Summary:December11,2012AdvisoryPanelMeeting
Advisory Panel members: Fred Anderson, Alan Bender, Melanie Ferris, Lisa Heins‐Nesvold, Geary Olsen, Patricia McGovern, Gregory Pratt, Cathy Villas‐Horns, Lisa Yost Steering Committee members attending: Joanne Bartkus, Aggie Leitheiser, Mary Manning. Other attendees: MDH: Blair Sevcik, Jim Kelly, Betsy Edhlund, Jeannette Sample, Jessica Nelson, Jean Johnson, Mary Jeanne Levitt, Dianna Roerig; MDA: Joe Zachman, Joe Spitzmueller; MCEA: Allison Wolf. Welcome and Introductions Pat McGovern, chair pro tem, welcomed panel members and attendees and invited them to introduce themselves and called attention to a designated time slot for audience members to ask questions or comment on the topics, presentations, or discussions. Legislative Update Assistant Commissioner Aggie Leitheiser reported that the legislature would convene on January 8 and the Governor’s budget would be released around 22 January. In the meantime, she has been attending meetings of the Environmental Quality Board (EQB)1, which is gathering comments and ideas from people around the state.2 In Bloomington, 400 people came to the meeting, and we had expected only 200. People met in small discussion groups and stayed after the meeting. Health comes up as an issue in these meetings, she said, and particularly the relationship between health and environment. The public has a lot of interest in these issues, including interest in how we find out and track them. The EHTB program fits well with that interest. The next large meeting will take place in March. Pat McGovern asked about themes in the EQB meetings. Aggie replied that she had been to only two meetings, one in a rural area and one in the city. Many city people expressed interest in wolves and the wolf hunt. In rural districts, people were concerned about exports to market, preserving habitat, and in population growth, including encouraging people to live where other people live, so as to preserve farmland. Report to the Legislature Barbara Murdock summarized MDH’s rigorous internal process for reviewing and accepting the report to the legislature. She noted that the general instructions for developing the report state that MDH staff may not give or circulate the report to the legislature or to any legislators. The report is to go to the legislative library, where legislative staff can find it and use it. Stakeholders outside of the legislature also read the report. [Note: as it turns out, the 2007 1
The EQB comprises the Governor’s Office (as chair), five citizens, and commissioners from nine state agencies. 2
To see the 2012 EQB Report, Minnesota Environment and Energy Report Card, copy or click on http://www.eqb.state.mn.us/documents/EQB%20Final%202012%20Report%20Card.pdf 1 legislation that established the EHTB program requires MDH to distribute the Report to the Legislature to the chairs and ranking members of the environment and health committees in both legislative chambers. We have done this.] Discussion Alan Bender asked what the response to the legislative reports had been in the past? Do legislators read it to your knowledge? Jean said that we haven’t received feedback on a report to the legislature in the past. Aggie added, “We think staff on committees and external organizations may be interested and seek it out to read it.” Chuck Stroebel said that the final PDF of the report would be circulated via our Gov Delivery list, which includes a number of legislators and their staff. East Metro PFC Biomonitoring Follow up: Phase 2 questionnaire analysis Jessica Nelson reported on preliminary data from the Phase 2 analysis of questionnaire data from the East Metro PFC Biomonitoring Follow‐up Project. The Phase 1 analysis measured the 2‐year change in PFC concentrations in blood samples from 164 project participants who had agreed to be contacted again. The analysis found that blood PFC levels in most study participants had declined between 2008 and 2010, demonstrating that removing PFCs from drinking water sources reduced exposure among exposed East Metro residents. Phase 2 was designed to learn more about other sources of PFC exposure, such as work or foods, in the East Metro residents. This presentation was the first of two, the second to be presented in March. The questionnaire requested data on the following:  Water consumption o type of filter, when installed o average cups of tap water per day  Residential history: all addresses in Oakdale, Lake Elmo, Cottage Grove o length of residence o type of water (city/well) o use of unfiltered water  Employment o current status o current employer o ever worked at 3M o past PFC‐related jobs  Diet o home garden: yes/no, how often consumed vegetables, type of vegetable o frequency of food consumption: red meat, eggs, potatoes, fast food meal, hamburger, French fries, sandwich, pizza, microwave popcorn, snacks, milk, soft drinks in bottle/can, soft drinks in take‐out cup, coffee in take‐out cup, East Metro fish, East Metro game 2 
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Product use o carpet and furniture stain‐resistance treatment (within the last year, before 2002) o carpet cleaning within the last year o new carpet last year o new furniture last year o non‐stick cookware use frequency o waterproofing spray last year Health history o height/weight o donated blood last 2 years, frequency o surgeries, blood transfusion, dialysis, pregnant, breastfeeding last 2 years Jessica presented the data distribution of a number of questionnaire variables: Demographics Because the original study had focused on recruiting longer‐term residents, most participants were older (average age 55.8; average length of residence 18.9 years). Forty five percent were men, and 55% were women. Most (65%) were employed, 27% were retired, 4% were homemakers, and 4% were not currently working. Occupational exposure Jobs that might involve exposure to PFCs range from working in fast food stores to printing services, firefighting, or photo processing, to Scotch Guard manufacture. Most (15%) participants who reported one of these jobs had worked in fast food shops, 7% in printing services, 5% in janitorial jobs; and 3% in firefighting. Two percent worked in chemical manufacture, 2% in food packaging, and 2% in electronics manufacture. Very few respondents (1% in each category) worked in other jobs, such as Scotch Guard or Teflon manufacture, airport maintenance, or dry cleaning. Other potential sources of exposure Survey questions also explored whether participants had home gardens (44% did) and ate the produce frequently (32% ate it 2‐4 times/ week, 14% 5‐6 times/week). Only 7 % ate locally caught fish or game. Only 18 participants (11%) never drank the local tap water. Most other participants drank between 1‐2 cups/day (20%) and 7‐8 cups/day (15%); a few drank as many as 10+ cups/day (9%). Other questions assessed the frequency of eating foods (red meat, eggs, potatoes, milk), fast foods (hamburgers, French fries, sandwiches, and pizza), and snack foods (microwave popcorn, snacks, soda in a can or in a cup, and coffee in a cup). Participants were asked about product uses that might involve PFCs: carpet and furniture treatments, carpet cleaning, new carpets or furniture, waterproof spray use, and use of non‐stick cookware. Finally, participants were asked about blood donation and frequency, surgeries, blood transfusions, pregnancies, or breast‐feeding in the last two years. 3 Jessica outlined her analysis plan and asked panel members for comments. The purpose of the questionnaire data analysis is to learn more about predictors of PFC exposure in East Metro residents. The analysis will study differences in the participants’ PFC blood levels measured in 2010 and compare them with the possible sources listed above. In one sub‐analysis, she plans to look at the relationships separately for the participants who had higher PFC concentrations in 2008 (those who likely had significant drinking water exposures) and the participants who had lower 2008 concentrations (those who were closer to background population exposures). A second sub‐analysis will look only at the participants whose PFC levels did not decline from 2008 to 2010. All analyses will consider age, gender, and length of residence. The results of the analysis will be reported in the March meeting. Discussion Lisa commented that, from a public health perspective, it seems as though the analysis should focus on people with levels that are still elevated. Pat McGovern suggested including a discussion about which foods may be confounders to provide a physiological background for including those questions in the analysis. Update on C8 Science Panel findings Jessica briefly reviewed the C8 probable link reports issued by the C8 Science Panel in October 2012. Because of concerns about PFCs among East Metro residents, MDH often gets media inquiries when the C8 science panel releases probable link reports. The C8 Science Panel research program gathered and assessed “information on health status and C8 exposure in Mid‐Ohio Valley communities potentially affected by the releases of C8 (PFOA) from the Washington Works plant in Parkersburg, West Virginia. The Science Panel consists of three epidemiologists who were chosen jointly by the parties to the legal settlement of a case between plaintiffs and DuPont regarding releases of C8 from the plant.”3 The definition of “probable link” is a legal definition, rather than a scientific definition. “A ‘probable link’ in this setting is defined in the Settlement Agreement to mean that given the available scientific evidence, it is more likely than not that among class members a connection exists between PFOA exposure and a particular human disease.”4 All probable link reports have now been released, Jessica said. There were six positive findings. Positive Probable Link reports 1) Diagnosed high cholesterol 2) Ulcerative colitis 3) Thyroid disease 4) Testicular and kidney cancer 3
http://www.c8sciencepanel.org/ 4
http://www.c8sciencepanel.org/pdfs/Probable_Link_C8_Kidney_29Oct2012.pdf 4 5) Preeclampsia 6) Pregnancy hypertension Negative Probable Link reports 
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diagnosed high blood pressure coronary artery disease liver disease osteoarthritis chronic kidney disease Parkinson's disease chronic obstructive pulmonary disease asthma childhood and adult infections such as influenza neurodevelopmental disorders in children stroke five autoimmune diseases (lupus, rheumatoid arthritis, Type 1 (juvenile) diabetes, Crohn’s disease, and multiple sclerosis) 19/21 cancers considered: bladder, brain, breast, cervical, colorectal, esophagus, leukemia, liver, lung, lymphoma, melanoma, oral (including larynx/pharynx), ovarian, pancreatic, prostate, soft tissue, stomach, thyroid, uterine Type II diabetes birth defects miscarriage stillbirth preterm birth low birth weight Now that the C8 Science Panel has finished its work, a new panel – the C8 Medical Panel – will determine whether and how medical monitoring should be done in the community for the six “probable link” conditions. At the same time, personal injury lawsuits can now begin. Jessica said that MDH does not plan to change its medical recommendations to the East Metro community, which are simply to continue routine checkups. She then asked whether the panel had any advice on how to present C8 findings to the community, given that MDH cannot carry out a full review and critique of the PFC literature. Discussion Lisa urged staff to distinguish the C8 kind of analysis from what is done in standard science and epidemiology. In the C8 case, you have people who are plaintiffs, and data analysis of [legal] evidence is very different from a scientific analysis. Alan commented that the judge used a different criterion – a legal criterion – to judge the case. He stressed that MDH needs Executive Office approval to decide what the probable link reports mean. We should work on deciding 5 what this information means in Minnesota and approach the legislature with this message with executive office support. It is important to help policy makers understand the difference between a scientific approach and the legal approach. He also stressed the need for a communication strategy for the public and for medical providers. Pat McGovern noted that the communication strategy for healthcare providers will be important, especially since participants may want to go to an individual physician to assess their cholesterol after reading about these findings. Jessica said that Dr. Mary Winnett has served as consulting physician during this project. Jean Johnson asked panel for their suggestions on ways to target these physicians. She commented that staff have done lunch sessions with limited success. Alan suggested that MDH might offer certification and continuing medical education credits (CME). Jill Heins‐Nesvold said that, in working with the MDH asthma program we learned that the time of year and the person who invites the physicians can determine the response rate. The ALA is having success with a peer‐to‐peer relationship with a staff member who is a physician. The ALA typically gets no response in the summer and generally gets a much better response in October and November, but not during flu season. She also recommended translating C8 and PFOA into easy to understand language like that used in Wikipedia’s explanation of PFCs in layman’s English. She agreed with Alan that some kinds of seminars can be part of continuing medical education. Melanie suggested midwives as a good potential target group. Pat suggested that staff work with health plans on mailings because they can help with contacting physicians in Metro area subgroups. She also suggested contacting organizations for such specialties as family medicine and internal medicine. Geary Olsen followed up on the statement on page 9 of the Advisory Panel background book for the December 2012 meeting that “MDH will not be conducting a formal epidemiologic review of the findings,” and that the update will only “be a summary of what the C8 Science Panel found.” Noting that the C8 reports are five to 10 page documents, he asked, “How many people have read them?” He commented that the C8 panel seems to base their probable link statement only on their own data, rather than using the comprehensive literature, including toxicological data. He pointed out, for example, that the thyroid disease probable link is based on hyperthyroidism in females and hypothyroidism in males. He said that this seems to be conflicting evidence, given that 80% of hypothyroidism occurs in women. He recommended that MDH should review the epidemiologic findings or do a formal review in order to comment on these findings, at least on the inconsistencies in the reports. “Is MDH just going to release a summary of six positive findings with no comment (as inferred by page 9 of today’s Question for the Advisory Panel)?” he asked. Jessica added that much of the data used in the C8 probable link reports isn’t even public or available. But she added that MDH staff do not plan to do a literature review, saying that, if staff start to compare the findings to the literature, it makes it appear that they have assessed the literature. Although MDH cannot take on the role of an expert review panel, Alan argued, a distinction exists between providing commentary on C8 findings and having MDH conduct a formal review. 6 What MDH can do, he said, is provide commentary on the conflicts we see in the findings. Lisa agreed, saying that it’s important to show the epidemiologic approach, explain the typical scientific method, and make it clear that C8 is using a different context, a legal context, which is not as rigorous as what scientists would do. If there is a lack of consensus, she added, point that out and explain how scientists do science. Then you could explain the problems with the probable link method. Alan concurred, saying that MDH might not comment on whether the conclusions are correct, for example, but could comment on the methods and study design. He added that a known conflict exists between their list of probable links and the information in the literature. Geary supported the idea that MDH should comment on the process and context, saying that the C8 panel is only three scientists, not a peer review committee. Much of the data presented by the C8 Science Panel has not been published yet. He added that he would be concerned about the approach of presenting a summary of C8 findings with no comment from MDH. But Alan said that MDH can present the findings and list the agency’s concerns. Pat recommended that MDH staff may also want to add talking points on what MDH recommends for the community. What are the standard medical recommendations for the health outcomes listed in the positive probable link reports? Point out that MDH does not recommend doing anything other than what MDH thinks are standard medical recommendations for these health outcomes, so people will know the appropriate action to take. Home and Garden PFC Study – Jim Kelly, Environmental Health Division The East Metro Perfluorochemicals in Home and Garden Study goal was to learn whether PFC‐
contaminated groundwater used for garden and lawn watering could contaminate soil and/or home‐grown produce or be tracked into the house on people’s shoes. The study measured PFCs in soil, household dust, and in vegetables grown on 20 properties in the three East Metro communities and on three control properties. The study was done in response to questions that came up at meetings with the East Metro community: could home‐grown produce, soil, or household dust be other routes of exposure to PFCs in the East Metro? Soil results In general, gardens had low PFC levels in the soil. In the control sites, the study found PFCs in almost all samples, but the levels were much lower than in the study area. These chemicals are ubiquitous, but MDH found no direct health implications for residents. The levels seen were thousands of times lower than a level of health concern. The PFCs that bioaccumulate in people were found less frequently than others. The study found PFBA in most water samples, but very low levels in the soil. Produce samples The study detected PFCs in 98% of produce in the study gardens, but the levels were very low and typically PFBA, rather than the bioaccumulators, PFOA & PFOS. Jim listed 7 the five highest produce categories: beans/peas, herbs, peppers, tomatoes, and broccoli/cauliflower. In summing up, he said, PFCs seem to be ubiquitous in the East Metro area in well and city water, soil, and produce, but at low to very low levels. The conclusion is that growing and consuming one’s own produce is not a health concern for the study area. MDH’s advice for the community is that no one needs to limit home gardening and eating homegrown food. We plan to join the EHTB program and meet with the community later in the year. Discussion Greg asked, when was the monitoring done? Jim replied that samples were collected during the summer of 2010, which was a wet summer, so gardeners may not have water as often as they had to do in 2012, which was dry. Greg asked whether Jim had any conclusions about exposure to different parts of the produce. And Lisa asked whether the produce was analyzed as it is typically eaten. That is, for example, were the cucumbers peeled? Jim answered that the study didn’t look at PFC levels in different parts of the produce, such as the vine, stem, or flesh of a tomato, but the produce was tested as it is typically prepared. Jill said that she noticed that the spring harvest was low in PFCs and that the lowest PFC levels were in the root vegetables and asked about PFC levels in produce in the hottest season. The uptake of PFCs is unclear; produce grown in the hottest season did not contain more PFCs than produce grown in the spring. Cathy Villas‐Horns commented that she was pleased to see the study done because of widespread community concerns about garden contamination. Biomonitoring Updates Jean Johnson gave a brief update on a new project, the Riverside Newborn Mercury Project and an update on the Pregnancy and Newborns Exposure Study, a University of Minnesota collaboration. The Riverside Newborn Mercury Project, a proposed collaboration with Logan Spector at the University of Minnesota, will analyze total mercury in banked newborn blood spots collected from participants in the UMN Riverside Birth Study. The results will be compared with results from the Pregnancy and Newborns Exposure Study, part of the University of Minnesota’s TIDES study. If the results are similar, they could be combined to increase the sample size because both studies are looking at the same population. In addition, the mercury results and questionnaire data will be used to assess prenatal mercury exposure and to discern any seasonal pattern to mercury results. These studies are an important first step to exploring newborn mercury exposures outside of the Lake Superior Basin. Jean also reported that the Pregnancy and Newborns Exposure Study had 40 matched cord and newborn spots pairs to date and that 10 remaining mothers would soon give birth. Jim Kelly’s brief update on the Fond du Lac project reported that the project is finally getting underway. Staff are starting to enroll participants. The Great Lakes Sawtooth Clinic Study is just beginning, as a follow‐up study to the Mercury in Newborns in the Lake Superior Basin study. The project received its funding just a month ago and will be testing the effectiveness of interventions to prevent mercury exposure in women of childbearing age before they become 8 pregnant. Staff will develop a survey instrument and then develop fish consumption advice to reduce mercury levels in this population of women of childbearing age. Tracking Updates Chuck Stroebel highlighted the recent CDC strategic planning meeting of the CDC Tracking Network that Jean and Chuck attended. CDC’s Tracking Network is facing a possible $7 million cut and is still operating under a continuing resolution. In addition, sequestration could severely affect federal funding. The discussion revolved around identifying where tracking should focus its efforts over the next six months. What are the unique strengths of our tracking program? What do we do and how do we make a difference? The ideas under discussion included having tracking states provide health outcome data at a finer level – below the county level – to make the data more relevant to communities and, perhaps, to address environmental justice and vulnerable communities. The tracking programs also do custom data analyses in communities on a case by case basis. Data linkage projects could analyze data to better understand relationships between health and environmental data and demonstrate that that tracking is looking at ways to use the data across agencies. Communicating EPHT’s mission and success more effectively was another important concern, one that could partly be addressed with tracking success stories. In an update for MN EPHT, Chuck described several new content areas: 1) Heat related illness data identifies important vulnerable groups and confirms the public health importance of severe heat events. 2) Interactive maps for melanoma and non‐Hodgkin’s lymphoma allow users to see and compare cancer incidence maps side‐by‐side. Geographic trends in incidence highlight the differences in melanoma rates between the two sexes. These maps were developed in collaboration with MDH’s Minnesota Cancer Surveillance System, the Minnesota Cancer Alliance, and the American Cancer Society.  The new interactive melanoma map can be used to inform policy, particularly with respect to the use of tanning booths.  Melanoma has increased nearly twofold since 1988, and MDH is trying to identify strategies to reduce UV exposure. Greg asked if Chuck could give some perspective on CDC’s tracking budget in the context of the president’s budget. What would that mean at both the federal and state program levels? Chuck said that would mean $7 million out of tracking’s $36 million budget. The cut may trickle down to cut funding across all grantees, or the CDC may cut some of the grantees. The funding decisions may be clear by the March meeting. Alan added that the Minnesota EPHT has provided a very useful interface for data access, but has been hit hard by staffing losses. Chuck also asked the panel for feedback and for suggestions for success stories on ways in which tracking data are being used. 9 A Minnesota Biomonitoring Summit Jean outlined an idea for a Minnesota biomonitoring summit that could be held during the legislative session to highlight the program’s achievements. The rationale, she explained, is that the state funding for biomonitoring and tracking will end on June 30, 2013. She asked, in the last six months of our state support, what can we do to draw attention to our work and our recommendations in the legislative report? She presented a suggestion for a biomonitoring summit and asked the panel for ideas and support in reaching local and state public health officials, legislators, NGOs, academics, and business interests. Discussion The panel addressed range of topics from scheduling, to stakeholders, to whether the summit should be aimed at scientists or at stakeholders, citizens, and advocacy groups. Pat asked whether the advisory panel members could recommend adding any people to the list of stakeholders. Who has an interest in using these data? Who in the list of participants would value this information? She suggested adding the Academic Health Center, including public health, medicine, and nursing. Both faculty and students would welcome this opportunity. Greg argued that the summit should have a strong science basis and an attractive keynote speaker. Lisa commented that other states might consider joining the summit via web access if it featured big name speakers, such as Lisa Aylward or Sean Hayes. Pat suggested involving the NIEHS’s Children’s Environmental Health Centers and the specific exposures they study. She also suggested the science and policy program at the Humphrey Institute at the University of Minnesota, and CTSI,5 an organization that works on translation of research into action, such as building infrastructure for translational research. Geary suggested contacting the environmental epidemiology community, including pharmacokinetics experts. He suggested 2 speakers for environmental pharmacokinetics – hard science speakers Matt Longnecker and Harvey Poole. Lisa suggested that the speaker could be a webinar guest star if the budget restricted travel. Pat suggested that the Summit could have concurrent conference sessions to appeal to a diverse audience, such as pharmacokinetics and health policy sessions. Geary pointed out that people attending sessions outside their expertise could encounter difficulties – it would be necessary to figure out how to translate science into policy. Jill Heins‐Nesvold asked whether Jean was proposing a half day or a full day seminar, and Jean said a half day. Fred Anderson commented that holding a half day summit requires a local geography and limits the scope of the audience. He suggested that MDH may want to invite or market to business partners, the media, and science editors to get the story out. Jill asked, is advocacy support one purpose? Jean said yes, she was hoping to hold the summit during the legislative session so that people could talk to their legislators, especially if the legislators have a proposed motion on the floor. Jill noted that state and local public health 5
Clinical & Translational Science Institute 10 staff cannot advocate. Instead, we need stakeholders, real advocacy folks, not hard scientists, because they will not motivate people to take action. So we are talking about two different audiences and two different summits. We can’t do both. NGOs and public or business partners will have to advocate for the EHTB program, but those people will not attend if the summit is too scientific. She said that the keynote speaker should be a motivational speaker to get advocates to attend. Pat asked Jean about the intended audience that she would like to attend the summit. Jean said that she would like to hold a stakeholder Summit, but that she would love to do a scientific summit as well. Jill suggested designing a webinar series, in that case, to tailor the message to these two very different audiences. Geary suggested involving the Northland Society of Toxicology meeting as a useful vehicle for our message and advised EHTB to make sure that some biomonitoring reports would be visible to visitors on the MN EPHT website. Following up on his last suggestion, Geary said that visitors should be able to get information about biomonitoring on the website, as a way to get people interested in the program. But, he said, the biomonitoring information is hard to find. He has had trouble finding full biomonitoring reports online. Jean explained that the website has only three technical reports on biomonitoring, and the rest are community briefs. Geary said he could not find the technical reports, and Jean replied that we would make them more prominent. MDH/MDA Meeting on pesticides and health In response to an Advisory Panel request for MDH to meet with the Minnesota Department of Agriculture (MDA) to discuss biomonitoring and health tracking, Cathy Villas‐Horns scheduled an early December meeting among MDA staff, MDH Environmental Health staff, and MDH EHTB staff. At the Advisory Panel meeting, she reported that 13 people from MDA and MDH had met for two hours in a round robin format, sharing information on their current projects and concerns. The topics included: 1) What are agencies hearing about community concerns? MDH and MDA hear about occupational exposures, pesticide drift, birth defects in animals, parental concerns about pesticide application on lawns and playgrounds, and pesticides in water. MDA routinely follows up on complaints about agricultural chemicals. Fifteen percent of the 2012 complaints were about alleged human injuries (eyes, skin, respiratory), strong odors from pesticides, and conditions that were too windy for application of insecticides and fungicides. MDA has more complaints about air applications (planes and helicopters), especially in the urban/rural interface. MDA does a lot outreach, works with growers to help them use best management practices (BMPs), and to reduce the overuse of pesticides and the use of the wrong pesticides. 2) What are the past/current/future biomonitoring projects in Minnesota? Neither MDH nor MDA conduct biomonitoring for current‐use pesticides, and both agencies collaborate on the feasibility of developing nationally consistent data measures for public health tracking. Because the MDA is not the primary agency for evaluation of pesticide health impacts, the agency turns to MDH for advice on any pesticide exposure health concerns. 11 In the Tracking program, MDH is working on arsenic in drinking water and on national and Minnesota Poison Control Center (PCC) pesticide tracking indicators. The CDC’s National Tracking Network reports on the pesticide, atrazine, in public drinking water supplies as a national interest for drinking water tracking indicators. To comply with indicator reporting, MDH will emphasize the extremely rare occurrences of atrazine in public water supplies, rather than submitting large datasets with non‐detection values. In Minnesota, both MDH and MDA are looking at Minnesota PCC data, and the Health Promotion Chronic Disease (HPCD) section is working on occupational pesticide exposures. MDH’s Environmental Health staff receive many calls from citizens with concerns about pesticides, but don’t keep a database of the calls. 3) What data are available to evaluate pesticide exposures and what are the known data gaps? Cathy gave examples of MDH/MDA data collected on pesticide exposure. One potential data source for pesticide usage (not necessarily exposure) may involve a right‐to‐
know program involving pesticide applicators/applications. MDA works with growers to reduce pesticide drift. 4) What policy initiatives for pesticides are expected in the next legislative session? Past suggestions for policy initiatives have included Right‐to‐Know laws, which MDA believes would be very expensive. Currently the state has 5 million agricultural pesticide applications per year, and such a law would involve extensive outreach and education to applicators, plus keeping records of all pesticide applications. Instead, MDA works with applicators to use BMPs and reduce pesticide drift. Another possible suggestion involves air monitoring of pesticide applications. An organization called PANNA6 collects air monitoring data in the potato growing region of Minnesota. MDA and MDH have reviewed PANNA data and do not dispute it, but MDA and MDH staff have concerns about PANNA’s sample collection methods, interpretation, and the use of certain human health benchmarks in risk screening. Overall, Cathy said, the group found the discussion valuable. Discussion The first question from the panel was, what actions does MDA take to respond to complaints? Cathy answered that MDA works with rural populations and tries to reduce exposure through best management practices (BMP). MDA is also working with the UMN on outreach and on decreasing the overuse or use of the wrong pesticides for bedbugs. Pat asked whether the group will meet regularly or ad hoc. Cathy said the group doesn’t plan to meet regularly, but will meet as needed. Jean noted that the EHTB program has regular connections with MDA: for instance, Joe Zachman participates in monthly Tech Team meetings and attends Advisory Panel meetings. Greg asked whether MDA keeps a record of private applicators in a database, as California does, or does it intend to do so? Cathy answered that MDA currently neither keeps a record of private applicators nor plans to do so without 6
Pesticide Action Network North America 12 legislative direction and funding. Greg also pointed out that the MPCA is interested in pesticide applications in the context of the agency’s statewide study of air pollution. He commented that nationally licensed pesticides are also licensed in Minnesota. Joe noted that no pesticide can be registered in Minnesota without federal registration, but MDA does not license all pesticides registered by the federal government. Occasionally, MDA has been more restrictive than the federal government. Developmental Disabilities (DD) Data Jeannette Sample reviewed existing and future data sources for developmental disabilities (DDs), as recommended by the Advisory Panel in March 2012, to evaluate developmental disabilities as a new content area for Minnesota EPHT. She reviewed the Phase 1 criteria of the MN EPHT evaluation process, which explores prevalence, causality, public health impact, and actionability for developmental disabilities and reviews the available data. Developmental disabilities are common, and affect one in six children. The causes of most developmental disabilities are largely unknown, but some well‐
understood toxicants, such as lead and mercury, are known to affect children's developing nervous systems. Thus, understanding the causes of DDs enables public health to take preventive actions. Minnesota has seen some increase in developmental disabilities; between 2001 and 2009/2010, the prevalence of DDs went from 12.4% to 14.3%. The health impacts of DDs are considerable – for instance, it costs twice as much to educate a child with DDs compared to educating a normal child. Do the data exist? In Minnesota, Jeannette said, we will look further at IDEA and also at two national surveys. Phase 2 of the MN EPHT entails data source evaluation. This involves evaluating Minnesota data from the national Individuals with Disabilities Education Act (IDEA) database, as recommended by the Advisory Panel in March, and evaluating Minnesota data from two other national health surveys: the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health. She presented Phase 2 criteria and piloted indicators from IDEA (charts). The data document the number of children receiving special services for four different indicators: 1)
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Autism Intellectual disability Developmental delay Specific learning disability (a disorder in one or more psychological ability in using spoken/written language, such as dyslexia) The strengths of IDEA are that the data are publicly available, are collected every year by the state, we can request data by district, and the data are standardized and inclusive. The limitations of IDEA are that we do not have data on the prevalence of DDs, but only on the number of children who receive services. Thus, the classification reflects service needs and 13 involves no clinical diagnosis. In addition, there are questions about uniformity and comparability between districts and over time. Jeannette then presented Phase 2 criteria and piloted three indicators from the National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NSCSHCN): 1) Autism (NSCSHCN only): 9.3 % of Minnesota children with special health care needs 2) ADD/ADHD: estimated 5.7% of all children in Minnesota; 30% of children with special health care needs 3) Developmental delay: estimated 2.2% of children in Minnesota, 17% of children with special health care needs. She then summarized the strengths and limitations of these two national surveys as follows: Strengths •
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Provide prevalence estimates Based on a large Random Digit Dial (RDD) sample design Data for every state On‐going Publicly available Limitations •
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Data not at county level Questions change over time Survey not conducted yearly Small sample sizes for each condition Parental report of health Barbara Dalbec, MDH Children and Youth with Special Health Needs (CYSHN) director, then gave an overview of autism projects in Minnesota in the second part of the joint presentation. She noted three trends: 1) Increasing concern about autism in communities 2) Increasing CDC prevalence data on autism 3) Increasing numbers of children in Minnesota who are in special education programs to receive special services for autism (a 446% increase over 10 years). Receiving special services defines these children as having autism, which she considers a shaky definition. She noted that the community interested in autism is very active, which reflects a huge increase in special education needs, especially in the Somali community. In response there have been several inter‐agency and other efforts to address autism: 1) In 2009, MDH and the Minneapolis public schools tried to find the true prevalence, but were left only with more questions. 14 2) The federal Race to the Top grant allows Minnesota to do data linkages, assess whether outcomes are improving, identify which data to collect and what questions to ask, and to obtain parental consent. This effort is still in early stages. 3) The University of Minnesota has obtained national funding to assess autism prevalence, with special focus on the Somali population. 4) In the 2012 legislative session, the autism task force worked at developing a statewide plan. One goal is to learn the true prevalence, which could become a legislative initiative. Another is a qualitative study of the reasons that people are not diagnosed. Discussion Pat McGovern recommended moving forward to explore the data sources. Melanie asked about accurate medical diagnosis and IDEA data with respect to splitting the data into age categories, especially for developmental delay at the youngest ages. She asked, is this a meaningful distinction, given the complexity of diagnosis? Jeannette answered the group will consider this question, pointing out that ADDM (Autism and Developmental Disabilities Monitoring Network; Minnesota does not take part in this network) evaluates autism at age 8. Jeannette agreed that developmental delay diagnosis at a young age is complex. Barbara Dalbec noted that often disability services put very young children with hearing problems in the developmental delay category at first. She said that most surveys use age 8 for autism diagnosis because most children are diagnosed by then, but she sees a trend toward identifying autism earlier. Jeannette recommended continuing the Phase 2 evaluation of the three data sources presented and plans to come back to the panel in a later meeting to ask for recommendations on which conditions to track. Lisa commented that the data should determine the conditions one should track. She agreed with Jeannette’s proposal to look at both national data surveys as recommended. Pat McGovern would like to see Jeannette and Barbara go back to the three data sources. She wondered whether there is a methodological difference among them, especially with the IDEA data services data, and whether there are any validity studies on the diagnoses. She would like to see staff go back and look at the diagnosis and special services data. Barbara Dalbec recommended using both. At 4 PM, Pat McGovern asked for any new business. Barbara Murdock advised the panel members to look for a draft of the near‐final legislative report in their email. Pat McGovern asked for a motion to adjourn, which was seconded, and adjourned the meeting. 15