Minnesota Department of Health Environmental Health Tracking and Biomonitoring Advisory Panel Meeting December 11, 2012 1:00 p.m. – 4:00 p.m. December11,2012AdvisoryPanelMeetingAgenda Time Agenda Item 1:00 PM Welcome & Introductions 1:05 Legislative Update 1:10 Update on Report to the Legislature 1:15 1:25 Presenters Pat McGovern, Chair pro tem Aggie Leitheiser, Assistant Commissioner Barbara Scott Murdock Descriptive/demographic Jessica Nelson data from the E. Metro PFC Follow‐up Discussion 1:40 West Virginia/C8 Probable Link Report Updates Jessica Nelson 1:50 Discussion Home & Garden PFC Study 2:00 Jim Kelly Manager EH/ESA 2:10 Biomonitoring Updates: Riverside Newborn Mercury Project Pregnancy & Newborns Exposure Sawtooth Clinic Mercury Project Fond du Lac National Initiatives Jim Kelly Jean Johnson 2:15 Audience questions Description/expected outcome Panel members & audience are invited to introduce themselves Information item. Informational item. Discussion item. Jessica Nelson will describe the available data, descriptive analysis, and analysis plans. Panel members are invited to ask questions and to provide input on the analysis plans. Discussion item. Jessica Nelson will update the panel on the most recent “probable link” reports from the C8 Science Panel and MDH communications. Panel members are asked to provide input on plans for keeping the community informed. Information item. Jim Kelly will present results to date of a study to measure PFCs in produce from East Metro home gardens. No presentation. Panel members are invited to ask questions about updates provided in the meeting materials. 2:20 2:30 2:35 2:40 2:50 3:00 3:25 3:50 3:55 4:00 Refreshments Tracking Updates Minnehaha‐ Hiawatha Corridor Strategic Planning with CDC Tracking Heat‐related Illness: New Measures Carbon Monoxide Poisoning Data New Cancer Maps Portal Updates Project proposal: EHTB Biomonitoring Summit Discussion Update on meeting with MDA to discuss pesticides and health Tracking Developmental Disabilities: Data Sources Discussion Audience questions New business Adjourn Chuck Stroebel No presentation. Panel members are invited to ask questions about updates provided in the meeting materials. Jean Johnson Discussion item: Jean Johnson will present a proposal for MDH/EHTB to host a Biomonitoring Summit in Spring 2013. Panel members are asked to comment on the proposal and advise MDH on suggested format, topics and speakers. Informational item. Cathy Villas‐ Horns Jeannette Sample, Barb Dalbec, MDH CYSHN director Discussion Item. Jeannette Sample will present a review of available data for Tracking developmental disabilities in MN. Panel members are invited to ask questions and recommend next steps. Pat McGovern Pat McGovern Pat McGovern Note to audience: The panel asks that audience members hold their comments and questions during each discussion item until the end of the panel’s discussion, when the panel chair will invite questions from the audience. Audience members are asked to identify themselves when they speak, and to please put their names and affiliations on the list at the sign‐in table. Meetings are recorded on audiotape. 2 TableofContents Section Overview: East Metro PFC Biomonitoring Follow‐up Project: Phase 2 questionnaire data analysis ................................................................................................ 5 Section Overview: Update on C8 Science Panel Findings .................................................. 9 Section Overview: Perfluorochemicals (PFCs) in Homes and Gardens Study ................. 13 Section Overview: Biomonitoring Updates ...................................................................... 19 Section Overview: Tracking Updates ............................................................................... 25 Section Overview: Proposal: A Minnesota Biomonitoring Summit ................................. 31 Section Overview: New MN EPHT Content Area: Developmental Disabilities ................. 35 Section Overview: Other Information .............................................................................. 41 2012 Advisory Panel Meetings ..................................................................................... 43 2013 Advisory Panel Meetings ..................................................................................... 43 Summary: September 11, 2012 Advisory Panel Meeting ............................................. 45 Advisory Panel Roster ................................................................................................... 57 Biographical sketches of advisory panel members ...................................................... 59 Staff biosketches ........................................................................................................... 63 Environmental Health Tracking and Biomonitoring Statute ........................................ 67 Recent PFC Abstracts of Interest .................................................................................. 73 3 This page intentionally left blank 4 SectionOverview:EastMetroPFCBiomonitoringFollow‐up Project:Phase2questionnairedataanalysis EHTB staff will introduce the Phase 2 analysis of questionnaire data from the East Metro PFC Biomonitoring Follow‐up Project. Jessica Nelson will present descriptive statistics for the diet, product use, and health history variables. She will also present a data analysis plan (also summarized below) and ask for the Panel’s comments and advice. Panel members are invited to comment on and ask questions about the data and data analysis plan. Questions for the Advisory Panel Have you recommendations or comments on the proposed data analysis plan? Are there additional analyses we should consider? 5 This page intentionally left blank 6 EastMetroPFCBiomonitoringFollow‐upProject: Phase2questionnairedataanalysis The Phase 2 analysis of questionnaire data from the East Metro PFC Biomonitoring Follow‐up Project is underway. (The Phase 1 analysis, which measured the 2‐year change in PFC concentrations among project participants, is complete and has been presented to the Advisory Panel.) Staff are working on cleaning the data, which was double‐entered in an MS Access database, and importing it into SAS, where it will be analyzed. A summary of the data collected in the questionnaire is below: Questionnaire data overview 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 frequency: never, 1‐6/yr, 7‐11/yr, 1/month, 2‐3/month, 1/wk, 2‐ 4/wk, 5‐6/wk, 1/day, 2+/day 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 7 o donated blood last 2 years, frequency o surgeries, blood transfusion, dialysis, pregnant, breastfeeding last 2 years Data analysis plan summary The purpose of this phase 2 questionnaire data analysis is to learn more about predictors of PFC exposure in East Metro residents. The analysis will study differences in PFC serum concentrations by many of the predictor variables summarized above. The main outcome variable will be PFC concentrations in 2010, which will be modeled continuously (with log transformation due to the log normal distribution of the biomonitoring data) for the most frequently detected PFCs and dichotomously (detect v. non‐detect) for the less frequently detected PFCs. Decisions will be made about whether and how to model predictor variables based on the distribution of the data (i.e. whether categories need to be collapsed, etc.). In addition to the analysis in the overall population, we will look at these relationships separately for those who had higher PFC concentrations in 2008 (i.e., those above a certain cut‐off such as the median concentration, who likely had significant drinking water exposures) and those who had lower 2008 concentrations (i.e. those below the cut‐off, who were closer to background population exposures). Another sub‐analysis will look at just those participants whose PFC levels did not decrease from 2008 to 2010. All analyses will also consider covariates such as age, gender, and length of residence. 8 SectionOverview:UpdateonC8SciencePanelFindings At the September 2012 Advisory Panel meeting, staff reviewed the background for the C8 Science Panel, the current status of the Science Panel’s probable link reports, and MDH messaging around the findings. All probable link reports were to be released at the end of the October. Panel members asked for an update at the December 2012 meeting, after all of the Science Panel’s probable link reports have been released. Jessica Nelson will update the panel on the most recent “probable link” reports from the C8 Science Panel and MDH communications. Panel members are invited to comment on and ask questions about the probable link reports and MDH staff plans for communicating with the East Metro community. Question for the Advisory Panel MDH has a responsibility to go back to the East Metro community and update the residents on the findings of the C8 Science Panel. The current plan is to do this as part of a follow‐up communication that will include results from the Phase 2 questionnaire analysis and other updates. MDH will not be conducting a formal epidemiologic review of the findings; the update will be a summary of what the C8 Science Panel found. Has the Advisory Panel advice about how best to present the findings of the C8 Science Panel to the community? 9 This page intentionally left blank 10 UpdateonC8SciencePanelFindings Introduction At the September 2012 Advisory Panel meeting, staff reviewed background about the C8 Science Panel, the current status of the Science Panel’s probable link reports, and MDH messaging around the findings. Panel members requested an update at the December 2012 meeting once all of the Science Panel’s probable link reports have been released. October 29, 2012 probable link findings The C8 Science Panel released its final round of probable link reports on October 29. They found a positive probable link between PFOA and diagnosed high cholesterol, and negative probable links with diagnosed high blood pressure, coronary artery disease, liver disease, osteoarthritis, chronic kidney disease, and Parkinson's disease. More details on the Panel’s positive finding with regards to high cholesterol can be found here: http://www.c8sciencepanel.org/pdfs/Probable_Link_C8_Heart_Disease_29Oct2012.pdf Summary of complete probable link reports Positive Probable Link reports diagnosed high cholesterol ulcerative colitis thyroid disease testicular cancer kidney cancer preeclampsia pregnancy‐induced hypertension Negative Probable Link reports 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) 11 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 What happens next in the affected communities in West Virginia and Ohio The Parkersburg (WV) News and Sentinel reported on 4/14/12 that the C8 Medical Panel, the group that will design the ongoing medical monitoring program for members of the class, has been chosen. The newspaper states: “The C8 Science Panel is to determine whether there are any probable links between C8 exposure and human disease. The newly appointed C8 Medical Panel will determine the nature and extent of any medical monitoring that would be appropriate for class members for any disease to which the C8 Science Panel finds a probable link. The C8 Medical Panel members are Dr. Dean Baker, a professor of medicine, pediatrics and epidemiology at the University of California, Irvine, School of Medicine; Dr. Melissa McDiarmid, a professor of medicine, epidemiology and public health at the University of Maryland and director of the school's Occupational/Environmental Health Program; and Dr. Harold Sox, professor of Medicine Emeritus at Dartmouth Medical School and associate director for faculty at Dartmouth Institute for Health Policy and Clinical Practice.” Text from the article “C8 Medical Panel draws positive reaction,” by Pamela Brust: http://www.newsandsentinel.com/page/content.detail/id/559952/C8‐Medical‐Panel‐ draws‐positive‐reaction.html?nav=5061 12 SectionOverview:Perfluorochemicals(PFCs)inHomesand GardensStudy MDH’s Environmental Health Division evaluated whether PFCs in public and private water supplies in East Metro communities had contaminated soil and residential produce gardens irrigated with contaminated water. The project also evaluated the extent to which crops grown in contaminated soil and water took up PFCs and whether non‐potable use of PFC‐contaminated water contributed to indoor PFC contamination in house dust through transfer from yard and garden soils. Environmental Health Manager Jim Kelly will briefly review the study and respond to questions and comments from the panel. No action need be taken on this item. Panel members are invited to ask questions and offer comments on the project. 13 This page intentionally left blank 14 Perfluorochemicals(PFCs)inHomesandGardensStudy Study Update: October 2012 Study Purposes: To evaluate: 1) whether PFC contamination (primarily perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA)) in public and private water supplies in Lake Elmo, Oakdale, and Cottage Grove, Minnesota has resulted in residual soil contamination in yards or residential produce gardens irrigated with contaminated water; 2) the extent to which various common food crops grown in potentially contaminated soil or irrigated with PFC contaminated water take up PFCs; and 3) whether non‐potable use of PFC‐ contaminated drinking water contributes to indoor PFC contamination in house dust via transfer from outdoor soil. Samples Collected: Study Participants: 20 Study Properties Water: 24 Oakdale: 9 Soil: 44 Lake Elmo: 7 Produce: 279 Cottage Grove: 4 Dust: 66 3 Control Properties PFCs Analyte List: perfluorooctane sulfonate (PFOS) perfluorooctanoic acid (PFOA) perfluorobutane sulfonate (PFBS) perfluorobutanoic acid (PFBA) perfluoropentanoic acid (PFPeA) perfluorohexane sulfonate (PFHxS) perfluorohexanoic acid (PFHxA) Water sample analysis complete and results communicated to participants. Produce sample results complete and resulted communicated. Soil sample analysis complete; results to be communicated Fall 2012. Dust analysis in final method development stage. The final report (spring 2013) will examine the relation between water, soil, produce and dust sample results, as well as look at geographic, temporal, or other factors that may have influenced PFC levels in the various media or produce types. Study Contact: James Kelly, M.S. Manager, Environmental Surveillance & Assessment Environmental Health Division Minnesota Department of Health 651‐201‐4910 [email protected] 15 Water: • At control sites, all outdoor tap water results were non‐detect for PFCs. • In the study area, PFBA was found most often and at higher concentrations compared to other PFCs (Table 1). • All PFC levels in drinking water were below MDH health‐based guidance values (see http://www.health.state.mn.us/divs/eh/risk/guidance/gw/table.html). Table 1. Water results in study area (20 homes/samples) PFOA PFOS PFBA PFBS PFHxA PFHxS PFPeA Percent detects 25 5 85 0 15 0 40 Median (ug/L) ND ND 0.98 ND ND ND ND Min-Max(ug/L) ND-0.12 ND-0.14 ND-2.50 ND-ND ND-0.09 ND-ND ND-0.18 ND = No detection. Percent detection, median, and min/max include estimated values below the reporting limit. Soil: • Low levels of multiple PFCs were detected in the majority of soil samples from both study area and control sites (Table 2). • PFOS, PFOA, and PFBA were found at the highest concentrations in soil. Median concentrations of these analytes were 2‐3 x higher in the study area. • Levels of PFOS, PFOA, and PFBA were well below residential soil reference values established by the Minnesota Pollution Control Agency (see http://www.pca.state.mn.us/index.php/waste/waste‐and‐cleanup/cleanup‐ programs‐and‐topics/topics/risk‐based‐site‐evaluation‐process‐guidance‐ documents.html). Table 2. Garden soil summary results All homes in the study area (20 homes, 34 samples) PFOA PFOS PFBA PFBS PFHxA PFHxS PFPeA Percent detects 100 100 100 9 82 71 79 Median (ug/kg) 0.73 2.9 0.98 ND 0.066 0.080 0.08 Min-Max (ug/kg) 0.11-3.0 0.57-12 0.037-13 ND-0.17 ND-0.66 ND-0.24 ND-0.57 All homes outside the study area (3 homes, 6 samples) PFOA PFOS PFBA PFBS PFHxA PFHxS PFPeA Percent detects 100 100 100 17 100 100 100 Median (ug/kg) 0.36 1.4 0.35 ND 0.053 0.094 0.054 Min-Max (ug/kg) 0.29-0.54 0.93-2.1 0.073-0.49 ND-0.031 0.029-0.088 0.028-0.11 0.035-0.098 ND = No detection. Percent detection, median, and min/max include estimated values below the reporting limit. More than one soil sample was collected from fifteen home gardens. Percent detection and min/max consider individual samples. Median reflects one result per garden – the average value was first calculated for gardens with >1 soil sample. 16 Produce: Table 3: Detection Frequency and Concentration Range by Location* Study area (20 homes, 232 samples) PFOA Number of detections (%) Min-Max (ug/kg) PFOS PFBA PFBS PFHxA PFHxS PFPeA 30 (13%) 18 (8%) 227 (98%) 3 (1%) 16 (7%) 2 (<1%) 86 (37%) ND-0.26 ND-0.38 ND-33 ND-0.065 ND-0.22 ND-0.066 ND-0.77 PFHxS PFPeA Controls (3 homes, 47 samples) PFOA Number of detections (%) Min-Max (ug/kg) PFOS PFBA PFBS PFHxA 3 (6%) 3 (6%) 35 (74%) 0 (0%) 1 (2%) 0 (0%) 4 (9%) ND-0.043 ND-0.029 ND-4.6 ND-ND ND-0.032 ND-ND ND-0.12 *ND=No detection. Number of detections includes estimated values TABLE 4: STUDY AREA SAMPLES: SUMMARY STATISTICS BY ANALYTE (Ug/Kg)* Analyte PFOS PFOA PFBA PFBS PFHxA PFHxS PFPeA Median 0.00 0.00 0.68 0.00 0.00 0.00 0.00 75th Pctl 0.00 0.00 2.50 0.00 0.00 0.00 0.05 95th Pctl 0.04 0.08 10.00 0.00 0.04 0.00 0.19 Lower 95% Upper 95% Mean CL for Mean CL for Mean 0.01 0.00 0.01 0.01 0.01 0.02 2.30 1.74 2.86 0.00 -0.00 0.00 0.00 0.00 0.01 0.00 -0.00 0.00 0.04 0.03 0.06 TABLE 5: CONTROL SAMPLES: SUMMARY STATISTICS BY ANALYTE (ug/kg)* Analyte Median 75th Pctl PFOS 0.00 0.00 PFOA 0.00 0.00 PFBA 0.07 0.19 PFBS 0.00 0.00 PFHxA 0.00 0.00 PFHxS 0.00 0.00 PFPeA 0.00 0.00 *Results less than estimation limit=0 95th Pctl 0.03 0.03 1.10 0.00 0.00 0.00 0.06 Lower 95% Upper 95% Mean CL for Mean CL for Mean 0.00 -0.00 0.00 0.00 -0.00 0.00 0.25 0.04 0.45 0.00 . . 0.00 -0.00 0.00 0.00 . . 0.01 -0.00 0.01 17 TABLE 6: MEDIAN PFBA CONCENTRATION (ug/kg) BY PRODUCE TYPE: STUDY AREA* produce type all beans/peas all cucumbers all fruits all green leafy veggies all herbs all peppers all squash all tomatoes asparagus Beets broccoli/cauliflower cabbage/Brussels sprouts/kohlrabi Carrots Celery Corn eggplant onions/leeks potatoes radish/horseradish rhubarb N PFBA Median 25 15 23 20 13 20 14 37 2 3 5 8 7 2 4 2 11 8 9 4 3.30 0.82 0.44 1.10 1.90 1.55 0.60 1.30 0.46 0.11 15.00 0.56 0.37 0.33 0.20 0.31 0.20 0.07 0.08 0.05 TABLE 7: MEDIAN PFBA CONCENTRATION (ug/kg) BY PRODUCE TYPE: CONTROLS* produce type all beans/peas all cucumbers all fruits all green leafy veggies all herbs all peppers all squash all tomatoes Beets broccoli/cauliflower cabbage/Brussels sprouts/kohlrabi Carrots eggplant onions/leeks potatoes rhubarb *Results less than estimation limit=0 N PFBA Median 5 1 5 6 4 3 2 6 2 1 2 1 2 3 1 3 0.17 0.00 0.23 0.08 0.19 0.08 0.06 0.13 0.00 0.21 0.09 0.00 0.01 0.00 0.00 0.00 18 SectionOverview:BiomonitoringUpdates These updates report progress in program areas that aren't featured in the current meeting. This section includes status reports/updates on the following projects: New: Riverside Newborn Mercury Project Update: Pregnancy and Newborns Exposure project (UMN Collaboration) New: Sawtooth Clinic Mercury Project (EPA Great Lakes) Update: Fond du Lac Community Biomonitoring Project (ATSDR/EPA Great Lakes) Update: National Biomonitoring Initiatives New: National Biomonitoring Guidance for Epidemiologists from CSTE CDC National Biomonitoring Conference ACTION NEEDED: No action need be taken at this time. Panel members are invited to ask questions and offer comments on these project updates. 19 This page intentionally left blank 20 BiomonitoringUpdates New: The Riverside Newborn Mercury Project Background. The Minnesota Department of Health’s (MDH) Mercury in Newborns in the Lake Superior Basin biomonitoring pilot study measured total mercury in residual newborn blood spots collected from 1,465 infants born to mothers in the U.S. Lake Superior Basin (MN, WI, MI; 2008‐2011). The project was conducted by MDH’s Fish Consumption Advisory Program (Pat McCann) and funded by the Environmental Protection Agency (EPA), with additional support from MDH’s Environmental Health Tracking and Biomonitoring (EHTB) Program. Results of the study revealed that 10% of the Minnesota babies tested (n= 1,126) may be exposed during gestation to mercury levels that may harm cognitive development; these spots had total mercury concentrations >5.8 µg/L, the level in umbilical cord blood corresponding to the EPA reference dose for methylmercury. Average mercury concentrations in the Minnesota newborn blood spots were higher in summer, which suggests that the mothers may have been exposed by eating fish from local lakes. An important public health question is whether this observation – that 10% of newborns tested were exposed to potentially harmful levels of mercury – is unique to babies in this region of the state or whether these newborn exposures are occurring in other parts of Minnesota as well. In response to the pilot study’s findings, the EHTB Advisory Panel recommended that MDH work to characterize exposure in broader populations of Minnesota to learn the extent of the problem identified in the Lake Superior pilot project. If possible, the Advisory Panel said MDH should also investigate sources of mercury exposure. Proposal: MDH’s EHTB Program proposes to collaborate with UMN Investigator Dr. Logan Spector to analyze total mercury in newborn blood spots collected from participants in the University of Minnesota’s Riverside Birth Study (RBS, n=~160 spots). MDH will receive one spot for each newborn. Samples will be transferred to the MDH Public Health Laboratory for analysis. MDH also will obtain limited demographic information on the mother (race/ethnicity, income, age, birthplace), date of birth of the baby or sample collection date, and responses to fish‐related diet questions from the survey (frequency of consumption of canned tuna, fried fish/fish sticks, other fish). MDH’s data analysis will summarize the distribution of the RBS bloodspots, including the geometric mean, median, and upper percentiles, and the portion of samples > 5.8 µg/L. We will compare these results to the Lake Superior project findings, which are currently the only publicly available data on mercury levels in newborn blood spots. Other states including Utah and New Mexico are actively pursuing newborn blood spot testing; when these data are available, we will compare RBS results to them as well. Newborn bloodspot data will also be available in future from a concurrent MDH project in the same clinic population (Fairview‐ Riverside) being done in collaboration with the 21 University of Minnesota’s TIDES study (Pregnancy and Newborns Exposure Study). RBS results will be compared to TIDES blood spots results, and, if similar, could be combined to increase the sample size (though the time points are different: 2008‐2010 for RBS v. 2012 for TIDES). In addition, we will use the questionnaire data to determine whether mercury levels differ by demographic characteristics of the mother and by self‐reported fish consumption within the RBS and TIDES study populations. Depending on the distribution of babies’ birth season, we may also assess whether there is a seasonal pattern to mercury levels. Public health impact. Results from this proposed project will serve as an important first step to exploring questions about exposures to newborns in other parts of the state. RBS participants will likely differ from the Lake Superior project population in geography, risk factors and demographics; they are a clinic‐based sample of an urban Minneapolis population with a range of incomes and racial/ethnic backgrounds. Comparisons to the Lake Superior population will be limited, however, because demographics, fish consumption and other risk factor data are not available from the Lake Superior study. Ultimately, the findings may help MDH determine whether the concerning levels of newborn mercury exposure in the Lake Superior basin are applicable to other parts of the state, and point to additional work needed. New: Great Lakes Sawtooth Clinic Study In August 2012, MDH‐EH and EPA announced a $1.4 million grant to MDH’s Environmental Health Division from the U.S. Environmental Protection Agency (EPA) for a project to improve health screening and develop more effective fish consumption advisories in the Lake Superior Basin. The goal is to protect women and children from mercury exposure through Great Lakes Basin fish consumption. The project builds on the earlier EPA/EHTB‐funded study, Mercury in Newborns in the Lake Superior Basin, which found that nearly one in 10 Minnesota infants tested had mercury levels higher than those recommended as safe by EPA. The Grand Portage Chippewa Tribe and the Sawtooth Mountain Clinics in Grand Portage and Grand Marais are participating in the MDH project. Physicians affiliated with the clinics will survey consenting women patients of childbearing age about fish consumption and will test blood mercury levels. Patients will also be counseled to promote safe fish consumption choices. Over the last three years, the GLRI has provided more than $320 million to clean up toxic contamination in Great Lakes Areas of Concern and to reduce risks associated with toxic substances in the Great Lakes ecosystem. More information about the Initiative is available at http://www.glri.us. 22 Update: Pregnancy and Newborns Exposure Study (UM Collaboration) The Pregnancy and Newborns Exposure Study, an EHTB collaboration with UM investigators, has been making good progress toward our recruitment goal of 75 pregnant women‐newborns by the end of 2012. University of Minnesota staff from The Infant Development and Environment Study (TIDES) are recruiting TIDES participants during their third trimester visit at the University Fairview‐Riverside prenatal clinic. As of 11/12/12, 56 women had consented to participate with 5 remaining to be approached for consent. As of 11/20/12, 37 dried blood spots, 38 cord blood tubes, and 36 paired specimens had been collected from study births. The project will compare mercury levels found in paired newborn cord blood and heel stick spots; the data will aid the interpretation of the blood spot results from the Lake Superior Mercury in Newborns project. Updated information about this and other EHTB mercury projects can be found at: http://www.health.state.mn.us/biomonitoring Update: The Fond du Lac Community Biomonitoring Project (Great Lakes Initiative) Since the last update, Fond du Lac staff completed training in all aspects of participant recruitment and data collection. At the federal level, the Office of Management and Budget completed their review of the Great Lakes Restoration Initiative (GLRI) biomonitoring package and approved the data collection on October 12, 2012. Study invitation letters will be mailed to the first batch of potential participants by the end of November 2012. Recruitment and enrollment is planned to continue for approximately 10 months. This project is part of a 3‐state biomonitoring initiative (NY, MI, MN) being funded by a federal grant from CDC/ATSDR and EPA as part of the US EPA’s Great Lakes Restoration Initiative, and is being led by staff in the MDH/Environmental Health Division (Deanna Scher and Rita Messing.) The project will measure exposure to several contaminants of concern in the Fond du Lac tribal community. Update on National Biomonitoring Initiatives Council of State and Territorial Epidemiologists (CSTE) Biomonitoring Guidance In November 2012, CSTE released a new document on their website entitled: “Biomonitoring in Public Health: Epidemiological Guidance for State, Local and Tribal health Agencies.” The guidance provides information about design, interpretation and application of biomonitoring activities in a public health setting. A checklist of key steps to developing a program or project is included. Several staff from MDH (Jean Johnson, Jessica Nelson and Deanna Scher) contributed to the authorship of this document. The document is a companion document to the earlier release from the Association of Public Health Laboratories: “Guidance for Laboratory Biomonitoring Programs.” This document outlines the infrastructure and expertise needed to develop laboratory capacity for a biomonitoring program and highlights some of the major considerations chemists should address before beginning a biomonitoring study. 23 CDC Public Health Laboratory Sponsors National Biomonitoring Conference Carin Huset, MDH PHL, and Jean Johnson presented aspects of Minnesota’s tracking and biomonitoring work at a national biomonitoring conference held in Atlanta, Ga, Nov. 28‐ 29, 2012. The conference brought together laboratorians from all 3 states (NY, CA, WA) currently funded by the CDC to conduct state‐based biomonitoring to share their progress, but was open to all interested in biomonitoring work. Carin and Jean both participate on the Association of Public Health Laboratories Biomonitoring Subcommittee which helped with the planning. Jean is a representative of a partner organization, the Council of State and Territorial Epidemiologists, CSTE. APHL is continuing to promote a National Biomonitoring Plan for laboratories and partners. 24 SectionOverview:TrackingUpdates These updates report progress in program areas that aren't featured in the current meeting. This section includes status reports on the following projects: Minnehaha‐Hiawatha Corridor Environmental Collaboration Strategic Planning with CDC Tracking Network Heat‐related Illness: New Data and Measures Carbon Monoxide Poisoning: Minnesota Public Health Data Access New Interactive Cancer Maps and 2009 Incidence Data Portal Updates ACTION NEEDED: No action need be taken at this time. Panel members are invited to ask questions and offer comments on the project updates. 25 This page intentionally left blank. 26 TrackingUpdates Minnehaha‐Hiawatha Corridor Environmental Collaboration Since 2011, MN EPHT has been working with the Minnehaha‐Hiawatha Corridor Environmental Collaboration in Minneapolis, established under an EPA Level I CARE cooperative agreement convened by Hennepin County. Through this CARE cooperative agreement, Hennepin County and neighborhood partners have held regular meetings with residents, community groups, and businesses to identify and set priorities for public health, safety, and environmental contamination issues affecting their community. The project focuses on the Minnehaha‐Hiawatha corridor in south Minneapolis and includes portions of the Longfellow and East Phillips neighborhoods. The corridor area includes the region’s first light rail transit line, a four‐lane highway with up to 45,000 vehicles per day, a freight rail line, and high‐power transmission lines. This project is the first CARE cooperative agreement awarded by USEPA in the State of Minnesota. MN EPHT‘s role in this partnership has been to help facilitate community access to local public health, biomonitoring, and environmental monitoring data. In October, 2011, MN EPHT received requests for community‐level data for asthma hospitalizations and child blood levels in the corridor community. In response to this request, MN EPHT and Minnesota Asthma program epidemiologist Wendy Brunner provided zipcode‐level asthma hospitalization data for four zipcodes in the project area. Epidemiologist Blair Sevick provided EPHT data on childhood lead poisoning and developed a fact sheet that explained what lead poisoning is and why blood lead testing is important. GIS developer Eric Hanson mapped the data for two measures by census tract level across the project area: blood lead testing (percent of children tested) and blood lead levels (percent with elevated levels). The Hennepin County CARE project staff are sharing data on these and other topics of interest with the community and will be using community input on high priority environmental risks to develop a final action plan. Strategic Planning with CDC Tracking Network In October 2012, MN EPHT’s Jean Johnson and Chuck Stroebel joined fellow program directors and PIs from all CDC EPHT cooperative agreement partners in a strategic planning discussion for the National Tracking Network in Atlanta, GA. The context was a proposed overall $7M budget cut for the CDC National Center for Environmental Health in the President’s FY13 budget. The CDC is still operating on a continuing resolution and expects 8‐9% sequestration cuts across the board unless the federal budget is resolved in Congress by Dec. 31. If/when the budget is resolved, strengthening biomonitoring programs and expanding Tracking are among the NCEH Director’s budget priorities. Discussion focused on identifying the Tracking Network’s unique strengths, and particularly on identifying where Tracking should focus efforts over the next 6 months and the next two years to remain valued and relevant. Tracking provides access to 27 health outcome data and is uniquely positioned to translate the data and make them relevant to communities. Meeting participants emphasized the need to market this value to build a broader base of support. Specific suggestions for future directions of Tracking in states included more emphasis on: Providing data at smaller spatial levels (below the county level) for communities Addressing environmental justice and vulnerable communities Evaluating available real‐time surveillance data (particularly for extreme weather events) Communicating EPHT’s mission and success more effectively Analyzing data to better understand relationships between health and environmental data (data linkage projects) Heat‐related Illness: New Data and Measures In summer 2012, the National Tracking Network adopted new measures for heat‐related illness. The new measures included hospitalizations, emergency department (ED) visits, and deaths directly attributed to heat from 2000 to 2011, the most current year of data available. In December 2012, MN EPHT made these new measures available through Minnesota Public Health Data Access: Heat‐related Illness: https://apps.health.state.mn.us/mndata/heat The new measures illustrate: The relationship between average summer temperatures and adverse health outcomes (hospitalizations, ED visits, deaths). The disproportionate impact of extreme heat on certain subpopulations in MN: Elderly people are more likely to be hospitalized than younger age groups; both the elderly and the younger age groups (15‐34 years of age) are more likely to visit the ED. Men were at increased risk of hospitalizations and ED visits than females. This greater risk may be attributed in part to differences in occupations and behavior. Typically urban populations are thought to be more at risk because of the urban heat island effect. But MN EPHT data suggest that populations in greater Minnesota may be more at risk for hospitalization during extreme heat events (2001, 2006 heat waves) and more likely to visit the ED for heat‐related illness in general. Differences in hospitalization rates may reflect limited access to public cooling centers and transportation. Another possible reason is that these populations are more exposed to heat because of differences in occupation or lifestyle. MN EPHT currently is working with the MDH Climate and Health Program, MDH Office of Emergency Preparedness, and the Minnesota Pollution Control Agency to use these data to raise awareness about heat‐related illness impacts in Minnesota. The MDH Climate and Health Program, also funded by CDC, developed an Extreme Heat Toolkit and maps of sub‐county data (statewide) to identify populations at risk to extreme heat 28 events. MN EPHT’s new measures, together with these tools, also will be used to inform state and local planning and assessment activities related to extreme heat events. Examples include using the data to inform strategies for outreach to vulnerable populations and to evaluate the effectiveness of interventions. For additional information about MDH’s Extreme Heat Toolkit and other climate health activities, see: http://www.health.state.mn.us/divs/climatechange/ In addition, the National Tracking Network is continuing to develop and evaluate other measures related to climate health, including harmful algal blooms, changes in pollen (e.g., composition, duration of season), and injuries from extreme events (floods, hurricanes, tornadoes). For information about the National Tracking Network data and measures for climate change, see: http://ephtracking.cdc.gov/showClimateChangeLanding.action Carbon Monoxide Poisoning: Minnesota Public Health Data Access In November, MN EPHT updated data for carbon monoxide (CO) poisonings through 2010, including hospitalizations, emergency department visits, and deaths. Every year CO poisons several hundred Minnesotans, particularly during the winter months. The data collected by MN EPHT shows that accidental CO poisonings peak during this time. See MN Public Health Data Access: https://apps.health.state.mn.us/mndata/co During Winter Hazard Awareness Week (November 5‐9), MN EPHT worked together with partners in the MDH Indoor Air Unit and the MN Department of Public Safety to highlight the public health importance of ongoing efforts to prevent CO poisoning. The new data also provide an opportunity for MN EPHT to evaluate the effectiveness of Minnesota’s new CO alarm law passed by the MN Legislature in 2007. New Interactive Cancer Maps and 2009 Incidence Data Interactive cancer maps have been added to MN Public Health Data Access for two new cancer types: melanoma and non‐Hodgkin lymphoma. Melanoma is one of the most rapidly increasing cancers in Minnesota and has doubled since 1988 for both sexes. Non‐ Hodgkin lymphoma is the 5th most common cancer diagnosed among males and females in Minnesota. The melanoma maps were added to the portal in response to feedback from external partners, such as the American Cancer Society and the MN Cancer Alliance. The new maps and other data from the portal will be used to inform strategies Cancer Plan Minnesota 2011‐2016 strategies aimed at preventing and reducing cancer in Minnesota. New comparison maps for cancer incidence allow portal users to display two cancer incidence maps side‐by‐side. This may be especially useful for comparing geographic trends in cancer incidence over time within a single cancer type or differences in a type 29 of cancer between sexes. Users can access the tool by clicking on the tab labeled “Comparison Map” at the top of the right‐hand section of the mapping window. Finally, all cancer materials on MN Public Health Data Access, including the basic facts & figures webpages, data query, and interactive maps, have been updated with 2009 incidence data, increasing the electronically‐available cancer data to a 22‐year range (1988‐2009). Reflecting the addition of the most recent year of incidence data, the cancer maps now display county‐level data for 1995‐2009 in 5‐year increments. See: https://apps.health.state.mn.us/mndata/cancer Portal Updates New data are on the state tracking data portal, along with updates for several topic areas. Minnesota Public Health Data Access: https://apps.health.state.mn.us/mndata New Data & Features Chronic Obstructive Pulmonary Disease interactive maps (hospitalizations) Smoking facts and figures (adult prevalence) Obesity facts and figures (adult prevalence) Heat‐related illness facts and figures (hospitalizations, emergency department visits, and deaths) Melanoma, non‐Hodgkin lymphoma interactive maps (incidence) Feature: Comparison maps for cancer (select/view maps side‐by‐side) Data Updates Air quality facts and figures, query (2011 monitoring data for ozone and fine particles) Childhood lead poisoning facts and figures, query, maps (2007, 2008 birth years) COPD, asthma facts and figures, query, maps (2009, 2010 hospitalizations; cross border hospitalizations from border states: IA, ND, SD) Heart attacks facts and figures, query (2009, 2010 hospitalizations; cross border hospitalizations) Carbon monoxide poisonings facts and figures, query (2009, 2010 hospitalizations, emergency department visits, deaths) Cancer data – all types currently on portal, facts and figures, query, maps (2009) Drinking water data facts and figures (2010, 2011 data for arsenic, nitrate, disinfection byproducts in MN Community Water Systems) 30 SectionOverview:Proposal:AMinnesotaBiomonitoringSummit Jean Johnson will present a proposal for the Minnesota Department of Health and the Environmental Health Tracking and Biomonitoring program to sponsor a biomonitoring summit in Spring 2013. Discussion Item: Panel members are invited to comment on the proposal and offer advice and suggestions. Questions for the panel: 1) Does the Advisory Panel support this proposal for promoting the work of the EHTB program in the state and soliciting input from stakeholders for the future? 2) Can the Advisory Panel recommend specific topics or speakers for this summit? 3) Can the Advisory Panel suggest specific questions to ask stakeholders to discuss or consider? 31 This page intentionally left blank 32 Proposal:AMinnesotaBiomonitoringSummit Background Minnesota’s Biomonitoring Program has made significant achievements over the 6 years since the EHTB legislation was passed in 2007. With the help of program partners and the Advisory Panel, MDH‐EHTB and MDH‐Public Health Laboratory staff have completed four biomonitoring pilot projects, monitoring arsenic, PFCs, mercury, cotinine, BPA, and parabens in specimens collected from diverse communities throughout the state, including adults, pregnant women, children, and newborns. This work has led to informing individuals, communities, and public health officials about actions they can take (or have taken) for the prevention of these chemical exposures. This work has also led to several follow‐up studies (PFCs, mercury) and research collaborations (UM Riverside and TIDES) and has had a significant role in leveraging additional federal grant support for special projects (Great Lakes studies, 2010‐2014). With this wealth of experience, Minnesota has taken a leadership role nationally , working with the CDC (Tracking Task Force, National Biomonitoring Program) and professional organizations (APHL, CSTE) in developing guidance for other states to follow, and promoting the application of biomonitoring as an integral part of environmental public health surveillance and practice. Despite this enormous success, the state appropriation for funding ongoing biomonitoring in the state was changed to a one‐time appropriation during 2011 budget negotiations, effectively ending the program at the end of June 2013. Many of the stakeholders and communities who supported the original legislation may be unaware of the impact this could have on the state’s capacity to respond to future community needs for information about chemical exposures, for identifying disparities in exposure, and for monitoring the efficacy of public health actions. Proposal The MDH EHTB program proposes to sponsor a Biomonitoring Summit in the spring of 2013 for the purposes of: 1. Informing program stakeholders and the public about the valuable work of the EHTB Biomonitoring Program and its public health benefits 2. To share lessons learned from the pilot projects and recommendations for an ongoing program to protect future generations, identify disparities, and respond to community needs. 3. To solicit suggestions from stakeholders on the recommendations and on how we might best promote ongoing support for biomonitoring as an integral part of environmental public health practice. 33 Intended Audience: Program stakeholders Local and state public health officials Environmental agency staff Legislators and other policy makers Environmental public health scientists Children’s environmental health organizations Public health associations and other NGO’s 34 SectionOverview: NewMNEPHTContentArea:DevelopmentalDisabilities In the March 2012 Advisory Panel meeting, staff reviewed the two data sources for tracking developmental disabilities on CDC’s data portal: CDC’s Autism and Developmental Disabilities Monitoring Network (ADDM) and the Department of Education’s Individuals with Disability Education Act (IDEA) data. The Advisory Panel recommended that staff Begin the evaluation process to add developmental disabilities as a MN EPHT content area, Further investigate the strengths and weaknesses of IDEA data, Explore other data sources, and Invite a staff member from MDH Division of Community and Family Health to speak. Jeannette Sample and Barb Dalbec, director of MDH’s Children and Youth with Special Health Needs section, will review the available data for tracking developmental disabilities in Minnesota. Discussion Item: Panel members are invited to ask questions and suggest ways to address the data limitations in Minnesota. Questions to the Advisory Panel: 1. Given the strengths and limitations of IDEA data, is IDEA a viable tracking data source for developmental disabilities? 2. Is there a recommendation to use either the National Survey of Children’s Health or the National Survey of Children with Special Health Care Needs, or both? 3. Are there other data sources on developmental disabilities that should be evaluated? 35 This page intentionally left blank. 36 NewMNEPHTContentArea:DevelopmentalDisabilities At the March 2012 Advisory Panel meeting, staff reviewed the two data sources for tracking developmental disabilities on CDC’s data portal: CDC’s Autism and Developmental Disabilities Monitoring Network (ADDM) and the Department of Education’s Individuals with Disability Education Act (IDEA) data. This content area was launched January 2012 on the CDC Tracking data portal at: http://ephtracking.cdc.gov/showDevelopmentalDisabilitiesLanding.action Indicator #2: Children receiving services Indicator #1: Estimated Prevalence of Autism Number and percent Per 1000 children age 8 By age group (3‐17 years) By race/ethnicity and sex Measure: Measures: Autism spectrum disorders (ASDs) Autism spectrum disorders (ASDs) Developmental delay Emotional disturbance (age 3‐5 only) Hearing impairment or hearing loss Intellectual disabilities Speech or language impairment Specific learning disability Data source: Autism and Developmental Data source: Individuals with Disabilities Disabilities Monitoring Network (ADDM) Education Act (IDEA) Biggest limitation: Biggest limitation: Data not available for Minnesota Not comparable across years or between states In March 2012, the Advisory Panel recommended that staff 1) Begin the evaluation process to add developmental disabilities as a MN EPHT content area 2) Look further at the strengths and weaknesses of IDEA data 3) Explore other data sources, and 4) Invite a staff member from MDH Division of Community and Family Health to speak. Staff have followed up on recommendations and will present findings from the evaluation process to add developmental disabilities as a MN EPHT content area. 37 Evaluation Process Phase I: Exploration Prevalence: Developmental disabilities are common: in 2006–2008, about 1 in 6 children in the U.S. had a developmental disability.1 Autism, ADHD, and developmental delays are increasing nationally. The percentage of Minnesota children (<18 years old) with special health care needs increased from 12.4% in 2001 to 14.3% in 2009‐2010. Causation: The causes of most developmental disabilities are unknown. However, evidence suggests that a combination of genetic, environmental, and social factors cause some disabilities. Actionability: Some developmental disabilities can be prevented or lessened by preventing harmful exposures and injuries. The legislation that established the EHTB program2 calls for tracking “chronic diseases including, but not limited to… developmental disorders.” The Minnesota Children and Youth with Special Health Needs (CYSHN) Section at MDH is accountable for the successful performance of core public health functions on behalf of CYSHN. Public health impact: People with developmental disabilities have problems with major life activities such as language, movement, learning, self‐help, and living by themselves. Families face a significant cost associated with care for children with special health care needs. Feasibility: Evaluate IDEA, National Survey of Children with Special Health Care Needs, and National Survey of Children’s Health. IDEA The Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities throughout the nation. Strengths Data collected every year for every state. Limitations Data do not document prevalence, but the number of children receiving interventions or services. Classification reflects service needs rather than diagnostic category that might be applied by a health professional Eligibility and services dependent on state funding, which can change over time County level data not publically available. Minnesota Department of Education may have county level data. 1 Boyle et al., Pediatrics 2011: (http://pediatrics.aappublications.org/content/early/2011/05/19/peds.2010‐2989.abstract ) 2 Minn. Stats. 144.995‐998. 38 Possible Indicators • Number receiving services • Total • Developmental delay • Autism • Intellectual disability • Specific learning disability National Survey of Children with Special Health Care Needs National Survey of Children’s Health The National Survey of Children with Special Health Care Needs (NSCSHCN) measures the prevalence and impact of special health care needs among children in the US. The National Survey of Children’s Health (NSCH) measures the prevalence of physical, emotional, and behavioral indicators among children in the US. Both use the State and Local Area Integrated Telephone Survey (SLAITS) mechanism, a large‐scale random‐digit‐dial sampling frame, conducted by the National Center for Health Statistics at CDC. Households with children under 18 years of age are identified. NSCSHCN screens all children in household for special health care needs. Both surveys randomly select one child to be subject of interview. The parent or guardian in the household who was most knowledgeable about the health and health care of the children under 18 years of age is interviewed. Strengths Provide prevalence estimates Based on a large Random Digit Dial (RDD) sample design Data for every state On‐going Publicly available Limitations Data not at county level Autism not available for NSCH at state level due to small numbers Possible indicators • Autism • ADD or ADHD • Developmental delay • Intellectual disability 39 This page intentionally left blank. 40 SectionOverview:OtherInformation This section contains documents that may be of interest to panel members. September 2012 Advisory Panel Meeting Summary 2012‐2013 Advisory Panel Meeting dates Advisory Panel Roster Biographical Sketches of Advisory Panel Members Biographical Sketches of Staff Environmental Health Tracking and Biomonitoring Legislation Abstract: Cohort Mortality Study of Workers Exposed to Perfluorooctanoic Acid 41 This page intentionally left blank 42 2012AdvisoryPanelMeetings Tuesday, December 11 1‐4pm The December meeting will take place at: The American Lung Association of Minnesota 490 Concordia Avenue St. Paul, Minnesota 2013AdvisoryPanelMeetings Tuesday, Mar 12 1–4 pm Tuesday, Jun 11 1–4 pm All meetings for 2013 will take place at The American Lung Association of Minnesota 490 Concordia Avenue St. Paul, Minnesota 43 This page intentionally left blank. 44 Summary:September11,2012AdvisoryPanelMeeting Panel members attending: Bruce Alexander, Alan Bender, David DeGroote, Tom Hawkinson, Pat McGovern, Geary Olsen, Cathy Villas‐Horns, Lisa Yost Attendees: Jim Kelly, Joanne Bartkus, Aggie Leitheiser, Jeanne Ayers, Shannon Lotthammer, Betsy Edhlund, Paul Moyer, Blair Sevcik, Christina Rosebush, Jeannette Sample, Carin Huset, Al Williams, Jean Johnson, Jessica Nelson, Barbara Scott Murdock Welcome and Introductions Bruce Alexander welcomed panel members and attendees, and invited them to introduce themselves. He also called attention to a designated time slot for audience members to ask questions or comment on the topics, presentations, or discussions. Introduction and Background The September 2012 meeting was designed to review plans for the biennial Report to the Legislature, due in January 2013. Thus, the first part of the meeting highlighted the program’s achievements since its beginning. A more detailed review emphasized the work that responded to the legislature’s 2011 directive that the biomonitoring program focus on PFCs (perfluorochemicals) in the East Metro communities of Lake Elmo and Oakdale/Cottage Grove and on mercury in the Lake Superior Basin. Discussions of the studies and ideas presented during the review of EHTB achievements and the proposals for future projects on PFCs, mercury, as well as examples of other likely state concerns listed in the outline for the Report to the Legislature were postponed to the discussion of the Report. Achievements of the EHTB Tracking and Biomonitoring Program Jean Johnson reviewed the program’s history and accomplishments. Over the five years since the Minnesota legislature established the Environmental Health Tracking and Biomonitoring program in 2007, MDH has made significant progress in building and maintaining a strong new state program for tracking environmental hazards, population exposures (biomonitoring), and related chronic diseases and health outcomes. Jean highlighted a short list of the EHTB program accomplishments and benefits to Minnesota. During the five years of the program’s development, MDH accomplished the following: Investigated public concern about PFC exposure from drinking water in the East Metro; the first biomonitoring study documented higher than background exposures in long‐term residents. A follow‐up study showed that public health actions were effective at reducing exposure in the community. Identified a potential public health problem―10% prevalence of unhealthy mercury exposures among Minnesota newborns in the Lake Superior Basin. Data will inform efforts to strengthen actions aimed at mercury exposure prevention. 45 Investigated children’s exposure to arsenic in Minneapolis; used chemical speciation to identify diet as a primary source of organic arsenic exposure, and found no association with soil contamination. The study reassured parents in the community and suggested ways to reduce arsenic exposure. Documented income and racial disparities in BPA and paraben exposures among pregnant women at Minneapolis‐Riverside clinic. Most BPA and paraben exposures were below US average levels. Cotinine measurements indicated that 14% of pregnant women tested were active smokers, comparable to the 13.8% self‐reported smokers in the MN Pregnancy Risk Assessment Monitoring Survey. Advanced MDH Public Health Laboratory capacity to measure PFCs, arsenic, BPA and parabens in human specimens and to develop novel methods to test newborn exposures to mercury, including heel stick spots and umbilical cord blood. Built state environmental epidemiology capacity for the collection, integration, and analysis of drinking water, air quality, and chronic disease data in Minnesota to examine trends and relationships. Successfully leveraged Minnesota’s investment in the EHTB program by attracting federal funding to enable the state to join the CDC Environmental Public Health Tracking Network of 23 states. CDC currently funds the Minnesota Public Health Data Access portal for broad dissemination of tracking data and interactive maps. Successfully added collaborative biomonitoring pilot projects to federally funded MDH and University of Minnesota projects, thereby further leveraging Minnesota’s support for the EHTB program. Ongoing Mercury Biomonitoring in Minnesota & Proposed Specific Aims Jean next reviewed the findings of the Mercury in Newborns in the Lake Superior Basin3 and the Advisory Panel’s motions to 1) recommend a cord blood: newborn blood spot study in collaboration with the University of Minnesota’s TIDES study, and 2) to plan ways to investigate mercury exposure in other populations in the state. Jean presented five goals, briefly described below, and explained the rationale and public health significance for these goals: Goal 1: Measure the distribution of concentrations and geographic and temporal patterns of total mercury in a representative sample of Minnesota newborns to provide a baseline for ongoing surveillance of exposure in at‐risk sub‐populations in the state. 3 McCann, Patricia. 2011. Mercury Levels in Blood from Newborns in the Lake Superior Basin. GLNPO ID 2007‐942. Final Report. US EPA. 46 Goal 2: Learn whether the problem of elevated mercury in newborns seen around Lake Superior is widespread in other regions of Minnesota and, if so, which subgroups are most likely to be affected. Goal 3: Measure how much maternal factors (e.g., age, income, education, race/ethnicity) and source contributions (e.g., fish consumption, dental amalgams, mercury‐containing products) explain variations in total and speciated mercury concentrations in newborns. Goal 4: Refine MDH laboratory methods for measuring mercury exposure in newborns. Goal 5: Inform and strengthen support for public health programs, actions, and interventions in order to use resources wisely, and to reduce the prevalence of elevated exposure in Minnesota newborns (exceeding the reference limit). Rationale: A pilot study4 that measured mercury in newborn blood spots suggests that a significant proportion (up to 10%) of babies in the Lake Superior Basin, and perhaps in other regions of Minnesota, may be exposed during gestation to mercury levels that could harm cognitive development. Significance: Nationwide, the incidence of learning and developmental disabilities (LDDs) appears to be rising.5 In 1999‐2000, the special education costs of LDDs amounted to $77.3 billion/year, about $12,500/pupil, nearly twice the per student cost for regular students.6 Improved monitoring of newborn exposure to mercury will yield data to guide public health actions, such as statewide fish consumption advisories for pregnant women and women of child‐bearing age and efforts to keep mercury out of the environment. Ongoing biomonitoring of newborns will complement current and proposed work in the Lake Superior region to screen women of child‐bearing age and improve educational interventions. The objective is to ensure that policy makers will be better informed so they can craft stronger public health policies and prevention efforts to protect Minnesota babies from developmental effects of mercury exposure during gestation. The ultimate goal is to move Minnesota communities toward a healthy start for all. Ongoing PFC Monitoring Recommendations Jessica Nelson reviewed the status of the PFC projects. Currently, biomonitoring pilot projects in the East Metro are close to completion. The follow up project’s questionnaire analysis is underway and will be finished by June 2013. She then 4 McCann, Patricia. 2011. Mercury Levels in Blood from Newborns in the Lake Superior Basin. GLNPO ID 2007‐942. Final Report. US EPA. 5 Scientific Consensus Statement on Environmental Agents Associated with Neurodevelopmental Disorders. Collaborative on Health and the Environment’s Learning and Developmental Disabilities Initiative, Nov 7, 2007. URL: http://neep.org/uploads/NEEPResources/id27/lddistatement.pdf 6 Center for Special Education Finance. American Institutes for Research. Special Education Expenditure Project. No. 1: What Are We Spending on Special Education Services in the United States, 1999‐2000? (246 KB) — Updated June 2004. URL: http://csef.air.org/publications/seep/national/AdvRpt1.PDF 47 presented the pros and cons of six scenarios for further PFC biomonitoring in Minnesota. Study options presented to the panel were the following: An East Metro follow‐up in the same participants who took part in the past two projects A MN reference population: a comparison population in another part of Washington Co. or elsewhere in state Children or pregnant women in the East Metro and/or another part of MN An occupational group likely exposed to PFCs: firefighters, ski waxers, plating shop workers, airplane mechanics Anglers: people who fish in contaminated pools of the Mississippi River No further study The 2012‐2013 Report to the Legislature Bruce Alexander led the discussion of the Report to the Legislature, commended the decision to begin with report with the program’s accomplishments, and reviewed the questions to the panel. These questions asked panel members To identify the program’s most important accomplishments To make recommendations about Whether the program should move ahead with plans for an ongoing program for Minnesota Plans for ongoing mercury biomonitoring of newborns as described in the Specific Aims, and/or plans for another round of biomonitoring for PFCs in the East Metro or in a different population Specific target populations of newborns or pregnant women for study Specific analytes of concern in Minnesota in addition to mercury and PFCs. Other urgent areas of concern for Minnesota that EHTB could address After commenting that the EHTB accomplishments are impressive, Pat McGovern suggested that, overall, the report should emphasize the program’s effects on Minnesotans by using case studies, individual stories, and comments from people who appreciated what the program did. She proposed emphasizing dietary sources of environmental toxicants and said that the arsenic study’s education and outreach illustrates why this study was important. She suggested that the report should give specifics in practical terms for lay people, such as including advice about diet in the report and samples of the handouts sent to study participants in the appendices. Alan Bender agreed, saying that people relate more to people and experiences than to data. Bruce seconded this advice, saying that federal agencies now ask University researchers to describe the impacts of their projects in their grant reports. He cited MDH’s PFC study as a good example. It responded to a very clear concern in the community and a public health response [filtering to remove PFCs in well water and city water treatment] that is working. Some questions remain, but without the biomonitoring program, 48 citizens would not have this answer that levels are declining. The mercury problem is another significant example. Many people have been asking questions about mercury. And in this case, biomonitoring documented a significant potential health problem in the Lake Superior Basin that might not have been picked up through national data. David DeGroote asked about the response rate in the second round of PFC sampling in the East Metro and suggested that the report explain why not everyone in the first study volunteered for a second round of biomonitoring. Jessica said that 10 participants who agreed to take part in the first round of PFC biomonitoring had checked the “do not contact me again” box in the consent form, before giving their blood. Thus, the pool of potential participants in the second PFC sample was smaller than the original study cohort. Bruce noted that the 88% participation in the second round was unusually good. Typically, participation in health studies these days is much lower— commonly, you get a 30% response to blood studies. The high participation in the second round shows that the community is very interested. David suggested that staff should show community engagement in the East Metro studies. Jessica Nelson said that program staff met with community members several times and did an evaluation for their opinions of the study and the public health response. We asked about the meetings, attendance, and other interactions. Alan pointed out that MDH was unable to say whether PFCs have any health consequences. The lack of information on health effects, said Jessica, is the primary frustration for participants, who would like to know whether these chemicals are, or are not, health risks. Despite that, the evaluations contained very positive comments, indicating that people are pleased about biomonitoring and about knowing their results, although they were concerned that they can’t know what their results mean for health. Lisa Yost said that the report’s readers are likely to be impatient readers, so a column with bulleted quotes from participants would offer a quick summary of community opinion. If the participants’ PFC levels are getting closer to the levels found in the CDC’s National Health and Nutrition Evaluation Survey (NHANES), she added, they are getting close to national population background levels. Lisa also recommended that MDH might try to communicate in ways that enhance health literacy or science literacy. Geary Olsen said that, when staff say they can’t interpret the data in terms of health effects, they may confuse the public or the legislature, since another branch of MDH has done risk assessments that led to published Health Risk Limits, or HRLs, for PFC levels in water. Lisa asked whether there is a biomonitoring number for safe PFC levels in blood, and Geary said that there is. The HRLs, based on reference doses developed in primate studies, indicate that people can safely drink water with that PFC content for a lifetime and consequently indicate some estimated safe PFC blood levels. He turned to Jim Kelly, from MDH Environmental Health, for confirmation, and Jim replied that his division could probably add some information [to support interpretation of the biomonitoring results]. Geary said the number is based on thyroid and cholesterol 49 effects. Aggie added that sometimes the public tells us “we want zero.” Lisa agreed that comparisons with a reference dose (RfD) are helpful, as was done for interpreting mercury exposures. Geary had commented earlier that studies of American Red Cross blood donors in Minnesota and study donors from the general population also had established some background data on Minnesota PFC levels. Results were consistent with NHANES (national) data, but Geary also noted that the Red Cross data did not come from a random representative sample of the Minnesota population. Bruce said that the progress report on biomonitoring capacity involves convincing the legislature that environmental issues unique to MN can’t be addressed by any other entity than MDH, and that this state capacity enables MDH to respond to local and in‐ state needs. He advised making that into an impact statement that CDC’s NHANES can’t effectively study these small populations. He also commented that the building of state capacity has been buried, yet this capacity allows the state to turn to MDH when it needs to respond to citizens’ concerns. Legislators have to recognize that some environmental issues can’t be farmed out to national agencies. Bruce suggested highlighting both accomplishments and challenges. The challenges are an aspect that hasn’t been brought out. Highlighting the Riverside study, for instance, illustrates that the state has some populations that are difficult to connect with, and some of their exposures are very different from those in the dominant population. We have challenges in engaging these populations in this activity. Alan agreed and said it will take resources to get at these populations, and noted that some members of the legislature may have interests in specific populations. Jeanne Ayers suggested addressing challenges and next steps for issues we couldn’t address before. Alan commented that these projects are like plumbing work – it’s a matter of paying now or paying more later. We should feel really good about this project. He also suggested that the proposal needs to say how the program intends to address those challenges. Bruce said that follow up for what we have done is fine. Bruce then directed the panel’s attention to the program’s next steps: protecting future generations and considering the specific proposals for more work on mercury and PFCs, among other suggested problems. With respect to PFCs, David said, the job is half done. One more round of PFC analysis is appropriate. If the community is still concerned, said Pat McGovern, a new round of analysis would help to satisfy them. Aggie noted that the East Metro is a very active community that knows that, even though their test results show declines in PFCs, their levels still are above background. Geary agreed that it would be very important to measure their PFC levels again. But he also cautioned that it will be a long time before those levels reach background, and it’s important to make citizens understand that PFOS, PFOA, and PFHxS have long half‐lives of 4 years or more. PFBA, on the other hand, has a half‐life of 3 days. Alan added that for the longer half‐ life chemicals, the baseline is also falling, so the decrease will be smaller. Geary said, that may make it difficult to catch up with the US baseline levels, but this study has been 50 a good success story for biomonitoring, and the participants haven’t even reached a half‐life period yet. Bruce said it would also be useful to expand the sample size in the community and to include new residents. If new residents have background levels, that will reassure the others. His guess is, based on the decline in PFC levels in the long‐term residents, that new residents from non‐exposed communities will have only background levels because the PFCs in drinking water in the East Metro have been removed. Lisa agreed, but said she was not [otherwise] on board with all of the proposed PFC projects. Geary said the project could be two separate studies, and the first—repeating the study in the same group of participants— is relatively straightforward since you are updating the original study. Jeanne Ayers asked whether the East Metro had any racial or ethnic differences, and whether new residents could be changing the demographics. Jessica replied it was a pretty homogeneous white community. Bruce moved the discussion on to mercury, saying that mercury exposure is an important issue in Minnesota, an issue that only Minnesota and MDH can answer. He supports continuing work in this area, and said that the team has done a good job on posing the questions of potential variability between cord blood and newborn blood spots, the prognosis for the rest of Minnesota, and the potential for exposures in disparate groups in the state. Alan asked, how would the panel choose between these two projects if only one is funded by the legislature? They represent two different kinds of issues, one with a known biological outcome and the other with a known concern in an active community. And am I correct that PFCs and mercury may affect very different ethnic groups? If so, comparing these two projects is almost an environmental justice issue. Aggie added that the panel’s advice on that would be useful, given that the issues for biomonitoring in MDH have often taken a political bend or have been legislatively directed. Your thoughts about priorities would be helpful. Geary asked, does the panel have a statement of public health concern for one chemical over another? Implicit in that argument that you are putting one chemical over the other is that you are using a definition of risk. Alan said that, from what we know, is that PFCs don’t have a public health outcome. Then Alan asked Geary directly, if he had to choose one or the other, which one would you choose? Geary responded to Alan’s question by saying, if we compare these things side by side, he would be more worried about mercury, but that is his immediate opinion in response to Alan’s question. In no way was he offering a risk assessment in responding to the question. Bruce said, we can reframe the question: If MDH receives only enough money to study one of these two problems, do MDH and its Advisory Panel members get to choose which is more important to follow up? We should consider what public health action we could take for each. It’s important to follow up the PFCs and monitor the controls that are in place for PFCs. We have some control on PFCs now. But for mercury, it’s an 51 open book. We don’t know what the extent of the problem is, as we do for PFCs. Geary added that risk management has happened for PFCs, and is needed for mercury. Therefore, we should recommend a mercury study (vs. PFCs) if you had to choose only one—referring back to Alan’s question—because mercury has greater potential for public health action. Bruce commented that he had been disappointed in the legislative directions in the original legislation, and said that MDH experts should have some flexibility to make decisions about priorities. Lisa agreed, saying that she liked weighing the value of doing one study rather than the other. Jeanne Ayers added, rather than saying which issue is more important, it’s important to say which has value for the next step—risk management. Lisa said, I need to answer that risk question to evaluate these two situations in terms of risk management. Bruce asked for a motion to recommend that MDH pursue the outlined activities on PFCs and mercury. David moved that the panel recommend that these two projects move forward. Pat McGovern seconded the motion, and all said, “Aye.” Bruce added that the panel had a write‐in vote from Fred Anderson in favor of follow up on the PFCs. Lisa agreed with the vote, but specified that she is not on board for all [PFC] proposals. Jessica asked for more clarification about which PFC studies should be done. Geary said his understanding is that MDH should pursue the East Metro work in another continuing round of PFC monitoring and then have a second study in a larger sample, which, Bruce added, definitely should include other residents in the East Metro to follow up on the public health intervention. Panel members agreed. Lisa asked whether that study could include anglers who fish in the Mississippi’s Pool 2. Jean Johnson said the project could capture these. But Geary thought the project wouldn’t find many anglers, since recent changes in the fish advisories recommend eating only one fish meal per week because of many other chemical pollutants that have the same dietary level in fish advisories. Jim Kelly affirmed this statement. Bruce then observed that we’ve demonstrated the value of the program with the studies of PFCs, arsenic, mercury, and others, but I think it would be useful to state in the report that we’ve demonstrated the importance of this program, mention examples of potential issues, and then ask for continued State support for biomonitoring to address emerging and re‐emerging problems in MN, as determined through scientific assessment. Geary added that we not only need to address emerging issues, but also need support for building laboratory capacities. Aggie suggested that staff not frame the argument in vague terms of “capacity building,” but in terms of the [benefits to Minnesota citizens]. Lisa asked about the status of lead (Pb) testing in Minnesota, given that this public health issue is so well understood and well established [Note: CDC has discontinued funding for lead surveillance. See Advisory Panel Meeting book from March 13, 2012]. Jim Kelly from the Environmental Health Division said that children will still be tested for lead poisoning at their doctor’s recommendation, but MDH is losing funding for surveillance, which limits its ability to follow up on elevated blood lead cases. He pointed out that city health departments have funds for clean‐up, but 52 don’t cover MDH’s role in following up on children with elevated blood lead levels. Alan added that this is another example of loss of core capacity at MDH. (~1:57 hour) In looking at the short list of examples of concerns, David asked, isn't exposure to arsenic, cadmium, and other heavy metals also a problem in Minnesota? Heavy metals are known to cause health problems, yet the program’s example list contains only lead and mercury. Is there an additional cost to broadening the work on heavy metals? Tom Hawkinson said that the TIDES project was looking at lead, mercury, and cadmium, which can all be analyzed as a single suite of metals, adding that this is another argument for the mercury follow up with the TIDES study. MDH chemist Betsy Edhlund said that costs depend on which metals are being analyzed. Analyzing a suite of metals doesn’t involve much added cost. Bruce said that other exposures can occur in different Minnesota populations, such as manganese in some areas and arsenic in others, so the program needs the capacity to address emerging concerns. Geary said he was concerned with what was not on the list of examples: pesticides and pesticide drift. Bruce agreed that this is an important issue, but suggested that the most appropriate way to address these would be to have MDH and the Minnesota Department of Agriculture (MDA) meet to figure out key questions about pesticide use and concerns. Jean Johnson said that pesticides—and especially pesticide drift—are definitely an issue, but is unsure whether biomonitoring would be the best tool to use in studying pesticides. Cathy Villas‐Horns said that both agencies hear about concerns, and that MDA would share information it has from misuse of pesticides, complaints about pesticides and other information when discussing this issue with MDH. The issue of pesticide drift comes back repeatedly. Jeanne Ayers asked whether Bruce was suggesting that agencies should pool their concerns about pesticides, and pesticide drift and whether biomonitoring would fit in. If so, she said, the panel should have a motion for a vote to include the recommendation in the report to the legislature. Otherwise, she thought the meeting should just be in the work plan. Bruce asked, where would biomonitoring fit in? And Jeanne said that she concluded that pesticides should be part of the work plan, but she was not hearing that they should be written into the report recommendations. Geary said the report should acknowledge pesticides somewhere in the report, as they are a concern, and Pat suggested that the report refer both to emerging concerns, such as manganese, and persistent concerns, such as pesticides. Bruce asked whether anyone had comments on the Report’s tracking progress report. Jean said that because tracking had been funded by CDC, rather than the State, for the last two years, she wasn’t sure it should go into the legislative report. Aggie said that the report should include tracking activities for the past two years, including the fact that it is currently funded by CDC. MDH doesn’t want it to be invisible, she said. The hazard‐to‐exposure‐to‐health outcome paradigm involves both tracking and biomonitoring. In addition, because tracking was an important part of the founding legislation, its current progress should be reported. Jeanne Ayers added that the CDC funding for tracking continues through August 2014, but because the funding for the 53 program has been shifted into the Affordable Care Act, it’s at greater risk than if it were still in CDC’s operating budget. Geary Olsen asked, has the panel had ever written a recommendation or endorsement to submit with the biennial report to the legislature? Aggie said that other programs’ reports to the legislature have been accompanied by endorsements in the past. Bruce and the other panel members agreed that the panel would provide an endorsement in December. PFC Presentation: Update on C8 Probable Link Reports Jessica Nelson discussed the upcoming C8 “probable link” reports, which are emerging from the study of health status and exposure in Ohio Valley communities exposed to PFOA (C8), a PFC released by a manufacturing plant in Parkersburg, West Virginia. The study, the result of a lawsuit, requires the researchers to issue “probable link” reports, defined “to mean that, given the available scientific evidence, it is more likely than not that… a connection exists between PFOA exposure and a particular human disease.” Jessica noted that the scientists leading the C8 Study are careful not to say the word “causal,” and that this makes communication with the public more complicated. Although the populations in West Virginia and Ohio had exposures about 10 times higher than those in the East Metro, the media and the East Metro residents are very interested in the C8 Health Project reports. MDH receives media calls each time “probable link” reports are released. Thus, anticipating a flurry of calls when more of these reports are released in October, MDH has developed a list of talking points, which Jessica presented to the panel to elicit their advice and suggestions for alterations or clarification. The talking points stress the following: • MDH is playing close attention to the reports. MDH shares the community’s concern about possible health effects of PFCs and is working on understanding these findings better. • “Probable link” does not necessarily mean that PFOA causes these diseases. • Exposure levels in the East Metro were 10 times lower than those in Ohio and West Virginia. • Many of the studies haven’t been published – and it will take time for the findings to be published and for other scientists to review the information and vet the results. • MDH is not changing its medical care recommendations—people should get regular health check‐ups and screenings as recommended by their doctors. • The good news is that blood PFC levels are decreasing in East Metro. Pat liked the fact that the approach points out that East Metro residents were 10 times less exposed than the people in the mid‐Ohio Valley, and she suggested that MDH might 54 do more follow‐up communication with healthcare providers. Lisa noted that the C8 studies came out of a legal requirement. Contrasting this with the way researchers typically do science, she hypothesized that such legal actions may create high stakes for finding positive (disease) outcomes. Bruce cautioned against that view, saying that if industry funds such a study, the implication people draw is that the industry wants a negative (no disease) result. We need to focus on the scientific merits of the studies, and Lisa agreed. Jessica noted that exposed residents will not get direct financial benefits from the settlement, but that any positive findings will trigger medical monitoring for possible disease. Panel members agreed with Bruce’s recommendation to focus on the scientific merit of the study, rather than on the source of the funding. Alan also stressed that it takes time to build scientific consensus: a single published paper is not a consensus. Biomonitoring Updates and Tracking Updates Panel members had no questions or comments on the updates. Legislative Report Aggie Leitheiser reported that the governor and MDH are working on parts of the Governor’s budget and are in conversation with the MPCA about the EHTB program. Funding for MDH’s EHTB program comes from the State’s Environmental Fund and is funneled through the MPCA. The challenge for the governor and for state agencies is that the state faces a $1.7 billion budget deficit, and that does not include repaying shifts in school funding, which total some $3‐4 billion. Jeanne Ayers added that state agencies are trying to explore hopeful avenues for reducing the budget deficit, but only 10 to 15% of MDH’s budget comes from the state’s general fund. She has not known any time before when both state and federal budgets were being cut at the same time. Some 90 percent of MDH funding comes from federal grants, and federal government funding is undergoing severe cuts that will result in far fewer grants. Alan noted that MDH has turned to using federal grants to support its core programs. As a result, MDH has no easy way to cut expenses and now will have to set priorities for its core programs and eliminate some of them. But, he warned, we’ll pay in the future if we don’t [have programs that focus on] prevention [of exposure and health problems] now. New Business Bruce asked the panel for suggestions about new business or new topics for discussion. Geary suggested that Jessica bring the panel up to date on the remaining C8 probable link studies and accompanying MDH communication about them. David asked for a report on the Minnesota Department of Agriculture (MDA)–MDH conversation about pesticides. Bruce then asked for a motion to adjourn. Pat McGovern moved to adjourn, and the motion was seconded and passed. 55 Summary of Meeting Decisions In summary, the panel… Discussed and made recommendations on the proposed Report to the Legislature; Concurred with the plan to highlight EHTB accomplishments; Recommended that EHTB use case studies, individual stories, comments from participants, survey comments, and bullet points to make the report easy to read and understand; Voted to recommend that EHTB follow up on the 2 analytes specified in the last legislative directive (PFCs and mercury) to… o Repeat the biomonitoring study of PFCs in the same participants in the East Metro to confirm that PFC levels are declining and expand the population to include new East Metro residents, who are likely to have only background PFC levels. o Follow up on the mercury findings by biomonitoring newborns in other regions of Minnesota to identify disparities, and geographic and spatial patterns in mercury exposure. Recommended that EHTB include the need to address emerging concerns and/or persistent concerns, such as pesticide drift in the Legislative report, and requested that staff report at the next panel meeting on the Minnesota Department of Agriculture (MDA)–MDH conversation about pesticides. Decided to submit a letter of endorsement for the program to accompany its Report to the Legislature at the December 2012 meeting. 56 EnvironmentalHealthTrackingandBiomonitoring AdvisoryPanelRoster As of December 2012 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 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 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 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 Melanie Ferris Wilder Foundation 451 Lexington Parkway N St. Paul, MN 55104 651‐280‐2660 [email protected] Nongovernmental organization representative Thomas Hawkinson, MS, CIH, CSP Toro Company 8111 Lyndale Avenue S Bloomington, MN 55420 [email protected] 952‐887‐8080 Statewide business org representative Jill Heins Nesvold, MS American Lung Association of Minnesota 490 Concordia Avenue St. Paul, Minnesota 55103 651‐223‐9578 [email protected] Nongovernmental organization representative 57 Patricia 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 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 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 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 cathy.villas‐[email protected] MDA appointee Lisa Yost, MPH, DABT ENVIRON International Corporation 333 West Wacker Drive, Suite 2700 Chicago, IL 60606 Local office 886 Osceola Avenue St. Paul, Minnesota 55105 Phone: 651‐225‐1592 Cell: 651‐470‐9284 [email protected] At‐large representative Vacant Minnesota Senate appointee 58 Biographicalsketchesofadvisorypanelmembers Bruce H. Alexander is an Associate Professor in the Division of Environmental Health Sciences at the University of Minnesota’s School of Public Health. Dr. Alexander is an environmental and occupational epidemiologist with expertise in cancer, reproductive health, respiratory disease, injury, exposure assessment, and use of biological markers in public health applications. Fred Anderson is an epidemiologist at the Washington County Department of Public Health and Environment and has over 30 years of public health experience. .He holds a Master of Public Health (MPH) in environmental and infectious disease epidemiology from the University of Minnesota and is a registered environmental health specialist. For over 20 years, he has led county‐wide disease surveillance and intervention programs, including numerous multidisciplinary epidemiologic investigations. Alan Bender is the Section Chief of Chronic Disease and Environmental Epidemiology at the Minnesota Department of Health. He holds a Doctor of Veterinary Medicine degree from the University of Minnesota and a PhD in Epidemiology from Ohio State University. His work has focused on developing statewide surveillance systems, including cancer and occupational health, and exploring the links between occupational and environmental exposures and chronic disease and mortality. David DeGroote is Dean of the College of Science and Engineering and Professor of Biological Sciences at St. Cloud State University. He has been at St. Cloud State University since 1985, initially as an Assistant Professor in Biological Sciences. He served as Department Chair from 1996 to 2003 before moving to the Dean’s Office. Most recently he had focused on providing up‐to‐date academic programming and facilities that serve the needs of Minnesota employers in the health sciences, engineering, computing, biosciences, and STEM education. Melanie Ferris is a Research Scientist at Wilder Research, a nonprofit research organization based in St. Paul, Minnesota. She conducts a variety of program evaluation and applied research projects focused primarily on public health and mental health. She has worked on a number of recent projects that focus on identifying disparities across populations and using existing data sources to develop meaningful indicators of health and wellness. Examples of these projects include a study of health inequities in the Twin Cities region related to income, race, and place, development of a dashboard of mental health and wellness indicators for youth living in Hennepin County, and work on local community health needs assessments. She has a Master’s of Public Health degree in Community Health Education from the University of Minnesota’s School of Public Health. 59 Tom Hawkinson is the Corporate Environmental, Health, and Safety Manager for the Toro Company in Bloomington, MN. He completed his MS in Public Health at the University of Minnesota, with a specialization in industrial hygiene. He is certified in the comprehensive practice of industrial hygiene and a certified safety professional. He has worked in EHS management at a number of Twin Cities based companies, conducting industrial hygiene investigations of workplace contaminants and done environmental investigations of subsurface contamination both in the United States and Europe. He has taught statistics and mathematics at both graduate and undergraduate levels as an adjunct, and is on the faculty at the Midwest Center for Occupational Health and Safety A NIOSH‐Sponsored Education and Research Center School of Public Health, University of Minnesota. Jill Heins Nesvold serves as the Director of the Respiratory Health Division for the American Lung Association in Iowa, Minnesota, North Dakota, and South Dakota. Her responsibilities include program oversight and evaluation related to asthma, chronic obstructive lung disease (COPD), lung cancer, and influenza. Jill holds a master’s degree in health management and a short‐course master’s of business administration. Jill has published extensively in a variety of public health areas. Pat McGovern is a Professor in the Division of Environmental Health Sciences at the University of Minnesota’s School of Public Health. Dr. McGovern is a health services researcher and nurse with expertise in environmental and occupational health policy and health outcomes research. She serves as the Principal Investigator for the National Children’s Study (NCS) Center serving Ramsey County, one of 105 study locations nationwide. The NCS is the largest, long‐term study of children’s health and development in the US and the assessment of environmental exposures will include data collection from surveys, biological specimens and environmental samples. Geary Olsen is a corporate scientist in the Medical Department of the 3M Company. He obtained a Doctor of Veterinary Medicine (DVM) degree from the University of Illinois and a Master of Public Health (MPH) in veterinary public health and PhD in epidemiology from the University of Minnesota. For 27 years he has been engaged in a variety of occupational and environmental epidemiology research studies while employed at Dow Chemical and, since 1995, at 3M. His primary research activities at 3M have involved the epidemiology, biomonitoring (occupational and general population), and pharmacokinetics of perfluorochemicals. 60 Greg Pratt is a research scientist at the Minnesota Pollution Control Agency. He holds a Ph.D. from the University of Minnesota in Plant Physiology where he worked on the effects of air pollution on vegetation. Since 1984 he has worked for the MPCA on a wide variety of issues including acid deposition, stratospheric ozone depletion, climate change, atmospheric fate and dispersion of air pollution, monitoring and occurrence of air pollution, statewide modeling of air pollution risks, and personal exposure to air pollution. He is presently cooperating with the Minnesota Department of Health on a research project on the Development of Environmental Health Outcome Indicators: Air Quality Improvements and Community Health Impacts. Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU) within the Pesticide and Fertilizer Management Unit of the Minnesota Department of Agriculture. Cathy holds a Master of Science in Geology from the University of Delaware and a Bachelor of Science in Geology from Carleton College and is a licensed Professional Geologist in MN. The IRU oversees or conducts the investigation and cleanup of point source releases of agricultural chemicals (fertilizers and pesticides including herbicides, insecticides, fungicides, etc. as well as wood treatment chemicals) through several different programs. Cathy has worked on complex sites with Minnesota Department of Health and MPCA staff, and continues to work with interagency committees on contaminant issues. She previously worked as a senior hydrogeologist within the IRU, and as a hydrogeologist at the Minnesota Pollution Control Agency and an environmental consulting firm. Lisa Yost is a Principal Consultant at ENVIRON, an international consulting firm. She is in their Health Sciences Group, and is based in Saint Paul, Minnesota. Ms. Yost completed her training at the University of Michigan’s School of Public Health and is a board‐certified toxicologist with expertise in evaluating human health risks associated with substances in soil, water, and the food chain. She has conducted or supervised risk assessments under CERCLA, RCRA, or state‐led regulatory contexts involving a wide range of chemicals and exposure situations. Her areas of specialization include exposure and risk assessment, risk communication, and the toxicology of such chemicals as PCDDs and PCDFs, PCBs, pentachlorophenol (PCP), trichloroethylene (TCE), mercury, and arsenic. Ms. Yost is a recognized expert in risk assessment and has collaborated in original research on exposure issues, including background dietary intake of inorganic arsenic. She is currently assisting in a number of projects, including a complex multi‐pathway risk assessment for PDDD/Fs that will integrate extensive biomonitoring data collected by the University of Michigan. Ms. Yost is also an Adjunct Instructor at the University of Minnesota’s School of Public Health. 61 This page intentionally left blank. 62 Staffbiosketches Wendy Brunner, 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 masters degree in Science and Technology Studies from Rensselaer Polytechnic Institute and a masters degree in Environmental and Occupational Health from the University of Minnesota. She is currently a doctoral student in the Division of Epidemiology and Community Health at the University of Minnesota. Jean Johnson, PhD, MS, is Program Director/Principal Investigator for Minnesota’s Environmental Public Health Tracking and Biomonitoring Program. Dr. Johnson received her Ph.D. and M.S. degrees from the University of Minnesota, School of Public Health in Environmental Health and has 25 years of experience working with the state of Minnesota in the environmental health field. As an environmental epidemiologist at MDH, her work has focused on special investigations of population exposure and health, including studies of chronic diseases related to air pollution and asbestos exposure, and exposure to drinking water contaminants. She is currently the Principal Investigator on an EPA grant to develop methods for measuring the public health impacts of population exposure to particulate matter (PM) in air. She is also an adjunct faculty member at the University of Minnesota School of Public Heath. Mary Jeanne Levitt, MBC, is the communications coordinator with the Minnesota Environmental Public Health Tracking program. She has a Masters in Business Communications and has worked for over 20 years in both the public and non‐profit sector in project management of research and training grants, communications and marketing strategies, focus groups and evaluations of educational needs of public health professionals. She serves on 3 institutional review boards which specialize in academic research, oncology research, and overall clinical research. Paula Lindgren, MS, received her Master of Science degree in Biostatistics from the University of Minnesota. She works for the Minnesota Department of Health as a biostatistician, and provides statistical and technical support to the MN EPHT and Biomonitoring programs for data reports, publications, web‐based portal dissemination and presentations in the Chronic Disease and Environmental Epidemiology section. Ms. Lindgren has also received training in the area of GIS for chronic disease mapping and analysis. In addition to her work for MN EPHT, she works for various programs within Chronic Disease and Environmental Epidemiology including the Asthma program, Center for Occupational Health and Safety, Minnesota Cancer Surveillance System, and Cancer Control section. 63 Barbara Scott Murdock, MA, MPH, is the Program Planner for the Environmental Public Health Tracking and Biomonitoring (EHTB) program, responsible for leading strategic planning and communications with stakeholders and the EHTB Advisory Panel. A biologist and public health professional by education, she has over 30 years of experience in writing and editing professional publications. Recently a grants coordinator/writer for social science faculty at the University of Minnesota, she also served as the biomonitoring project manager at the Minnesota Department of Health (2001‐2003); senior research fellow in the Center for Environment & Health Policy, UMN School of Public Health (1995‐ 2001); director of water and health programs at the Freshwater Foundation (1991‐1992); and founding editor of the Health & Environment Digest, a peer‐reviewed publication for environmental health and management professionals in the US and Canada (1986‐1992). She holds a BS in biochemistry from the University of Chicago, an MA in zoology from Duke University, and an MPH from the University of Minnesota. Jessica Nelson, PhD, is an epidemiologist with the Minnesota Environmental Public Health Tracking and Biomonitoring Program, working primarily on design, coordination, and analysis of biomonitoring projects. Jessica received her PhD and MPH in Environmental Health from the Boston University School of Public Health where her research involved the epidemiologic analysis of biomonitoring data on perfluorochemicals. Jessica was the coordinator of the Boston Consensus Conference on Biomonitoring, a project that gathered input and recommendations on the practice and uses of biomonitoring from a group of Boston‐area lay people. Jeannette M. Sample, MPH, is an epidemiologist with the Minnesota Environmental Public Health Tracking program at the Minnesota Department of Health, working primarily with the collection and statistical analysis of public health surveillance data for EPHT. She also works on research collaborations with academic partners relating to reproductive outcomes and birth defects. Prior to joining EPHT, she was a CSTE/CDC Applied Epidemiology Fellow with the MDH Birth Defect Information System. Jeannette received her Masters degree in epidemiology and biostatistics from The George Washington University in Washington, DC. Blair Sevcik, MPH, is an epidemiologist with the Minnesota Environmental Public Health Tracking (EPHT) program at the Minnesota Department of Health, where she works on the collection and statistical analysis of public health surveillance data for EPHT. Prior to joining EPHT in January 2009, she was a student worker with the MDH Asthma Program. She received her Master of Public Health degree in epidemiology from University of Minnesota School of Public Health in December 2010. 64 Chuck Stroebel, MSPH, is the MN EPHT Program Manager. He provides day‐to‐day direction for program activities, including: 1) development and implementation of the state network, 2) development and transport of NCDMs and metadata for the national network, and 3) collaboration and communication with key EPHT partners and stakeholders. Chuck received a Master’s 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. Chuck also played a key role in early initiatives to build tracking capacity at the Minnesota Department of Health. Currently, he is a member of the IBIS Steering Committee (state network), the MDH ASTHO Grant Steering Committee (climate change), and the Northland Society of Toxicology. He also serves on the MN EPHT Technical and Communications Teams. Allan N. Williams, MPH, PhD, is an environmental and occupational epidemiologist in the Chronic Disease and Environmental Epidemiology Section at the Minnesota Department of Health. He is the supervisor for the MDH Center for Occupational Health and Safety, which currently includes both the state‐funded and federally‐funded Environmental Public Health Tracking and Biomonitoring programs. For over 25 years, he has worked on issues relating to environmental and occupational cancer, cancer clusters, work‐related respiratory diseases, and the surveillance and prevention of work‐related injuries among adolescents. He has served as the PI on two NIOSH R01 grants, as a co‐investigator on four other federally‐funded studies in environmental or occupational health, and is an adjunct faculty member in the University of Minnesota’s School of Public Health. He received an MA in Biology from Indiana University, an MPH in Environmental Health and Epidemiology from the University of Minnesota, and a PhD in Environmental and Occupational Health from the University of Minnesota 65 This page intentionally left blank. 66 EnvironmentalHealthTrackingandBiomonitoringStatute $1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount, $900,000 each year is for transfer to the Minnesota Department of Health. The base appropriation for this program for fiscal year 2010 and later is $500,000. 144.995 DEFINITIONS; ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING. (a) For purposes of sections 144.995 to 144.998, the terms in this section have the meanings given. (b) "Advisory panel" means the Environmental Health Tracking and Biomonitoring Advisory Panel established under section 144.998. (c) "Biomonitoring" means the process by which chemicals and their metabolites are identified and measured within a biospecimen. (d) "Biospecimen" means a sample of human fluid, serum, or tissue that is reasonably available as a medium to measure the presence and concentration of chemicals or their metabolites in a human body. (e) "Commissioner" means the commissioner of the Department of Health. (f) "Community" means geographically or nongeographically based populations that may participate in the biomonitoring program. A "nongeographical community" includes, but is not limited to, populations that may share a common chemical exposure through similar occupations, populations experiencing a common health outcome that may be linked to chemical exposures, populations that may experience similar chemical exposures because of comparable consumption, lifestyle, product use, and subpopulations that share ethnicity, age, or gender. (g) "Department" means the Department of Health. (h) "Designated chemicals" means those chemicals that are known to, or strongly suspected of, adversely impacting human health or development, based upon scientific, peerreviewed animal, human, or in vitro studies, and baseline human exposure data, and consists of chemical families or metabolites that are included in the federal Centers for Disease Control and Prevention studies that are known collectively as the National Reports on Human Exposure to Environmental Chemicals Program and any substances specified by the commissioner after receiving recommendations under section 144.998, subdivision 3, clause (6). (i) "Environmental hazard" means a chemical or other substance for which scientific, peerreviewed studies of humans, animals, or cells have demonstrated that the chemical is known or reasonably anticipated to adversely impact human health. (j) "Environmental health tracking" means collection, integration, analysis, and dissemination of data on human exposures to chemicals in the environment and on diseases potentially caused or aggravated by those chemicals. 144.996 ENVIRONMENTAL HEALTH TRACKING; BIOMONITORING. Subdivision 1. Environmental health tracking. In cooperation with the commissioner of the Pollution Control Agency, the commissioner shall establish an environmental health tracking program to: (1) coordinate data collection with the Pollution Control Agency, Department of Agriculture, University of Minnesota, and any other relevant state agency and work to promote the sharing of and access to health and environmental databases to develop an environmental health tracking system for Minnesota, consistent with applicable data practices laws; (2) facilitate the dissemination of aggregate public health tracking data to the public and researchers in accessible format; (3) develop a strategic plan that includes a mission statement, the identification of core priorities for research and epidemiologic surveillance, and the identification of internal and external stakeholders, and a work plan describing future program development and addressing issues having to do with compatibility with the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program; (4) develop written data sharing agreements as needed with the Pollution Control Agency, Department of Agriculture, and other relevant state agencies and organizations, and develop additional procedures as needed to protect individual privacy; (5) organize, analyze, and interpret available data, in order to: (i) characterize statewide and localized trends 67 and geographic patterns of population-based measures of chronic diseases including, but not limited to, cancer, respiratory diseases, reproductive problems, birth defects, neurologic diseases, and developmental disorders; (ii) characterize statewide and localized trends and geographic patterns in the occurrence of environmental hazards and exposures; (iii) assess the feasibility of integrating disease rate data with indicators of exposure to the selected environmental hazards such as biomonitoring data, and other health and environmental data; (iv) incorporate newly collected and existing health tracking and biomonitoring data into efforts to identify communities with elevated rates of chronic disease, higher likelihood of exposure to environmental hazards, or both; (v) analyze occurrence of environmental hazards, exposures, and diseases with relation to socioeconomic status, race, and ethnicity; (vi) develop and implement targeted plans to conduct more intensive health tracking and biomonitoring among communities; and (vii) work with the Pollution Control Agency, the Department of Agriculture, and other relevant state agency personnel and organizations to develop, implement, and evaluate preventive measures to reduce elevated rates of diseases and exposures identified through activities performed under sections 144.995 to 144.998; and (6) submit a biennial report to the chairs and ranking members of the committees with jurisdiction over environment and health by January 15, beginning January 15, 2009, on the status of environmental health tracking activities and related research programs, with recommendations for a comprehensive environmental public health tracking program. Subd. 2. Biomonitoring. The commissioner shall: (1) conduct biomonitoring of communities on a voluntary basis by collecting and analyzing biospecimens, as appropriate, to assess environmental exposures to designated chemicals; (2) conduct biomonitoring of pregnant women and minors on a voluntary basis, when scientifically appropriate; (3) communicate findings to the public, and plan ensuing stages of biomonitoring and disease tracking work to further develop and refine the integrated analysis; (4) share analytical results with the advisory panel and work with the panel to interpret results, communicate findings to the public, and plan ensuing stages of biomonitoring work; and (5) submit a biennial report to the chairs and ranking members of the committees with jurisdiction over environment and health by January 15, beginning January 15, 2009, on the status of the biomonitoring program and any recommendations for improvement. Subd. 3. Health data. Data collected under the biomonitoring program are health data under section 13.3805. 144.997 BIOMONITORING PILOT PROGRAM. Subdivision 1. Pilot program. With advice from the advisory panel, and after the program guidelines in subdivision 4 are developed, the commissioner shall implement a biomonitoring pilot program. The program shall collect one biospecimen from each of the voluntary participants. The biospecimen selected must be the biospecimen that most accurately represents body concentration of the chemical of interest. Each biospecimen from the voluntary participants must be analyzed for one type or class of related chemicals. The commissioner shall determine the chemical or class of chemicals to which community members were most likely exposed. The program shall collect and assess biospecimens in accordance with the following: (1) 30 voluntary participants from each of three communities that the commissioner identifies as likely to have been exposed to a designated chemical; (2) 100 voluntary participants from each of two communities: (i) that the commissioner identifies as likely to have been exposed to arsenic; and (ii) that the commissioner identifies as likely to have been exposed to mercury; and (3) 100 voluntary participants from each of two communities that the commissioner identifies as likely to have been exposed to perfluorinated chemicals, including perfluorobutanoic acid. Subd. 2. Base program. (a) By January 15, 2008, the commissioner shall submit a report on the results of the biomonitoring pilot program to the chairs and ranking members of the committees with jurisdiction over health and environment. (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 68 members of communities assessed during the pilot program and to identify other communities and other designated chemicals to be assessed via biomonitoring; (2) work with the advisory panel to assess the pilot program, including but not limited to the validity and accuracy of the analytical measurements and adequacy of the guidelines and protocols; (3) communicate the results of the pilot program to the public; and (4) after consideration of the findings and recommendations in clauses (1) and (2), and within the appropriations available, develop and implement a base program. Subd. 3. Participation. (a) Participation in the biomonitoring program by providing biospecimens is voluntary and requires written, informed consent. Minors may participate in the program if a written consent is signed by the minor's parent or legal guardian. The written consent must include the information required to be provided under this subdivision to all voluntary participants. (b) All participants shall be evaluated for the presence of the designated chemical of interest as a component of the biomonitoring process. Participants shall be provided with information and fact sheets about the program's activities and its findings. Individual participants shall, if requested, receive their complete results. Any results provided to participants shall be subject to the Department of Health Institutional Review Board protocols and guidelines. When either physiological or chemical data obtained from a participant indicate a significant known health risk, program staff experienced in communicating biomonitoring results shall consult with the individual and recommend follow-up steps, as appropriate. Program administrators shall receive training in administering the program in an ethical, culturally sensitive, participatory, and community-based manner. Subd. 4. Program guidelines. (a) The commissioner, in consultation with the advisory panel, shall develop: (1) protocols or program guidelines that address the science and practice of biomonitoring to be utilized and procedures for changing those protocols to incorporate new and more accurate or efficient technologies as they become available. The commissioner and the advisory panel shall be guided by protocols and guidelines developed by the Centers for Disease Control and Prevention and the National Biomonitoring Program; (2) guidelines for ensuring the privacy of information; informed consent; follow-up counseling and support; and communicating findings to participants, communities, and the general public. The informed consent used for the program must meet the informed consent protocols developed by the National Institutes of Health; (3) educational and outreach materials that are culturally appropriate for dissemination to program participants and communities. Priority shall be given to the development of materials specifically designed to ensure that parents are informed about all of the benefits of breastfeeding so that the program does not result in an unjustified fear of toxins in breast milk, which might inadvertently lead parents to avoid breastfeeding. The materials shall communicate relevant scientific findings; data on the accumulation of pollutants to community health; and the required responses by local, state, and other governmental entities in regulating toxicant exposures; (4) a training program that is culturally sensitive specifically for health care providers, health educators, and other program administrators; (5) a designation process for state and private laboratories that are qualified to analyze biospecimens and report the findings; and (6) a method for informing affected communities and local governments representing those communities concerning biomonitoring activities and for receiving comments from citizens concerning those activities. (b) The commissioner may enter into contractual agreements with health clinics, community-based organizations, or experts in a particular field to perform any of the activities described under this section. 144.998 ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING ADVISORY PANEL. Subdivision 1. Creation. The commissioner shall establish the Environmental Health Tracking and Biomonitoring Advisory Panel. The commissioner shall appoint, from the panel's membership, a chair. The panel shall meet as often as it deems necessary but, at a minimum, on a quarterly basis. Members of the panel shall serve without compensation but shall be reimbursed for travel and other necessary expenses incurred through performance of their duties. Members appointed by the commissioner 69 are appointed for a three-year term and may be reappointed. Legislative appointees serve at the pleasure of the appointing authority. Subd. 2. Members. (a) The commissioner shall appoint eight members, none of whom may be lobbyists registered under chapter 10A, who have backgrounds or training in designing, implementing, and interpreting health tracking and biomonitoring studies or in related fields of science, including epidemiology, biostatistics, environmental health, laboratory sciences, occupational health, industrial hygiene, toxicology, and public health, including: (1) at least two scientists representative of each of the following: (i) nongovernmental organizations with a focus on environmental health, environmental justice, children's health, or on specific chronic diseases; and (ii) statewide business organizations; and (2) at least one scientist who is a representative of the University of Minnesota. (b) Two citizen panel members meeting the scientific qualifications in paragraph (a) shall be appointed, one by the speaker of the house and one by the senate majority leader. (c) In addition, one representative each shall be appointed by the commissioners of the Pollution Control Agency and the Department of Agriculture, and by the commissioner of health to represent the department's Health Promotion and Chronic Disease Division. Subd. 3. Duties. The advisory panel shall make recommendations to the commissioner and the legislature on: (1) priorities for health tracking; (2) priorities for biomonitoring that are based on sound science and practice, and that will advance the state of public health in Minnesota; (3) specific chronic diseases to study under the environmental health tracking system; (4) specific environmental hazard exposures to study under the environmental health tracking system, with the agreement of at least nine of the advisory panel members; (5) specific communities and geographic areas on which to focus environmental health tracking and biomonitoring efforts; (6) specific chemicals to study under the biomonitoring program, with the agreement of at least nine of the advisory panel members; in making these recommendations, the panel may consider the following criteria: (i) the degree of potential exposure to the public or specific subgroups, including, but not limited to, occupational; (ii) the likelihood of a chemical being a carcinogen or toxicant based on peer-reviewed health data, the chemical structure, or the toxicology of chemically related compounds; (iii) the limits of laboratory detection for the chemical, including the ability to detect the chemical at low enough levels that could be expected in the general population; (iv) exposure or potential exposure to the public or specific subgroups; (v) the known or suspected health effects resulting from the same level of exposure based on peer-reviewed scientific studies; (vi) the need to assess the efficacy of public health actions to reduce exposure to a chemical; (vii) the availability of a biomonitoring analytical method with adequate accuracy, precision, sensitivity, specificity, and speed; (viii) the availability of adequate biospecimen samples; or (ix) other criteria that the panel may agree to; and (7) other aspects of the design, implementation, and evaluation of the environmental health tracking and biomonitoring system, including, but not limited to: (i) identifying possible community partners and sources of additional public or private funding; (ii) developing outreach and educational methods and materials; and (iii) disseminating environmental health tracking and biomonitoring findings to the public. Subd. 4. Liability. No member of the panel shall be held civilly or criminally liable for an act or omission by that person if the act or omission was in good faith and within the scope of the member's responsibilities under sections 144.995 to 144.998. INFORMATION SHARING. On or before August 1, 2007, the commissioner of health, the Pollution Control Agency, and the University of Minnesota are requested to jointly develop and sign a memorandum of understanding declaring their intent to share new and existing environmental hazard, exposure, and health outcome data, within applicable data privacy laws, and to cooperate and communicate effectively to ensure sufficient clarity and understanding of the data 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 70 committees having jurisdiction over judiciary, environment, and health and human services. Effective date: July 1, 2007 This document contains Minnesota Statutes, sections 144.995 to 144.998, as these sections were adopted in Minnesota Session Laws 2007, chapter 57, article 1, sections 143 to 146. The appropriation related to these statutes is in chapter 57, article 1, section 3, subdivision 4. The paragraph about information sharing is in chapter 57, article 1, section 169. The following is a link to chapter 57: http://ros.leg.mn/bin/getpub.php?type=law&year =2007&sn=0&num=57 LawsofMinnesota2011First SpecialSessionChapter2. Bill for an Act. SF 3, Sec.3. Pollution Control Agency, Subd.4 Land Cite as: Laws of Minnesota 2011 First Special Session Chapter 2. Environmental 6,916,000 6,916,000 Remediation 10,496,000 10,496,000 General 268,000 268,000 All money for environmental response, compensation, and compliance in the remediation fund not otherwise appropriated is appropriated to the commissioners of the Pollution Control Agency and agriculture for purposes of Minnesota Statutes, section 115B.20, subdivision 2, clauses (1), (2), (3), (6), and (7). At the beginning of each fiscal year, the two commissioners shall jointly submit an annual spending plan to the commissioner of management and budget that maximizes the utilization of resources and appropriately allocates the money between the two departments. This appropriation is available until June 30, 2013. $3,616,000 the first year and $3,616,000 the second year are from the petroleum tank fund to be transferred to the remediation fund for purposes of the leaking underground storage tank program to protect the land. $252,000 the first year and $252,000 the second year are from the remediation fund for transfer to the commissioner of health for private water supply monitoring and health assessment costs in areas contaminated by unpermitted mixed municipal solid waste disposal facilities and drinking water advisories and public information activities for areas contaminated by hazardous releases. $268,000 the first year and $268,000 the second year are for transfer to the Department of Health to complete the environmental health tracking and biomonitoring analysis related to perfluorochemicals and mercury monitoring in Lake Superior and disseminate the results. This is a onetime appropriation. 71 This page intentionally left blank. 72 RecentPFCAbstractsofInterest Cohort Mortality Study of Workers Exposed to Perfluorooctanoic Acid Kyle Steenland* and Susan Woskie * Correspondence to Dr. Kyle Steenland, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 (e‐mail: [email protected]). American Journal of Epidemiology, October 18, 2012. DOI: 10.1093/aje/kws171 Initially submitted July 24, 2011; accepted for publication March 13, 2012. Abstract Perfluorooctanoic acid (PFOA) is persistent in the human body; the general population has serum levels of approximately 4 ng/mL. It causes tumors of the liver, pancreas, and testicles in rodents. The authors studied the mortality of 5,791 workers exposed to PFOA at a DuPont chemical plant in West Virginia, using a newly developed job exposure matrix based on serum data for 1,308 workers from 1979–2004. The estimated average serum PFOA level was 350 ng/mL. The authors used 2 referent groups: other DuPont workers in the region and the US population. In comparison with other DuPont workers, cause‐specific mortality was elevated for mesothelioma (standardized mortality ratio (SMR) = 2.85, 95% confidence interval (CI): 1.05, 6.20), diabetes mellitus (SMR = 1.90, 95% CI: 1.35, 2.61), and chronic renal disease (SMR = 3.11, 95% CI: 1.66, 5.32). Significant positive exposure‐response trends occurred for both malignant and nonmalignant renal disease (12 and 13 deaths, respectively). PFOA is concentrated in the kidneys of rodents, and there are prior findings of elevated kidney cancer in this cohort. Multiple‐cause mortality analyses tended to support the results of underlying‐ cause analyses. No exposure‐response trend was seen for diabetes or heart disease mortality. In conclusion, the authors found evidence of positive exposure‐response trends for malignant and nonmalignant renal disease. These results were limited by small numbers and restriction to mortality data, which are of limited relevance for several nonfatal outcomes of a priori interest. fluorocarbons; mortality; occupational exposure; octanoic acids; perfluorooctanoic acid Abbreviations: CI, confidence interval; JEM, job exposure matrix; PFOA, perfluorooctanoic acid; SMR, standardized mortality ratio. 73
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