth weight, and pregnancy complications) were excluded because the consent process (within weeks after the birth) would cause unnecessary stress to the parent. 25
Questions for the panel: 1. Should the EHTB program seek to develop consensus on the best methods for obtaining informed consent for future use of newborn blood spots as a biomonitoring specimen? 2. Should the EHTB program seek to inform elected representatives of the costs and benefits of biomonitoring for public health surveillance, given the informed consent requirements currently in law, in order to inform future decision‐making? 3. Table 1. Comparison values for mercury biomonitoring in women, pregnant women and children Study Population n Total Blood Hg 95th Percentile (CI) GM (CI) µg/L (µg/L) 1709 1.02 (0.85 ‒ 0.96) 7.13 (5.79 ‒ 8.48) Schober et al., Women (16‐49 yrs) NHANES 1999‐
286 0.97 (0.68 ‒ 1.27) 5.98 (4.56 ‒ 7.40) 2000 Pregnant women 448 1.94 (1.52‐2.35) 10.91 (8.42 – 13.39) Women who ate >3 fish meals in 30 days Caldwell et al., All females (16‐49 1880 .920 (.826‐1.03) 4.48 (3.88‐5.60) NHANES 2005‐
yrs) 2006 502 .706 (.583‐.855) 2.37 (1.76‐3.31) Mex‐Am 477 .958 (.810‐.1.14) 4.09 (3.15‐4.66) Non‐Hisp black 725 .900 (.782‐1.04) 4.92 (3.73‐5.82) Non‐Hisp white Woodruff et al., Pregnant women 253 .67 (0.07 GSE) 3.4 NHANES 2003‐04 Total blood Hg Mortensen et al., Pregnant women 433 0.580 ( 0.533‐0.631) 2.920 (2.270‐3.760) National (convenience sample from 7 sites) Children’s Study Pilot 2011 Caldwell et Children 1‐5 al.,NHANES 2005‐ 968 Not calc’d < LOD 1.43 (1.25‐1.59) 2006 Sexton et al., Children 7‐12, 134 3.0 µg/L 25 µg/L 2011 SHIELD disadvantaged neighborhood, Mpls Grandjean et al., Faroe Island birth 996 22.31 2005 cohort: cord blood Interquartile range (methylmercury) 13.1‐40.4 µg/L 4.
*Note: Sexton et al. reported results as µg/dL, which has been translated to µg/L. 26
SectionOverview:StrategicPlanning:EHTBandtheNational
Children’sStudy
Criteria for Selecting a Target Population Barbara Scott Murdock will briefly review the criteria for selecting a target population, based on criteria discussed at the last panel meeting and criteria suggested by the Advisory Panel. She will then introduce Patricia McGovern and her presentation on the National Children’s Study (NCS) and on ways in which the EHTB’s biomonitoring program can complement the NCS in Minnesota. The National Children’s Study: How Might the EHTB Program Complement the NCS? Patricia McGovern, PI for the NCS study planned for Ramsey County, Minnesota, will discuss the current status of the NCS and its biomonitoring plans with respect to mercury and other neurotoxic chemicals. She will then discuss ways in which the EHTB program might do biomonitoring pilots or projects that would provide useful comparative data to NCS data and engage populations of interest to the NCS. In particular, a potential collaboration in the White Earth tribal community will be introduced for discussion. ACTION NEEDED: Panel members are invited to ask questions and to comment on the materials and presentations. Panel members are asked in particular to address the following questions: 1) What do Panel members see as the strengths and weaknesses for the suggested collaboration between the EHTB, the NCS, and the White Earth families? 2) Do Panel members have other suggestions related to a collaboration between the EHTB program, the NCS and members of the White Earth reservation? 3) What other project might the EHTB program do that might complement the NCS or address other problems in Minnesota? 27
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CriteriaforSelectingaTargetPopulation
Presented in October 2011, based on Stakeholder Interviews 
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Exposure Demographic and geographic diversity Public health policy impacts Information potential for individual results interpretation Advisory Panel’s Additional Criteria 
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Vulnerability: defined under cumulative risk assessment1 as differential…  Biological susceptibility  Exposure  Preparedness to withstand stressor effects  Ability to recover from stressor effects Feasibility  Ability to recruit & obtain informed consent from target population  Ability to take appropriate blood or urine samples from target population  Ability to transport samples to the laboratory without damage  Ability to analyze samples in the laboratory Fundability  Ability to identify relevant funding programs (e.g., NIEHS subpart, NIH PAR‐11‐
346)  Ability to find and develop partnerships for applying to identified programs Importance of potential health outcome  Analytes of interest: mercury and other neurotoxic chemicals  Neurological endpoints are used as the health outcome of concern in adults2  The reference value for maternal blood Hg (5.8 µg/L) is derived from a benchmark dose for mercury (58 µg per L/10 uncertainty factor) based on a benchmark response dose of 0.05, which would lead to a doubling of the number of children at or below the 5th percentile in an un‐exposed population (children who would struggle in school or need special education)3 Likelihood that exposure at community levels could lead to that outcome Policy opportunity for intervention Value as Target Population: i.e., adds information vs. duplicating other efforts  Questions about overlap with NCS target population and analytes  Ability to complement, not duplicate NCS target populations References 1. Sexton K, Linder stakeholder. 2010. The Role of Cumulative Risk Assessment in Decisions about Environmental Justice. Int. J. Environ. Res. Public Health 7: 4037‐4049. 2. Mahaffey KR. 2004. Environmental Research 95: 414‐428 3. Rice DC, Schoeney R, Mahaffey K. 2003. Risk Analysis 23(1): 107‐115. 29
TheNationalChildren’sStudy:MighttheEHTBProgramFindaWay
toCollaboratewiththeNCS?
Overview The National Children’s Study (NCS) will examine the effects of the environment, including such factors as air, water, diet, sound, family dynamics, community and cultural influences, and genetics, on the growth, development, and health of children across the United States. The NCS plans to follow these children from before birth until age 21 years. The goal is to improve the health and well‐being of children and contribute to understanding the role that various factors have on health and disease. Findings from the Study will be made available as the research progresses, so that its potential benefits can be known to the public as soon as possible. The NCS plans to follow children in 105 study locations across the United States. All study locations were originally selected using a scientifically based method to ensure that children and families across the nation—from diverse ethnic, racial, economic, religious, geographic, and social groups—are included. The study sample is designed as a statistically valid population that will permit both generalizations about the nation as a whole and detailed analysis of specific communities and subpopulations. The NCS has two main phases: the Vanguard Study and the Main Study. The Vanguard Study began before the Main Study. The Main Study will focus on exposure outcome relationships with a data driven, evidence‐based approach. The Vanguard Study is a pilot study designed to evaluate the feasibility, acceptability, and cost of three different recruitment strategies, as well as Study procedures and outcome assessments that are to be used in the Main Study. Feasibility refers to technical performance and reliability; acceptability looks at the impact on Study participants and Study infrastructure; and cost examines the level of effort, personnel, resources, and money. The three recruitment strategies being studied include: 
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Provider‐based Recruitment Strategy: In this strategy, women will be given information about the Study through their health care providers (doctor, midwife, or public health nurse) in a familiar, trusted environment. Outreach activities aimed at raising broader awareness of the study will supplement these efforts. Enhanced Household‐based Recruitment Strategy: Here, the study will be introduced to potential participants through door‐to‐door enrollment at their homes. These household visits will complement information the families receive about the NCS through community engagement and media activities. Two‐Tiered Recruitment Strategy (High Intensity/Low Intensity): In this strategy, potential participants will be introduced to the Study through public media. Participants will be enrolled in the low intensity data collection effort; some participants will be invited to join a higher intensity data collection. The NCS Ramsey County Study Location Patricia McGovern, Principal Investigator, from the University of Minnesota, School of Public Health (SPH) leads the National Children’s Study for the Ramsey County Study Location. Housed 30
in the Division of Environmental Health Sciences of the SPH, the study is supported by a multidisciplinary staff from the SPH Divisions of Epidemiology and Community Health, plus researchers from the Medical School’s Department of Family Medicine and Community Health and the College of Education and Human Development’s Institute of Child Development. Staff affiliated with the Health Studies Section (HSS) of the Division of Environmental Health Sciences provide operational support for the University of Minnesota Study Center, from managing information systems, recruiting, and follow‐up, to working with the Institutional Review Board. The University of Minnesota contracts with the National Opinion Research Center (NORC) to conduct household screening and participant recruitment and enrollment. Current Status of the NCS Nationally and in Minnesota The 30 NCS Vanguard Study Centers nationwide will transition from participant recruitment to retention on November 23, 2011 as more than 6000 families across the country are now participating in this pilot phase of the Study. Retention activities will focus on Study visits, quality control of field efforts, and data transmission to the federal data repository. Additionally the NSC staff will continue with a low level of community outreach and health care engagement, and continuous monitoring of sampled dwelling units. There are also some 200 formative research studies in process to evaluate study methodology and measures. For example, one formative study investigated blood metals in pregnant women to provide exposure and nutritional biomarker data to inform a decision regarding analytes for inclusion in the Main Study. Conducted by Mortenson, Caldwell, Lawrence and Moye, and presented in a poster at NCS Research Day (NICHD, Bethesda, 2011), the study is described below. An update on Ramsey County will be provided at the meeting. Biomonitoring and the NCS To address the panel’s question about how an MDH biomonitoring project in pregnant women could bring value to the National Children’s Study or other studies of pregnant women’s exposures, we consulted with Dr. Jack Moye at NIEHS. Dr. Moye is a pediatrician and former state public health laboratory official who joined the National Children’s Study Program Office to serve as Senior Scientist and Director of Laboratories and Repository. His view is that an MDH biomonitoring project on pregnant women with a list of analytes similar to the NCS menu would allow the NCS to compare and contrast MDH results with NCS results or with other reference populations. The CDC’s National Center for Environmental Health (NCEH) is very interested in information on pregnant women and their fetuses. To date, NHANES has not emphasized studies of pregnant women and thus lacks substantial information on that population. Currently, the NCEH is doing a pilot study of environmental chemicals and nutrition in pregnant women in the NCS Vanguard phase of the NCS. To date, seven Vanguard sites have recruited a convenience sample of 400–500 matched pregnant women and their babies; the population sampled is not a representative sample of the US population. 31
NCEH is measuring a short list of analytes in maternal blood and breast milk in these women. NCS Vanguard results from the analysis of blood metals show that total Hg and Pb levels in the NCS populations were lower than those in the 2007‐08 NHANES assessment; Cd was similar to NHANES 2007‐08 (Mortenson et al.)*. It is still unclear whether the analysis of the Vanguard studies has speciated mercury to differentiate inorganic Hg from methylmercury. Potential EHTB Activities to Complement NCS: Collaboration with White Earth Tribe As directed by the Legislature, the EHTB program is focusing on Hg exposure tracking and biomonitoring in the coming year. One strong option for an EHTB pilot study would be a study of blood I‐Hg and MeHg in a population of 200 families who live on the White Earth reservation in Mahnomen County, Minnesota. This group of families has taken part in a diet and health study, conducted by the North American Water Office (NAWO) in collaboration with environmental health scientists at the University of Minnesota, and published in Sacred Water, Water for Life. The study documented a diet that relied heavily on fish in the families who participated. The community is also concerned about rising numbers of children being placed in autism services in the school system. The community would like to have these families biomonitored for exposure to mercury and other neurotoxins. Pending final decisions about sample size and resources for the Main Study a strong working relationship with Mahnomen County would enhance the possibility of exploring the Location for future NCS activity. The NAWO study laid the ground for a follow‐up study that would biomonitor these families to establish whether or not their diet or environment has exposed them to unsafe levels of mercury or other neurotoxic metals. That groundwork offers an opportunity to MDH and the University of Minnesota that would address an expressed concern of the White Earth community and enable MDH and the UMN to build a relationship with the community. If a biomonitoring pilot or special investigation of the NAWO families is successful, it may open the door to a future NCS Vanguard‐UMN‐MDH collaboration focused on pregnant women. That study would measure Hg and other analytes in pregnant women in a community that both raises and eats fish in a community that is likely subject to methylmercury and other exposures of concern. Questions for the Panel 1) What do Panel members see as the strengths and weaknesses for the suggested collaboration between the EHTB, the NCS and the White Earth families? 2) Do Panel members have other suggestions related to a collaboration between the EHTB program, the NCS and members of the White Earth reservation? 3) What other projects might the EHTB program do that might complement the NCS or address other problems in Minnesota? *Mortenson, Caldwell, Lawrence, and Moye. Poster presented at NCS Research Day, NICHD, Bethesda, 2011.
32
SectionOverview:BiomonitoringUpdates Status Update East Metro PFC Biomonitoring Follow‐up Project Update 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. Jessica Nelson will give a brief update of the project’s status: laboratory questions, results reporting, community meetings, and press release. The Giigoonh Ogikendaan Biomonitoring Study This study, also known as the Great Lakes Biomonitoring Project, is led by investigators Deanna Scher and Rita Messing in the MDH Environmental Health Division, Environmental Surveillance and Assessment Section. The project is funded by a three‐year grant from ATSDR. EHTB biomonitoring program staff serve on an MDH interdivisional team providing scientific and ethical consultation, epidemiologic and statistical support as needed, and serving as the project’s liaison to the EHTB Advisory Panel. ACTION NEEDED: No action is needed at this time. Panel members are invited to ask questions or offer comments on the project updates. 33
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BiomonitoringUpdates
East Metro PFC Biomonitoring Follow‐up Project Update Project summary 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. At the October Advisory Panel meeting, MDH staff presented preliminary results of the Phase 1 analysis. These included the distribution of 2010 PFC concentrations and a comparison to concentrations from the 2008 project. (The Phase 2 analysis, to be completed in future, will examine project questionnaire data on possible sources of PFC exposure.) Status and timeline of results communication Phase 1 data analysis has been completed, and staff are preparing to report results to participants and the community. Participants will receive a letter, graph, and table with their individual results; a report to the community that summarizes the project findings; a stamped postcard that they can return to MDH if they would like to speak to an MDH physician; and a flier for the upcoming community meeting. As the Advisory Panel recommended, staff will send a slightly modified letter to participants whose PFC levels increased between 2008 and 2010. Staff pilot‐tested the letters, graphs, and tables that will be used to communicate individual results. Participant letters will be mailed in early December, and will be followed by a full public release of results and a community meeting in Oakdale shortly thereafter. Dates and locations must still be confirmed. The Giigoonh Ogikendaan Biomonitoring Study* Background This study has a non‐research public health focus on susceptible subpopulations with increased risk of exposure to persistent contaminants common to Great Lakes watersheds. Funding for the study originated from the Great Lakes Restoration Initiative and was provided through EPA to ATSDR, who funded cooperative agreements with public health agencies in Minnesota, Michigan and New York to conduct human biomonitoring studies. In Minnesota, the Fond du Lac (FDL) Band of Lake Superior Chippewa Reservation is located in the Great Lakes Basin and within the St. Louis River Area of Concern (SLRAOC). The SLRAOC has been affected by industrial activities over decades, resulting in contaminated sediments, abandoned hazardous waste sites, landfill and industrial discharges, and surface runoff. American Indians affiliated with FDL or other tribes who live near the SLRAOC (herein called the “FDL Community”) may experience greater exposure to contaminants as consumers of traditional foods from local aquatic environments, such as fish and waterfowl. Within the FDL 35
Community, certain subgroups are also more sensitive to the effects of contaminants due to life stage, including elders and women of child‐bearing age. MDH and FDL Human Services are collaborating on the study, which was given the Ojibwe name “Giigoonh Ogikendaan”, meaning “the fish know.” The overall strategy is to measure contaminant levels in, and to administer questionnaires to, a representative sample of 500 adults in the FDL Community. Study findings will be used by MDH and FDL to develop a public health action plan to prevent or reduce exposures to Great Lakes contaminants through targeted interventions. Timeline The project period is September 30, 2010 to September 29, 2013, with an expected one‐year, no‐cost extension to fully implement the public health action plan. Recruitment and enrollment are anticipated to begin in spring 2012. The project timeline is largely dictated by the Office of Management and Budget (OMB) Paperwork Reduction Act clearance process, as data collection cannot begin until after OMB approval. The clearance process is extensive and long, requiring a detailed application to OMB and two Federal Register notices (FRNs). The first FRN (60‐day) was published by CDC on November 4, 2011 (76 FR 68462). Status Update Efforts to date have focused on laying the groundwork for study implementation. This includes finalizing the study protocol, creating study instruments and communication materials, developing a contract with FDL Human Services, and completing IRB and OMB review processes. Input from tribal partners and the Biomonitoring Advice Council have continued to inform these activities. After review on October 12, the MDH IRB determined that the study is not research. Although the study is not research, the board agreed that the rights of human subjects are adequately protected. On November 16, MDH submitted an application and request for review to the FDL Human Services IRB administrator. The emphasis of this review will be on the protection of, and risks and benefits to, the tribe and community as well as the individual participant. Currently, staff are developing training and procedural manuals and building IT infrastructure for the study. A videoconference with staff from the First Nations Biomonitoring Initiative (FNBI) is being planned to share information and advice. The goal of the FNBI is to create baseline data for contaminants in First Nations communities. *This study, also known as the Great Lakes Biomonitoring Project, is led by investigators Deanna Scher and Rita Messing in the MDH Environmental Health Division, Environmental Surveillance and Assessment Section. EHTB biomonitoring program staff serve on an MDH interdivisional team providing scientific and ethical consultation, provide epidemiologic and statistical support as needed, and serve as the project’s liaison to the EHTB Advisory Panel. 36
SectionOverview:Otherinformation
These documents are included in this meeting packet as items that may be of interest to panel members:  EHTB Advisory Panel 2012 meeting dates ‐Revised  EHTB Advisory Panel roster  EHTB Staff bios  EHTB statute Additional reference materials are available online at www.health.state.mn.us/tracking/ 37
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2012AdvisoryPanelMeetings
Tuesday, March 13 1‐4pm March meeting will take place at: The American Lung Association of Minnesota 490 Concordia Avenue St. Paul, Minnesota Tuesday, June 12 1‐4pm Tuesday, Sept. 11, 1 – 4pm Tuesday, Dec. 11 1‐4pm Other meetings will take place at MDH’s Snelling Office Park location at 1645 Energy Park Drive. 39
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ENVIRONMENTAL HEALTH TRACKING AND
BIOMONITORING
ADVISORY PANEL ROSTER
As of April 2011
Thomas Hawkinson, MS, CIH, CSP
Toro Company
8111 Lyndale Avenue S
Bloomington, MN 55420
[email protected]
Statewide business org representative
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
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
Home office
651-647-9017
[email protected]
Nongovernmental organization
representative
Alan Bender, DVM, PhD
Minnesota Department of Health
Health Promotion and Chronic Disease
Division
85 East 7th Place
PO Box 64882
Saint Paul, MN 55164-0882
651-201-5882
[email protected]
MDH appointee
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
41
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
42
StaffBiosketches
Wendy Brunner, MS, PhD, 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 Master’s degree in Science and Technology Studies from Rensselaer Polytechnic Institute ,a Master’s degree in Environmental and Occupational Health from the University of Minnesota, and completed her doctorate in the Division of Epidemiology and Community Health at the University of Minnesota in 2011. 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 Master’s 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 and supervisor of the Environmental Epidemiology Unit at MDH. 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 Health. Mary Jeanne Levitt, MBC, is the communications coordinator with the Minnesota Environmental Public Health Tracking program. She has a Master’s 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, Center for Occupation Health and Safety, Minnesota Cancer Surveillance System, and Cancer Control section. 43
Barbara Scott Murdock, MA, 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 Master’s 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 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 44
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, MSPH, 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. 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 work‐related 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 Health. 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
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EHTBSTATUTE:MINN.STATUTES144.995‐144.998
Minnesota: Environmental Health Tracking and Biomonitoring
$1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount, $900,000 each year is
for transfer to the Minnesota Department of Health. The base appropriation for this program for fiscal year 2010 and
later is $500,000.
other substance for which scientific, peer-reviewed
studies of humans, animals, or cells have
demonstrated that the chemical is known or
reasonably anticipated to adversely impact human
health.
(j) "Environmental health tracking" means
collection, integration, analysis, and dissemination of
data on human exposures to chemicals in the
environment and on diseases potentially caused or
aggravated by those chemicals.
144.995 DEFINITIONS; ENVIRONMENTAL
HEALTH TRACKING AND
BIOMONITORING.
(a) For purposes of sections 144.995 to 144.998,
the terms in this section have the meanings given.
(b) "Advisory panel" means the Environmental
Health Tracking and Biomonitoring Advisory Panel
established under section 144.998.
(c) "Biomonitoring" means the process by which
chemicals and their metabolites are identified and
measured within a biospecimen.
(d) "Biospecimen" means a sample of human fluid,
serum, or tissue that is reasonably available as a
medium to measure the presence and concentration of
chemicals or their metabolites in a human body.
(e) "Commissioner" means the commissioner of the
Department of Health.
(f) "Community" means geographically or
nongeographically based populations that may
participate in the biomonitoring program. A
"nongeographical community" includes, but is not
limited to, populations that may share a common
chemical exposure through similar occupations,
populations experiencing a common health outcome
that may be linked to chemical exposures,
populations that may experience similar chemical
exposures because of comparable consumption,
lifestyle, product use, and subpopulations that share
ethnicity, age, or gender.
(g) "Department" means the Department of Health.
(h) "Designated chemicals" means those chemicals
that are known to, or strongly suspected of, adversely
impacting human health or development, based upon
scientific, peer-reviewed animal, human, or in vitro
studies, and baseline human exposure data, and
consists of chemical families or metabolites that are
included in the federal Centers for Disease Control
and Prevention studies that are known collectively as
the National Reports on Human Exposure to
Environmental Chemicals Program and any
substances specified by the commissioner after
receiving recommendations under section 144.998,
subdivision 3, clause (6).
(i) "Environmental hazard" means a chemical or
144.996 ENVIRONMENTAL HEALTH
TRACKING; BIOMONITORING.
Subdivision 1. Environmental health tracking. In
cooperation with the commissioner of the Pollution
Control Agency, the commissioner shall establish an
environmental health tracking program to:
(1) coordinate data collection with the Pollution
Control Agency, Department of Agriculture,
University of Minnesota, and any other relevant state
agency and work to promote the sharing of and
access to health and environmental databases to
develop an environmental health tracking system for
Minnesota, consistent with applicable data practices
laws;
(2) facilitate the dissemination of aggregate public
health tracking data to the public and researchers in
accessible format;
(3) develop a strategic plan that includes a mission
statement, the identification of core priorities for
research and epidemiologic surveillance, and the
identification of internal and external stakeholders,
and a work plan describing future program
development and addressing issues having to do with
compatibility with the Centers for Disease Control
and Prevention's National Environmental Public
Health Tracking Program;
(4) develop written data sharing agreements as
needed with the Pollution Control Agency,
Department of Agriculture, and other relevant state
agencies and organizations, and develop additional
procedures as needed to protect individual privacy;
(5) organize, analyze, and interpret available data,
in order to:
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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.
(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
144.997 BIOMONITORING PILOT
PROGRAM.
Subdivision 1. Pilot program. With advice from
the advisory panel, and after the program guidelines
in subdivision 4 are developed, the commissioner
shall implement a biomonitoring pilot program. The
program shall collect one biospecimen from each of
the voluntary participants. The biospecimen selected
must be the biospecimen that most accurately
represents body concentration of the chemical of
interest. Each biospecimen from the voluntary
participants must be analyzed for one type or class of
related chemicals. The commissioner shall determine
the chemical or class of chemicals to which
community members were most likely exposed. The
program shall collect and assess biospecimens in
accordance with the following:
(1) 30 voluntary participants from each of three
communities that the commissioner identifies as
likely to have been exposed to a designated chemical;
(2) 100 voluntary participants from each of two
communities:
(i) that the commissioner identifies as likely to
have been exposed to arsenic; and
(ii) that the commissioner identifies as likely to
have been exposed to mercury; and
(3) 100 voluntary participants from each of two
communities that the commissioner identifies as
likely to have been exposed to perfluorinated
chemicals, including perfluorobutanoic acid.
Subd. 2. Base program. (a) By January 15, 2008,
the commissioner shall submit a report on the results
of the biomonitoring pilot program to the chairs and
ranking members of the committees with jurisdiction
over health and environment.
(b) Following the conclusion of the pilot program,
the commissioner shall:
(1) work with the advisory panel to assess the
usefulness of continuing biomonitoring among
members of communities assessed during the pilot
program and to identify other communities and other
designated chemicals to be assessed via
biomonitoring;
(2) work with the advisory panel to assess the pilot
program, including but not limited to the validity and
accuracy of the analytical measurements and
adequacy of the guidelines and protocols;
(3) communicate the results of the pilot program to
the public; and
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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.
(4) after consideration of the findings and
recommendations in clauses (1) and (2), and within
the appropriations available, develop and implement
a base program.
Subd. 3. Participation. (a) Participation in the
biomonitoring program by providing biospecimens is
voluntary and requires written, informed consent.
Minors may participate in the program if a written
consent is signed by the minor's parent or legal
guardian. The written consent must include the
information required to be provided under this
subdivision to all voluntary participants.
(b) All participants shall be evaluated for the
presence of the designated chemical of interest as a
component of the biomonitoring process. Participants
shall be provided with information and fact sheets
about the program's activities and its findings.
Individual participants shall, if requested, receive
their complete results. Any results provided to
participants shall be subject to the Department of
Health Institutional Review Board protocols and
guidelines. When either physiological or chemical
data obtained from a participant indicate a significant
known health risk, program staff experienced in
communicating biomonitoring results shall consult
with the individual and recommend follow-up steps,
as appropriate. Program administrators shall receive
training in administering the program in an ethical,
culturally sensitive, participatory, and communitybased manner.
Subd. 4. Program guidelines. (a) The
commissioner, in consultation with the advisory
panel, shall develop:
(1) protocols or program guidelines that address
the science and practice of biomonitoring to be
utilized and procedures for changing those protocols
to incorporate new and more accurate or efficient
technologies as they become available. The
commissioner and the advisory panel shall be guided
by protocols and guidelines developed by the Centers
for Disease Control and Prevention and the National
Biomonitoring Program;
(2) guidelines for ensuring the privacy of
information; informed consent; follow-up counseling
and support; and communicating findings to
participants, communities, and the general public.
The informed consent used for the program must
meet the informed consent protocols developed by
the National Institutes of Health;
(3) educational and outreach materials that are
culturally appropriate for dissemination to program
participants and communities. Priority shall be given
to the development of materials specifically designed
to ensure that parents are informed about all of the
benefits of breastfeeding so that the program does not
result in an unjustified fear of toxins in breast milk,
which might inadvertently lead parents to avoid
144.998 ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
ADVISORY PANEL.
Subdivision 1. Creation. The commissioner shall
establish the Environmental Health Tracking and
Biomonitoring Advisory Panel. The commissioner
shall appoint, from the panel's membership, a chair.
The panel shall meet as often as it deems necessary
but, at a minimum, on a quarterly basis. Members of
the panel shall serve without compensation but shall
be reimbursed for travel and other necessary
expenses incurred through performance of their
duties. Members appointed by the commissioner are
appointed for a three-year term and may be
reappointed. Legislative appointees serve at the
pleasure of the appointing authority.
Subd. 2. Members. (a) The commissioner shall
appoint eight members, none of whom may be
lobbyists registered under chapter 10A, who have
backgrounds or training in designing, implementing,
and interpreting health tracking and biomonitoring
studies or in related fields of science, including
epidemiology, biostatistics, environmental health,
laboratory sciences, occupational health, industrial
hygiene, toxicology, and public health, including:
(1) at least two scientists representative of each of
the following:
(i) nongovernmental organizations with a focus on
environmental health, environmental justice,
children's health, or on specific chronic diseases; and
(ii) statewide business organizations; and
(2) at least one scientist who is a representative of
the University of Minnesota.
(b) Two citizen panel members meeting the
scientific qualifications in paragraph (a) shall be
49
(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.
appointed, one by the speaker of the house and one
by the senate majority leader.
(c) In addition, one representative each shall be
appointed by the commissioners of the Pollution
Control Agency and the Department of Agriculture,
and by the commissioner of health to represent the
department's Health Promotion and Chronic Disease
Division.
Subd. 3. Duties. The advisory panel shall make
recommendations to the commissioner and the
legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based on
sound science and practice, and that will advance the
state of public health in Minnesota;
(3) specific chronic diseases to study under the
environmental health tracking system;
(4) specific environmental hazard exposures to
study under the environmental health tracking
system, with the agreement of at least nine of the
advisory panel members;
(5) specific communities and geographic areas on
which to focus environmental health tracking and
biomonitoring efforts;
(6) specific chemicals to study under the
biomonitoring program, with the agreement of at
least nine of the advisory panel members; in making
these recommendations, the panel may consider the
following criteria:
(i) the degree of potential exposure to the public or
specific subgroups, including, but not limited to,
occupational;
(ii) the likelihood of a chemical being a carcinogen
or toxicant based on peer-reviewed health data, the
chemical structure, or the toxicology of chemically
related compounds;
(iii) the limits of laboratory detection for the
chemical, including the ability to detect the chemical
at low enough levels that could be expected in the
general population;
(iv) exposure or potential exposure to the public or
specific subgroups;
(v) the known or suspected health effects resulting
from the same level of exposure based on peerreviewed scientific studies;
(vi) the need to assess the efficacy of public health
actions to reduce exposure to a chemical;
(vii) the availability of a biomonitoring analytical
method with adequate accuracy, precision,
sensitivity, specificity, and speed;
(viii) the availability of adequate biospecimen
samples; or
(ix) other criteria that the panel may agree to; and
(7) other aspects of the design, implementation,
and evaluation of the environmental health tracking
and biomonitoring system, including, but not limited
to:
INFORMATION SHARING.
On or before August 1, 2007, the commissioner of
health, the Pollution Control Agency, and the
University of Minnesota are requested to jointly
develop and sign a memorandum of understanding
declaring their intent to share new and existing
environmental hazard, exposure, and health outcome
data, within applicable data privacy laws, and to
cooperate and communicate effectively to ensure
sufficient clarity and understanding of the data by
divisions and offices within both departments. The
signed memorandum of understanding shall be
reported to the chairs and ranking members of the
senate and house of representatives committees
having jurisdiction over judiciary, environment, and
health and human services.
Effective date: July 1, 2007
This document contains Minnesota Statutes, sections
144.995 to 144.998, as these sections were adopted in
Minnesota Session Laws 2007, chapter 57, article 1,
sections 143 to 146. The appropriation related to
these statutes is in chapter 57, article 1, section 3,
subdivision 4. The paragraph about information
sharing is in chapter 57, article 1, section 169. The
following is a link to chapter 57:
http://ros.leg.mn/bin/getpub.php?type=law&year=20
07&sn=0&
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