EnvironmentalHealthTracking&BiomonitoringProgram AdvisoryPanelMeetingAgenda,March12,2013 Time Agenda Item Presenters 1:00 Welcome & Introductions Bruce Alexander, Panel members & audience are invited chair to introduce themselves 1:05 Legislative Update, Legislative Initiative 1:15 Air Quality, Health, & Traffic Aggie Leitheiser, Assistant Commissioner; Shannon Lotthammer, Division Director, MPCA Envl. Analysis & Outcomes Paula Lindgren, Greg Pratt 1:40 Discussion 2:00 Population Characteristics Blair Sevcik  Poverty  Income  Health insurance 2:10 Discussion 2:25 Refreshments Description/expected outcome Information item. Panel members are invited to ask questions. Discussion item. Using data from the MN Dept. of Transportation and the Rochester Epidemiology Project, Paula and Greg will discuss an MDH‐EPA study measuring associations of traffic exposure and asthma exacerbations in Olmsted county. Question for the panel:  Can the panel suggest how EPHT might further develop and pilot measures of population exposure to traffic for local area analyses and health impact assessment? Discussion Item. Using data from the US Census Bureau’s Small Area Income and Poverty Estimates, Blair will explore the MN data and demonstrate side‐by‐side comparison maps for such indicators as lead or asthma. Questions for panel:  What other measures might EPHT link to poverty on the portal?  What other measures of population characteristics would be useful indicators for Minnesota? 2:35 2:50 3:05 Tracking Updates:  CDC Tracking data use projects  Web page update  Melanoma success story  Joint COPD Report The East Metro PFC Follow‐up Study: Results from Survey Data Analysis Discussion Jean Johnson Chuck Stroebel Information item. Jean and Chuck will provide brief updates. Panel members are invited to ask questions and comment about updates provided in the meeting materials. Jessica Nelson, Discussion item. Staff will describe the Christy Rosebush results of preliminary analysis of participant questionnaire data. Questions for panel  Would the panel recommend a combined variable using years of drinking unfiltered water and current tap water consumption (as a surrogate for past consumption)?  Do panel members recommend additional phase 2 analyses?  How should MDH staff interpret these results for participants and the community? Jessica Nelson No presentation. Panel members are invited to ask questions about updates in the meeting materials. 3:25 Biomonitoring Updates:  Pregnancy & Newborns Exposure  Fond du Lac (GLRI) 3:30 Protocol for National Children’s Study collaboration Jessica Nelson 3:50 3:55 4:00 New business Audience questions Motion to adjourn Bruce Alexander Bruce Alexander Bruce Alexander Information item. Panel members are invited to ask questions and comment on the proposed study protocol. Note to audience: The panel asks that audience members hold comments and questions on discussion items until the end of the panel’s discussion, when the chair will invite questions from the audience. Audience members are asked to identify themselves when they speak, and to please record their names and affiliations on the list at the sign‐in table. Meetings are recorded on audiotape. 2 TableofContents Section Overview: Legislative Update & Joint Legislative Initiative ................................... 5 Section Overview: Air Quality, Health, and Traffic ............................................................. 9 Section Overview: Population Characteristics .................................................................. 15 Section Overview: Tracking Updates ............................................................................... 19 Section Overview: The East Metro PFC Biomonitoring Follow‐Up Project: Results from Survey Data Analysis ......................................................................................................... 25 Section Overview: Biomonitoring Updates ...................................................................... 37 Section Overview: Minnesota National Children’s Study Newborn Mercury Project Proposal ............................................................................................................................ 41 Section Overview: Other Information .............................................................................. 47 3 This page intentionally left blank. 4 SectionOverview:LegislativeUpdate&JointLegislativeInitiative
Aggie Leitheiser will give a brief summary of legislative actions and efforts relevant to the Environmental Health Tracking and Biomonitoring program at the legislature. Shannon Lotthammer will give a brief review of the joint legislative initiative proposed by the MPCA and MDH. A summary of the proposal is included in the following pages. Information Item. After these presentations, panel members are invited to comment and ask questions. 5 This page intentionally left blank. 6 2014-15 Biennial Budget
MN Pollution Control Agency
Change Item Title: Environmental Health Risk
Fiscal Impact ($000s)
Environmental Fund
Expenditures
Net Fiscal Impact
FY 2014
FY 2015
FY 2016
FY 2017
$600
$600
$600
$600
$600
$600
$600
$600
Recommendation:
The Governor recommends an increase of $600,000 in FY 2014 and $600,000 in FY 2015 in the appropriation to
the Environmental Assistance/Cross Media Program from the Environmental Fund. Of this amount $499,000 will
be transferred annually to the MN Department of Health (MDH). This appropriation will fund a joint project with
MDH focused on providing the information and tools needed to better identify the public health and environmental
management actions needed to address specific environmental risks and achieve public health goals. For FY
2014-15 the collaboration will focus on chronic respiratory disease burden in high-density urban areas and
mercury levels in children and newborns.
Rationale/Background:
The environment plays an important role in human health – clean water, air and healthy foods are essential to
good health, and some chemical exposures, such as tobacco smoke or lead, can lead to poor health. In this
sense, the environment is more than the natural world; it’s our homes and workplaces, the air we breathe, the
water we drink, our foods, our habits, and our hobbies. Meaningful information about the environment and our
health can lead to actions that result in healthier communities.
Environmental health tracking and biomonitoring help “connect the dots” between environment, exposures, and
health. Understanding these connections is key to knowing how best to reduce environmental risks and improve
and protect the health of Minnesota communities. Other tools and information are also critical to understanding
these connections, such as health impact assessment, community-based environmental monitoring, and risk
assessment. The relative importance of each of these tools depends on the issue of concern and the available
information.
Over the last three biennia the one-time funding appropriated for the environmental health tracking and
biomonitoring (EHTB) effort has been reduced significantly, from $2 million for the FY2008-2009 biennium, to $1
million for the FY2010-2011 biennium, to $536,000 for the FY2012-2013 biennium. At the same time, the need for
the MPCA and MDH to work together to better understand, evaluate and communicate with the public about
environmental health risks has, if anything, increased.
To address this need, MDH and MPCA have developed a joint legislative initiative focused on the link between
environmental risks and public health, particularly community health. This proposal builds on the information and
expertise gained through the implementation of a statewide Environmental Public Health Tracking and
Biomonitoring Program (EHTB) to further develop a coordinated, risk/issue-driven approach for identifying and
addressing the areas of greatest need in our communities.
Proposal:
Based on the successes of the EHTB program over the last five years and identified additional needs, MPCA and
MDH propose $600,000 per year in ongoing funding to provide the information and tools needed to better identify
the public health and environmental management actions needed to address specific environmental risks and
achieve public health goals.
This approach involves applying key investigative tools to specific health issues. For the FY14-15 biennium the
investigation will focus on chronic respiratory disease burden in the Twin Cities and mercury levels in children and
newborns. The investigator's tools include health impact assessments, biomonitoring, and exposure-based
monitoring/risk assessment. The MPCA and MDH will engage individuals and health professionals in affected
communities. The work of the two agencies is intended to shape future public health and environmental
management action needed to effectively address these environmental risks and achieve public health goals.
State of Minnesota
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Governor’s Recommendation
2014-15 Biennial Budget
2/7/2013
2014-15 Biennial Budget
MN Pollution Control Agency
Performance Measures:
The success of this initiative will be measured on many levels. The initial success will be based on development
of the tools and their application to better understand environmental risks associated with chronic respiratory
disease burden and children’s mercury exposure. Output measures will include the number of health impact
assessments completed (HIAs); number of HIA trainings; and identification of any disparities, trends and
geographical differences in children’s mercury exposure. The long-term outcomes of this effort include:
Enhanced understanding of the effects of environmental exposures on community public health.
Better information for permitting, land use and individual decisions, to enhance public health.
Greater engagement and dialogue among state and local agencies and concerned/affected communities
and businesses, leading to better-informed decisions and enhanced partnerships.
Reduced exposure to environmental risks.
Enhanced community public health as measured by chronic respiratory disease burden in urban areas
and children’s mercury exposure.
The ultimate result is fewer deaths and chronic health diseases by reduced environmental exposure and
preventative action through community/public health efforts.
Statutory Change: Not Applicable
State of Minnesota
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Governor’s Recommendation
2014-15 Biennial Budget
2/7/2013
SectionOverview:AirQuality,Health,andTraffic
A substantial scientific literature associates airborne fine particulate matter (PM2.5) exposures with health outcomes, most significantly with cardiovascular and respiratory disease. These studies suggest that PM2.5 has a “no‐threshold” effect on some health outcomes and that air pollution‐related adverse health effects occur even in areas in attainment with National Ambient Air Quality Standards (NAAQS) for PM2.5. Studies further show that exposure to local sources of PM, such as living in close proximity to traffic, also contributes to exacerbation of chronic respiratory disease. Since 2007, MDH Chronic Disease and Environmental Epidemiology staff have been working collaboratively with air pollution scientists at the Minnesota Pollution Control Agency on an EPA funded research study for linking air pollution (PM) monitoring and chronic disease surveillance data here in Minnesota. The study uses existing data to develop a set of indicators for measuring the impact of local, regional, and national PM2.5 emission‐reduction strategies on population distributions of ambient PM exposures and on population health in the 7‐county Metro Area and Olmsted county. Staff epidemiologist, Naomi Shinoda, presented the results of our analyses for the metro area at a previous Advisory Panel meeting (June 2012). This presentation focuses on a separate analysis from this project that was conducted using a unique health data set from Olmsted County and a method for measuring population traffic exposure developed with MPCA investigator, Greg Pratt. Staff developed a health outcome indicator that used data on asthma encounters (defined below) from the Rochester Epidemiology Project (REP), a medical records linkage database for all Olmsted County residents. REP data allow geocoding of patient residence, leading to data of much finer geographic resolution than ZIP code level that can be used to assign traffic exposure. The presentation will present the methods and results from the Olmsted County REP/Traffic analyses to include the following: 
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REP description Asthma exacerbation definition from the REP Traffic exposure assessment methods Statistical analyses/results Future directions Question for the panel: 
Can the panel suggest how EPHT might further develop and pilot measures of population exposure to traffic for additional local area analyses, tracking and health impact assessment? 9 This page intentionally left blank. 10 AirQuality,Health,andTraffic
Background The EPA funded (R833627010) study used existing data to develop and evaluate a set of outcome‐based indicators for monitoring the impacts of local, regional, and national particulate matter emission‐reduction strategies on population distributions of ambient PM exposures and on population health in the seven county Metro area and Olmsted county. For Olmsted County, staff developed a supplemental health outcome indicator that used data on asthma encounters (defined below) from the Rochester Epidemiology Project (REP), a medical records linkage database of all Olmsted County residents. The REP medical records linkage database is unique to Olmsted County, MN. Because it links all medical clinic visits, hospitalizations, outpatient clinic visits, urgent care visits, and ED visits for each patient, this database is an outstanding resource for research. It enables researchers to identify recurrent events within individuals and to create unique health indicators, such as the occurrence of asthma exacerbations. The REP data allow geocoding of patient residence, leading to data of much finer geographic resolution than ZIP code level, which is the geographic resolution at which hospitalization and mortality data are available. We were able to obtain information on Olmsted County residence status for each patient during 2000‐2010 (the number of days/year each patient was a resident of Olmsted County during 2000‐2010). This information enabled us to use the number of asthma exacerbations per patient per year as a metric in the analyses. Methods REP asthma data For this study we collected information from the REP on all encounters for asthma and asthma exacerbation‐related diagnostic codes for individuals with two or more asthma codes within any 18‐month period during 2000‐2010. We used the criterion of two asthma codes within an 18‐month period as a way to define asthma patients and to ensure that the codes were not in error or part of differential diagnosis, as may happen when a single asthma‐related code is found. Asthma‐related hospitalization and ED visits were included if asthma (ICD‐9 code 493) was assigned in the first diagnostic code. Asthma‐related outpatient visits were included if asthma was present in any of the first three diagnostic code fields. Asthma exacerbations were defined as one of three types of events: 1) An inpatient hospitalization for asthma 2) An ED visit for asthma, or 3) Three or more outpatient visits for asthma within a two‐week time period 11 The asthma encounter data were linked to date of service, site of service (ED, office, hospital, etc.) and facility (e.g., Mayo Clinic, Olmsted Medical Center, or Rochester Family Care). To allow geocoding for each individual, the most recent street addresses on record were collected as well. For each individual, the number of asthma exacerbations experienced per year was calculated by dividing the total number of asthma exacerbations experienced by the individual during 2000‐2010 by the number of years the individual was an Olmsted County resident during the same time period. Traffic exposure Traffic‐related exposure indicators were developed for Olmsted County using traffic count data from the Minnesota Department of Transportation (MNDOT) as the primary data source:  Vehicle Kilometers Traveled (VKT) within 250 and 500 meter buffers of residence  Traffic density VKT calculations were made for years 2005 and 2009 using the ArcGIS program (ESRI 2011. ArcGIS Desktop: Release 10. Redlands, CA: Environmental Systems Research Institute). The length of all roadway segments within each buffer (250m and 500m) around residential locations identified in Rochester Epidemiology Project data was calculated. The VKT on each segment in each buffer was calculated by multiplying the traffic count on the segment by the length of the segment. The VKT were summed by buffer. Total VKT were calculated within each buffer as the sum of traffic counts on counted roadway segments and estimated traffic counts on uncounted segments. Greg Pratt will describe the traffic density calculations, which were made for year 2005 using the Hawth's Tools kernel density function in ArcGIS. The resulting raster shows the influence at any particular point of all of the traffic within a 300 meter distance of the point. Analyses To assess the crude association between traffic exposure and asthma exacerbations, we calculated the average number of asthma exacerbations per person/year within each quintile of the three traffic exposure measures. We also ran the following multivariate models to observe associations of traffic and asthma exacerbations after accounting for sex, age, and poverty index (the percentage of households within each census block group with an income‐to‐poverty ratio less than one; 2000 U.S. Census): 1. Logistic regression models, using any asthma exacerbations vs. no exacerbations as the outcome variable 2. Poisson regression models, using the number of asthma exacerbations/person/year as the outcome variable. For models using VKT as the traffic exposure measure, the log of the VKT was used to normalize the distribution. 12 Results The number of asthma exacerbations per person per year had similar distributions within adult and pediatric age categories (adult mean=0.068, pediatric mean=0.060, t‐
test p value=0.287). Female patients had slightly higher numbers of exacerbations/year (female mean=0.067, male mean=0.062, t‐test p value = 0.148). Univariate analyses of the association between traffic exposure and asthma exacerbations showed that the number of asthma exacerbations experienced per person/year increased with increasing levels of all three traffic exposure measures (traffic density, VKT traveled within 250m and within 500m buffers). In both the logistic regression and the Poisson regression multivariate analyses (accounting for sex, age, and poverty index), traffic exposure remained associated with asthma exacerbations. Poverty index was also a statistically significant predictor of asthma exacerbations. In both of the analyses, the associations between traffic and asthma exacerbations grew stronger as the defined traffic exposure boundaries became more geographically refined. In short, the odds ratios for the traffic exposure measures were stronger for the 250m buffer compared with the 500m buffer. Regression analyses of asthma exacerbations and traffic exposure, REP, 2000‐2010 Traffic Density LOG(VKT) LOG(VKT) (Kernel (250m (500m density) buffer) buffer) Odds Ratio Odds Ratio Odds Ratio (95% CI) (95% CI) (95% CI) Logistic model* 1.080 1.124 1.060 (1.059,1.101) (1.097, (1.040, 1.152) 1.081) 1.065 Poisson model** 1.073 1.125 (1.052, (1.062, 1.085) (1.108, 1.079) 1.142) *The asthma exacerbation outcome was defined as 1=any exacerbations/year, 0=no exacerbations. **The asthma exacerbation outcome was defined as number of asthma exacerbations per person/year. Variable The presentation for the Advisory Panel will present results from the REP/Traffic analyses:  REP description  Asthma exacerbation definition  Traffic exposure development  Statistical analyses/results  Future directions  Questions for the AP 13 This page intentionally left blank. 14 SectionOverview:PopulationCharacteristics
Measures of social and economic factors are important covariates for understanding the relationships between environmental hazards, exposures, and population health. Many harmful environmental exposures are distributed unequally across populations. Social and economic factors can affect whether and how much people might be exposed to lead or PM2.5; whether they have access to healthcare; whether they can buy healthful food. Poverty may force people to live in neighborhoods with high levels of lead, old pesticides, dense traffic, vermin, and crime. Low wages can limit their access to healthcare and nutritious food. For these reasons, the Tracking program has developed new Minnesota‐specific indicators using data from the U.S. Census Bureau’s Small Area Estimates Program. These indicators, grouped under the new Population Characteristics content area, include:  People in Poverty  Median Household Income  People without Health Insurance Tracking staff (with the help of a new GIS developer) will develop interactive maps of the percent of people living poverty and percent of people without health insurance in order to view side‐by‐side comparisons with other map‐able indicators. Questions for the Advisory Panel: 
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What other measures might we link to poverty or health insurance on the data portal? What other data users would be interested in the population characteristics displayed on the data portal? What other Population Characteristics indicators do you recommend pursuing? Examples include: o Housing age (from the American Community Survey) o Poverty 200% below the poverty threshold (from SAIPE data source) o Population density (U.S. Census Bureau) 15 This page intentionally left blank. 16 PopulationCharacteristics
The Tracking program has developed new Minnesota‐specific indicators using data from the U.S. Census Bureau’s Small Area Estimates Program, including the Small Area Health Insurance Estimates (SAHIE) and the Small Area Income and Poverty Estimates (SAIPE). These indicators, grouped under the new Population Characteristics content area, include: 
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People in Poverty Median Household Income People without Health Insurance (proposed measure) These new data & measures could be used by local public health, researchers, legislators, and the public to examine trends over time in poverty, income, and health insurance, as well as identify any disparities between groups of people. Tracking staff (with the help of a new GIS developer) will develop interactive maps of the percent of people living poverty and percent of people without health insurance in order to view side‐by‐side comparisons with other map‐able indicators. Possible comparisons might include: poverty and childhood lead poisoning indicators, or health insurance and emergency department (ED) visits. Next, Tracking would like to pursue potential indicators to add to the Population Characteristics content area, such as housing age or population density. Poverty estimates are available by:  Year  Age group (children <5 years, children <18 years, and all ages)  County (children <18 years, all ages) 17 Median household income estimates are available by:  Year  County Proposed Measure Health insurance estimates are available by:  Year  Age group (all ages <65 years, children <19 years)  Sex  Race/ethnicity category  County 18 SectionOverview:TrackingUpdates
These updates report progress in program areas that aren't featured in the current meeting. Panel members are invited to comment and ask questions about these reports. This section includes status reports on the following projects: 
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CDC Tracking data use projects Update on web pages Melanoma success story Joint COPD Report (copies available) 19 This page intentionally left blank. 20 TrackingUpdates
Update: CDC Tracking Network Solicits “Data Use” Project Proposals In January 2013, the CDC outlined a new strategy for the National Environmental Public Health Tracking Network to highlight and promote the use and relevance of Tracking work. The proposed approach is to focus on key environmental health priorities and demonstrate application of Tracking’s unique data, innovative informatics, and marketing capacity. To achieve this goal, existing national teams and workgroups will temporarily suspend their efforts (development of new national data and measures). Instead, Tracking grantees are being asked to submit proposals for short‐term projects that explore data presentation and impact analysis, apply innovative informatics techniques, and publicize highly relevant results or products. The intent is to generate several work products over the next year that will substantially raise awareness of the Tracking Program as a unique and valued resource. The CDC is requesting proposals from the Tracking Network grantee investigators in five broad topic areas focused on key environmental health issues (see table below). Minnesota EPHT has expressed particular interest in working on Grantee proposals in the areas of climate and weather, private drinking water, and place‐based analysis of multiple variables, though we may be asked to contribute in any of these areas. Conference calls to solicit and discuss proposals will take place in March. CDC’s decisions about which proposals will go forward is expected in April. Projects will last 9‐
12 months. Topics that CDC Identified for Data Use Projects Hazards Outcomes Air Quality 
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Birth outcomes Cardiovascular disease (CVD) Climate and Weather 
Multiple exposures and impacts Private Drinking Water 
Birth Outcomes Place‐based analysis of multiple variables 
Multiple exposures and impacts Air Quality 21 Tracking and Biomonitoring Program Website Update MDH has updated several tracking and biomonitoring web pages, including launch of the 2013 Legislative Report. To access these web pages, go to http://www.health.state.mn.us/tracking/ and link to the following in the left‐hand column: Here are the highlights:  Tracking in Action: This page provides several new success stories about how tracking and biomonitoring data are being used to inform public health action and policy.  Biomonitoring: This page provides more links to explore, including… o Framework for an Ongoing Biomonitoring Program: This page describes the vision, purpose, and strategies for an ongoing biomonitoring program in Minnesota. o Pregnancy and Newborns Exposure Study: This page describes why we are doing this study and what we will learn.  Publications and Presentations: This page includes a new section for biomonitoring reports, as well as a new 2013 report, Scope of COPD in Minnesota. We also added the 2013 Legislative Report.  Advisory Panel: This page provides an updated list of members, EHTB statutes, Panel recommendations in the 2013 report, and an updated archive of previous meeting documents. Melanoma Success Story Melanoma, the most dangerous form of skin cancer, is one of the most rapidly increasing cancers among Minnesotans. The incidence of melanoma in Minnesota has doubled since 1988 for both males and females, with a notable rise among young women (20‐49 years of age) over the last 15 years. The increases are likely the result of exposure to ultraviolet (UV) light, both natural (sunlight) and artificial (tanning beds), and better medical detection. The Centers for Disease Control and Prevention (CDC) estimate that exposure to UV light causes 65‐90% of all melanoma. Use of tanning beds continues to be common in Minnesota, especially during winter months. These circumstances provided a unique opportunity to use tracking data to inform outreach and policy to prevent melanoma and stop this alarming trend. The MN Environmental Public Health Tracking Program (MN EPHT or Tracking) published interactive maps and charts showing trends and geographic patterns of melanoma. See: Minnesota Public Health Data Access (https://apps.health.state.mn.us/mndata/); click on Cancer and then on Melanoma to see Melanoma: Basic Facts and Figures. 22 MDH’s Tracking program collaborated with state programs and other partners, including the American Cancer Society in Minnesota and the MN Cancer Alliance, to use tracking data to support program and policy initiatives to prevent melanoma. These partners identified reducing the use of artificial UV light for tanning as a key objective in Cancer Plan Minnesota: 2011‐2016. Tracking data are helping to raise awareness about this important public health issue and to evaluate the effectiveness of program and policy initiatives over time. Tracking also worked with partners to integrate state and county‐level melanoma data into the MN County Health Tables, a combined set of indicator profiles used by state and county health professionals. Incorporating melanoma data into these tables enables state and local health professionals to use melanoma data to inform their planning and assessment activities. Last, Tracking worked with our partners to issue a press release, entitled Melanoma rates on the rise in Minnesota, which led to statewide coverage on radio and television networks in the state. The press release highlighted the importance of reducing exposure both to natural UV light and tanning beds and included a link to the melanoma data and maps available at MN Public Health Data Access. This press release, a joint effort of three federally funded programs (Tracking, American Cancer Society‐MN, and MN Cancer Alliance), provides a good example of how state programs can leverage funding and work together to address an important public health issue. Tracking continues to work with the MN Cancer Alliance, American Cancer Society in MN, and other partners to identify opportunities for using data to support outreach and education initiatives on melanoma. The program is also working with the MN Cancer Surveillance System to develop and evaluate additional tracking data and measures that inform cancer prevention initiatives (such as data on colon cancer, radon, and smoking). The Scope of COPD: A Tracking and American Lung Association of Minnesota Collaboration Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, is the fifth leading cause of death in Minnesota. COPD affects an estimated 24 million adults in the US. As many as half remain undiagnosed, and few states track COPD hospitalizations. Before 2011, no national surveillance data on COPD prevalence existed. Given COPD’s public health and economic impacts, filling the COPD data gap is important for informing public health action and policy. Starting in 2010, MN EPHT developed and published state‐specific data and measures for COPD hospitalizations on its data portal, Minnesota Public Health Data Access (Chronic Obstructive Pulmonary Disease) https://apps.health.state.mn.us/mndata/copd. MN EPHT developed these data using methods consistent with those used by the CDC 23 National Tracking Network, so they can be easily adapted to use in other states and nationally. Minnesota is one of the first states to measure statewide COPD prevalence using the Minnesota Behavioral Risk Factor Surveillance System. The data provide useful information to evaluate trends and spatial patterns over time and to inform health professionals and the public about important risk factors and public health actions. In 2013, in a collaborative effort with the American Lung Association‐Minnesota, Tracking released The Scope of COPD in Minnesota (PDF: 1.9 KB/4 pages) http://www.health.state.mn.us/divs/hpcd/tracking/pubs/copdreport2013.pdf on (COPD) prevalence, mortality, hospitalizations, and emergency department visits in Minnesota. Report highlights:  In 2011, 4.1% of Minnesotans adults reported ever being told that they had COPD. That translates to over 164,000 Minnesota adults living with COPD.  Smoking is the leading cause of COPD. In 2011, over 79 percent of adults in Minnesota who have COPD reported being a current or former smoker. Over 44% of Minnesota adults with COPD do not take any daily medication for COPD, and about 35% still smoke. The American Lung Association in Minnesota is working with Tracking to use COPD data to inform and evaluate plans to prevent and treat COPD in Minnesota. This activity has started discussions with key partners regarding ways to raise awareness about this poorly recognized, costly, and underestimated public health issue, and resulted in additional media coverage of COPD in the state. 24 SectionOverview:TheEastMetroPFCBiomonitoringFollow‐UpProject:
ResultsfromSurveyDataAnalysis
The East Metro PFC Biomonitoring Follow‐up Project measured the concentration of perfluorochemicals (PFCs) in 164 East Metro residents who had participated in MDH’s 2008 pilot project. The 2010 Follow‐up Project also surveyed participants to gather more detailed information on residential and water consumption history and other possible sources of exposure to PFCs. In this presentation, staff will present preliminary results of the questionnaire data on the following:  Residential history and water consumption,  Blood donation, product use, and home garden variables,  Dietary variables Questions for panel 
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Would the panel recommend a combined variable using years of drinking unfiltered water and current tap water consumption (as a surrogate for past consumption)? Do panel members recommend additional analyses for the phase 2 analysis? How should MDH staff interpret these results for participants and the community? 25 This page intentionally left blank. 26 TheEastMetroPFCBiomonitoringFollow‐UpProject:
ResultsfromSurveyDataAnalysis
Overview The East Metro PFC Biomonitoring Follow‐up Project measured the concentration of perfluorochemicals (PFCs) in serum of 164 East Metro residents who had participated in MDH’s 2008 pilot project. The Phase 1 analysis, which is complete, measured the 2‐year change in PFC concentrations among project participants. The Phase 2 analysis is studying participant questionnaire responses to investigate sources of exposure to PFCs. The 2008 project gathered limited information on participants. The 2010 project’s questionnaire was designed to gather more detailed information on residential and water consumption history, allowing us to construct a better measure of each participant’s exposure to PFC‐contaminated water. In addition, the questionnaire asked about a range of other possible sources of exposure to PFCs reported in other studies. Methods Questionnaire data were double‐entered in MS Access, reconciled, and imported into SAS for analysis. A summary of the data collected in the questionnaire, along with descriptive statistics for product use and dietary variables, was presented at the December 2012 AP meeting. New water and residential history variables Four new variables were derived from questionnaire data. 1) Total time living at any address in Oakdale, Cottage Grove, or Lake Elmo. Participants listed all past addresses in these 3 cities and length of residence. Variable created by summing total time living at all addresses. Time living at addresses in near‐by cities (such as Woodbury, Hastings) not included. 2) Total time drinking unfiltered water at addresses in #1. For each address, participants reported how long they used unfiltered private well and city water. Variable created by summing total time drinking unfiltered city and well water at all addresses. If the response indicated that filter was used for most of the drinking water, this was considered the “start” of filtered time; conversely, if response indicated that filter was in place but not used much, the time was not considered filtered. For Oakdale city water drinkers, the end of unfiltered time was 10/30/2006, the date when municipal water supply filtration began. If self‐
reported date of intervention (city water connection, granular activated carbon (GAC) filter installation, bottled water use) did not match MDH records, the MDH date was used. 3) Type of filter used while living at 2008 address, divided into 3 groups based on likelihood of sustained, effective filtration: a) reverse osmosis (RO) or GAC filter (under sink or whole house), b) pitcher, refrigerator, or kitchen filter, or bottled water, or c) no filtration. 27 4) Tap water consumption, asked as current average cups/day from home tap. Data analysis The data analysis studied differences in PFC serum concentrations by questionnaire variables. The main outcome was PFC concentration in 2010. This was modeled as a log‐transformed continuous variable for PFOS, PFOA, and PFHxS due to the log normal distribution of the data, and as a dichotomous variable (detect v. non‐detect) for PFBA, which was detected in only 21% of participants. The other 3 PFCs measured (PFBS, PFPeA, PFHxA) were not included in this analysis as they were detected too infrequently. Differences were first assessed with two‐sample t tests, ANOVA and linear regression. Decisions were made about whether and how to model categorical variables based on distribution of the data. For the final adjusted multivariate models presented below, we assessed whether predictor variables shown to be associated with PFCs in univariate analyses were significant predictors in multivariate regression models. The final models included age (continuous), years drinking unfiltered water (continuous), blood donation (yes/no), and gender. The p‐values presented are for the F‐test for that particular term in the adjusted model. Preliminary Results Residential history and water consumption Thirty‐nine percent of participants had two different addresses in Oakdale, Lake Elmo, or Cottage Grove, 15% had three addresses, and 7% had four or more addresses. Table 1 summarizes the new continuous variables representing cumulative exposure (variables 1 & 2, above). The mean total years living in these towns was 26 (compared to 19 for length of residence at 2008 address, used in prior analyses), ranging from 6 to 66. The mean total years drinking unfiltered water was 19, ranging from 0 to 62. Histograms (Figure 1) show a wide distribution of data. In multivariate regression models adjusted for age, gender, and blood donation, all four new variables were important and significant predictors of serum levels of PFOS, PFOA, and PFHxS. Analyses using the new cumulative exposure variables showed a clear increasing trend in PFC levels with years of both residing in the community and drinking unfiltered water, though results were stronger for the latter variable. Table 2 displays adjusted geometric means (GM) by categories of these variables; the positive association was also seen in models using continuous variables, with even smaller p‐
values (data not shown). Again, total years of drinking unfiltered water was the strongest predictor. Participants who did not use any water filtration had the highest serum levels of all three PFCs, followed by those who used bottled water or pitcher/refrigerator/kitchen filters. People who used RO or GAC filters had the lowest levels. We also saw a strong 28 positive association between serum PFCs and current tap water consumption; for PFOA, people who drank 7 or more cups of water per day had levels almost twice the geometric mean than that of people who drank up to 2 cups per day. All four of these variables appear to be important predictors of PFC exposure in this community. Because they are correlated, we did not include them in the same models, which makes it difficult to distinguish the contribution of each. Blood donation, product use, and home garden variables Participants who reported donating blood in the last 2 years (n=23) had lower levels of serum PFOS, PFOA, and PFHxS compared to participants who did not report blood donation (Table 3 and Figure 2). Results were not statistically significant for PFOA. When examined by frequency of blood donation, the group who donated most frequently (more than three times/year) had markedly lower levels than the other two groups, though numbers are very small in this analysis. Results were mostly null for questions about product use and home gardens (Table 4). Participants who reported having new carpet installed in the last year had higher PFOS, PFOA, and PFHxS levels, but results were not statistically significant for PFOA and PFHxS. Conversely, participants who reported using waterproof spray had lower levels of PFOS and PFOA (both statistically significant). Levels did not differ between people who had home gardens (n=72) and those who didn’t; results for frequency of home garden produce consumption were also null (data not shown). While the questionnaire asked about frequency of consumption of fish and game caught in the East Metro, the number of positive responses was too small (n=12 for fish and n=11 for game) for a reliable analysis. Dietary variables Participants answered a series of food frequency questions about their intake of selected items over the 12 months preceding the survey. Food items analyzed were of a priori interest because of associations with serum PFCs found in previous studies (e.g., red meat, snack foods), direct measurements of PFCs in these items in market‐based studies, and hypothesized migration of PFCs from food packaging. Variables assessed included red meat, potato, milk, egg, overall fast food meal, hamburger, French fry, sandwich, pizza, microwave popcorn, snacks, and take‐out beverages. Intake was dichotomized, resulting in a low intake group and high intake group for each food variable. Unadjusted univariate analyses showed a consistent inverse relationship between dietary intake and PFC levels in the fast food meal, hamburger, and French fry categories. After adjustment for confounding factors, no significant differences between low and high intake groups were apparent for any of the food variables (a sample of results is presented in Table 5). 29 Preliminary Conclusions This Phase 2 analysis of questionnaire data allowed an improved, more refined look at participants’ exposure to PFC‐contaminated drinking water. The derived measure of total years drinking unfiltered water was the best predictor of serum PFCs among the variables representing cumulative exposure. In addition, two new water consumption‐
related variables―filter type and current tap water consumption―were also strong and important predictors of serum PFCs. That current water consumption predicts PFC serum levels so well is surprising, but given the long half‐lives of PFCs, the finding indicates that current consumption reflects past consumption patterns. Overall, these results further support our conclusion that drinking water was a major source of exposure in this community, and that the interventions to reduce this exposure were key in reducing PFC serum levels. The results regarding the markedly lower levels of serum in PFCs in people who reported donating blood are quite striking and, to our knowledge, have not been reported before. Despite our small sample size we saw a significant, consistent trend. This difference is biologically plausible in that people who donate blood are in a sense excreting PFCs, which are known to bind to proteins in the blood. For the most part, we did not see associations with the dietary and product use variables we considered. A possible association was observed with new carpet installed in the last year, and this should be investigated further. The lack of positive results is perhaps not surprising, as our sample size was too small to detect possible differences in these background exposures and, more important, exposure in much of this population was dominated by intake of contaminated water. Stratified analyses by PFC median groups were limited by the small sample size. Next Steps. Once our analysis is complete, we will report results to participants (via letter and summary of findings) and the community (via a community meeting). We will also present results to local public health officials and East Metro health care providers. In addition, we will prepare a manuscript on the entire follow‐up project for submission. This will conclude our work on the follow‐up project. 30 PFCTables&Figures
Table 1. Data distribution (n=164). Mean
Total yrs living in Oakdale/Lake Elmo/Cottage Grove
Total yrs drinking unfiltered water 26.0
19.0
Median 75th %ile 95th %ile
22.7
15.5
36.5
28.8
50.5
43.0
Min
Max
6.2
0
65.7
61.5
Table 2. Adjusted 2010 GM PFC concentrations (µg/L) by residential history & water variables (n=164)* PFOS (GM) PFOA (GM) PFHxS (GM)
Total yrs living in Oakdale/Lake Elmo/Cottage Grove
0‐15 (n=38)
16‐30 (n=66)
31+ (n=60)
p‐value
Total yrs drinking unfiltered water
0‐10 (n=50)
11‐20 (n=48)
21+ (n=66)
p‐value
Filter type
RO, GAC (whole house, under sink) (n=61)
pitcher, refrigerator, kitchen filters or bottled water (n=63)
no filters (n=40)
p‐value
Current tap water consumption
None‐2 cups/day (n=51)
3‐6 cups/day (n=68)
7+ cups/day (n=45)
p‐value
17.5
22.6
24.7
0.07
6.8
10.3
12.2
0.01
3.5
5.6
6.8
0.003
18.9
21.3
26.4
0.04
7.5
10.0
13.4
0.004
4.1
5.6
7.1
0.007
18.4
23.2
27.0
0.02
7.9
10.0
14.9
0.001
4.5
5.4
7.4
0.02
15.6
25.6
23.5
0.0003
6.2
11.7
12.0
<.0001
3.8
5.9
6.7
0.002
* adjusted for age, gender, blood donation 31 Table 3. Adjusted 2010 GM PFC concentrations (µg/L) by blood donation categories (n=162)*. PFOS (GM) PFOA (GM) PFHxS (GM)
Donated blood in last 2 years
No (n=139)
Yes (n=23)
p‐value
Blood donation frequency
Never (n=139)
1‐2/year (n=9)
3+/year (n=14)
p‐value
26.1
19.0
0.04
12.1
8.7
0.08
7.0
4.5
0.02
26.0
28.6
14.7
0.01
12.1
11.8
7.2
0.08
6.9
7.0
3.3
0.01
* adjusted for age, gender, total years drinking unfiltered water 32 Table 4. Adjusted 2010 GM PFC concentrations (µg/L) by product use and home garden variables (n=162)*. Carpet treated pre‐2002
No (n=122)
Yes (n=40)
p‐value
Furniture treated pre‐2002
No (n=129)
Yes (n=33)
p‐value
Carpet cleaned in last year
No (n=141)
Yes (n=21)
p‐value
New carpet in last year
No (n=139)
Yes (n=23)
p‐value
Used waterproof spray in last year
No (n=132)
Yes (n=30)
p‐value
How often use non‐stick cookware
Never, occasionally (n=54)
Often, always (n=108)
p‐value
Have home garden
No (n=90)
Yes (n=72)
p‐value
PFOS (GM)
PFOA (GM)
PFHxS (GM)
22.2
22.6
0.9
10.3
10.0
0.8
5.5
6.0
0.6
22.8
20.0
0.3
10.2
10.6
0.8
5.6
5.3
0.7
22.2
23.5
0.7
10.4
9.1
0.5
5.6
5.1
0.7
21.5
29.0
0.05
9.9
13.5
0.10
5.4
7.5
0.08
23.6
17.6
0.03
10.9
7.9
0.05
5.8
4.6
0.2
20.1
23.4
0.2
9.2
10.9
0.2
4.9
5.9
0.2
22.4
22.2
0.9
10.6
9.8
0.6
5.6
5.5
0.9
* adjusted for age, gender, total years drinking unfiltered water, blood donation 33 Table 5. Adjusted 2010 GM PFC concentrations (µg/L) by food intake groups (n=162)*. Fast food meal
< 1/wk (n= 99)
≥ 1/wk (n= 63)
p‐value
Microwave popcorn
< 1/month (n= 107)
≥ 1/month (n= 55)
p‐value
Snacks
< 1/wk (n= 71)
≥ 1/wk (n= 91)
p‐value
Red meat
< 1/wk (n= 31)
≥ 1/wk (n= 131)
p‐value
Potato
< 1/wk (n= 49)
≥ 1/wk (n= 112)
p‐value
Milk
< 1/wk (n= 52)
≥ 1/wk (n= 110)
p‐value
PFOS (GM)
PFOA (GM)
PFHxS (GM)
26.2
23.2
0.2903
11.9
11.1
0.5951
7.0
5.9
0.2604
24.9
24.9
0.997
11.2
12.3
0.4816
6.7
6.2
0.5695
22.4
27.1
0.083
10.8
12.2
0.3496
6.2
6.8
0.4322
25.7
24.8
0.7825
12.0
11.5
0.7959
7.1
6.4
0.5263
26.6
24.2
0.4317
11.3
11.7
0.8302
7.2
6.3
0.359
22.3
26.3
0.1554
11.0
11.9
0.5848
6.0
6.8
0.3799
* adjusted for age, gender, total years drinking unfiltered water, blood donation 34 Figure 1. Histograms (n=164) Figure 2. 2010 PFC serum concentrations by blood donation category (n=162)* * adjusted for age, gender, total years drinking unfiltered water 35 This page intentionally left blank. 36 SectionOverview:BiomonitoringUpdates
These updates are for information only. Panel members are invited to ask questions about these projects. Updates  Pregnancy and Newborns Exposure Study  Fond du Lac Community Biomonitoring Study 37 This page intentionally left blank, 38 Update: Pregnancy and Exposure Study (UM‐TIDES Collaboration) The Newborns and Pregnancy Exposure follow‐up study with UM TIDES investigator, Ruby Nguyen, is on track. This study will compare mercury levels found in paired newborn cord blood and heel stick spots for aiding in the interpretation of the blood spot results. Recruitment from TIDES study participants and specimen collection is complete. A total of 49 matched pairs of infant cord blood‐spot specimens were collected by hospital staff and transferred to the MDH lab for analysis, with the final transfer on January 10, 2013. In mid‐February, MDH PHL chemist Betsy Edhlund completed the analysis of the cord blood specimens for total mercury, lead, and cadmium levels and sent results to EHTB‐CDEE. Only one specimen exceeded the action level for mercury, and no specimens exceeded the action level for lead. Staff are preparing individual results letters for UM‐TIDES study staff who will mail them to the participants in accordance with study protocol. EHTB physician consultant, Mary Winnett, MD, is available for participants who request individual medical consultation. Next steps will be analyses for speciated mercury in cord blood and total mercury in the blood spots. Updated information about this and other EHTB mercury projects can be found at: http://www.health.state.mn.us/biomonitoring Fond du Lac Community Biomonitoring Study (Great Lakes Restoration Initiative, GLRI) The Fond du Lac study is underway. Staff mailed study invitation letters to the first batch of potential participants in December 2012, and recruitment and enrollment will continue for about 10 months. So far, the outreach campaign in the community has been very successful. The number of “hard to contact” people is lower than expected, partly because people’s cell phone numbers have remained the same when they changed residence. In addition, “hard refusals” have been relatively few because community members are very interested in the project. As of February 15 of this year, 55 participants had enrolled in the study. The goal is 500 participants by September 30, 2013. All blood draws to date have been successful, laboratory analysis has begun, and some results are available. Challenges to date have been relatively small and reparable. Minor coding problems found in the participant tracking database and interview tool are being resolved by the MDH Data Systems Manager and a Database Designer/Applications Developer at FDL. Given that the project has a small number of laboratory and study staff, only 18 appointment slots have been available to study participants each week. But FDL staff are working to raise the weekly number of appointment slots to 21 and to find ways to limit appointment no‐shows and cancellations. 39 This page intentionally left blank. 40 SectionOverview:MinnesotaNationalChildren’sStudyNewborn
MercuryProjectProposal
In response to findings that 10% of the newborns tested in MDH’s Mercury in Newborns in the Lake Superior Basin1 study had blood mercury levels that might harm cognitive development, the EHTB Advisory Panel recommended looking at mercury in newborns in other regions of Minnesota. The goal of this recommendation is to learn whether babies in other areas of the state are being exposed to potentially harmful mercury levels during prenatal development. In the project proposed here, MDH’s EHTB Program would obtain matched cord blood, cord blood spot, maternal blood, and newborn blood spot samples that were collected from participants in the former National Children’s Study (NCS ) South Dakota State University Vanguard pilot study. Samples will be transferred to the MDH Public Health Laboratory, where all samples will be analyzed for total mercury and cord blood will also be analyzed for speciated mercury, lead, and cadmium. The proposed project would address two questions addressed in Advisory Panel recommendations: 1. Because the lab method used in the Mercury in Newborns study is novel, do mercury levels in newborn blood spots accurately reflect those in more common measures of prenatal exposure to mercury, including cord blood, the basis for the EPA reference dose? 2. Is the observation that 10% of newborns tested were exposed to potentially harmful levels of mercury unique to babies in the Lake Superior or are these exposures also occurring in other parts of Minnesota? Information item Panel members are invited to ask questions and comment on the proposed study protocol. 1
Mercury in Newborns in the Lake Superior Basin, conducted by MDH’s Fish Consumption Advisory Program and funded by the Environmental Protection Agency (EPA), with additional support from MDH’s Environmental Health Tracking and Biomonitoring (EHTB) Program. 41 This page intentionally left blank.
42 Proposal:MinnesotaNationalChildren’sStudyNewbornMercuryProject
Proposal from: Jean Johnson, PhD, Program Director and Jessica Nelson, PhD, Program Coordinator, Environmental Health Tracking and Biomonitoring Program, MN Dept. of Health; Betsy Edhlund, PhD, Chemist, Public Health Laboratory, MN Dept. of Health; Pat McGovern, Professor, Division of Environmental Health Sciences, University of MN, 2/15/13 Background The Minnesota Department of Health’s (MDH) Mercury in Newborns in the Lake Superior Basin pilot study measured total mercury in residual newborn blood spots collected from infants born in the U.S. Lake Superior Basin (2008‐2010). The project was conducted by MDH’s Fish Consumption Advisory Program 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 cord blood corresponding to the EPA reference dose for methylmercury. This pilot study raised important public health questions: 1. Given the novel use of newborn blood spots to measure total mercury,, do the observed mercury levels accurately reflect those in more commonly used measures of prenatal exposure to mercury, such as cord blood, on which the EPA reference dose is based? 2. Is the observation that 10% of newborns tested were exposed to potentially harmful levels of mercury unique to babies in Minnesota’s Lake Superior region, or are these exposures occurring elsewhere in Minnesota? In response to the pilot study’s findings and the questions raised, the EHTB Advisory Panel recommended that MDH work to address these questions. MDH proposes to do so using samples collected from National Children’s Study participants enrolled through South Dakota State University’s former Vanguard study center which was located in Brookings. Specific aims and rationale 1. Assess the comparability of different measures of prenatal exposure to mercury. Different types of biological specimens can be used to measure an infant’s exposure to mercury; these include maternal blood collected during pregnancy, cord blood collected at birth, and newborn blood spots collected soon after birth. While interest in newborn blood spot biomonitoring is growing, the lab method is still relatively new and the relationship between mercury levels in the newborn blood spot and those in both cord blood and maternal blood is unknown. Comparing mercury levels in these different biospecimens from the same mother‐baby pairs 43 will help answer important questions for future studies and public health surveillance efforts. The cord blood‐to‐newborn blood spot comparison, for example, will aid in the interpretation of blood spot results using comparisons to the EPA reference dose. A concurrent MDH study, the Pregnancy and Newborns Exposure Study, is measuring mercury in paired cord and blood spot samples from 50 women receiving care at an urban Minneapolis clinic. The addition of the NCS samples will increase the sample size for this analysis. 2. Compare paired whole cord blood and cord blood spot mercury levels. Given the use of a novel lab method for measuring mercury in blood spots, it is important to determine whether the levels measured in the blood spot accurately reflect those in the original blood sample, i.e., to verify that the process of spotting the blood onto filter paper and extracting the sample does not introduce error into the measurement. This procedure will provide important evidence to validate the use of blood spots as a surrogate for whole blood measurements. As whole blood samples from a newborn are not available to compare against the newborn blood spots, analyzing paired whole cord blood‐cord blood spot samples will serve as a good substitute. 3. Explore the extent of newborn exposure to mercury in Minnesota. Results from this proposed project will help MDH determine whether the elevated levels of newborn mercury exposure in the Lake Superior basin are applicable to other parts of the state. SDSU NCS participants differ from the Lake Superior project population in geography and risk factors for mercury exposure; they are a rural population in a part of the state not known for extensive local fishing. Moreover, because the MDH Pregnancy and Newborns Exposure Study is also measuring lead and cadmium in cord blood, the SDSU NCS samples will serve as a comparison population. Methods MDH’s EHTB Program proposes to obtain matched cord blood, cord blood spot, maternal blood, and newborn blood spot samples that were collected from participants in the former SDSU NCS Vanguard study. Samples will be transferred to the MDH Public Health Laboratory, where all samples will be analyzed for total mercury and cord blood will also be analyzed for speciated mercury, lead, and cadmium. MDH’s data analysis re: specific aims 1 and 2 will compare results for each maternal blood‐cord blood‐newborn blood spot group. We will calculate an average ratio for each and examine the full distribution of the relationships. We will do the same for the whole cord blood‐cord blood spot pairs. We will also document the methylmercury and inorganic mercury content for the cord blood samples. We may combine the cord blood‐newborn blood spot results with those from the Pregnancy and Newborns Exposure Study to increase the sample size. MDH’s data analysis re: specific aim 3 will summarize the distribution of mercury levels in the newborn bloodspots, including the geometric mean, median, and upper percentiles, and the portion of samples higher than 5.8 μg/L. We will compare these 44 results to the Lake Superior project findings, which are currently the only publicly available data on mercury levels in blood spots, and to findings from two concurrent MDH projects (the Pregnancy and Newborns Exposure, and Riverside Newborn Mercury studies) both measuring mercury in blood spots from an urban Minneapolis population of mixed incomes. In addition, we will compare lead and cadmium levels in cord blood to results from the Pregnancy and Newborns Exposure Study. 45 This page intentionally left blank. 46 SectionOverview:OtherInformation
This section contains documents that may be of interest to panel members. 
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2013 Upcoming Advisory Panel Meeting dates December 2012 Advisory Panel Meeting Summary Advisory Panel Roster Biographical Sketches of Advisory Panel Members Biographical Sketches of Staff Environmental Health Tracking and Biomonitoring Legislation 47 This page intentionally left blank. 48 2013AdvisoryPanelMeetings
Tuesday, Mar 12 1–4 pm The March meeting will take place at: The American Lung Association of Minnesota 490 Concordia Avenue St. Paul, Minnesota The June Meeting will take place on 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 49 This page intentionally left blank.
50 Summary:December11,2012AdvisoryPanelMeeting
Advisory Panel members: Fred Anderson, Alan Bender, Melanie Ferris, Lisa Heins‐
Nesvold, Geary Olsen, Patricia McGovern, Gregory Pratt, Cathy Villas‐Horns, Lisa Yost Steering Committee members attending: Joanne Bartkus, Aggie Leitheiser, Mary Manning. Other attendees: MDH: Blair Sevcik, Jim Kelly, Betsy Edhlund, Jeannette Sample, Jessica Nelson, Jean Johnson, Mary Jeanne Levitt, Dianna Roerig; MDA: Joe Zachman, Joe Spitzmueller; MCEA: Allison Wolf. Welcome and Introductions Pat McGovern, chair pro tem, welcomed panel members and attendees and invited them to introduce themselves and called attention to a designated time slot for audience members to ask questions or comment on the topics, presentations, or discussions. Legislative Update Assistant Commissioner Aggie Leitheiser reported that the legislature would convene on January 8 and the Governor’s budget would be released around 22 January. In the meantime, she has been attending meetings of the Environmental Quality Board (EQB)2, which is gathering comments and ideas from people around the state.3 In Bloomington, 400 people came to the meeting, and we had expected only 200. People met in small discussion groups and stayed after the meeting. Health comes up as an issue in these meetings, she said, and particularly the relationship between health and environment. The public has a lot of interest in these issues, including interest in how we find out and track them. The EHTB program fits well with that interest. The next large meeting will take place in March. Pat McGovern asked about themes in the EQB meetings. Aggie replied that she had been to only two meetings, one in a rural area and one in the city. Many city people expressed interest in wolves and the wolf hunt. In rural districts, people were concerned about exports to market, preserving habitat, and in population growth, including encouraging people to live where other people live, so as to preserve farmland. Report to the Legislature 2
The EQB comprises the Governor’s Office (as chair), five citizens, and commissioners from nine state agencies. 3
To see the 2012 EQB Report, Minnesota Environment and Energy Report Card, copy or click on http://www.eqb.state.mn.us/documents/EQB%20Final%202012%20Report%20Card.pdf 51 Barbara Murdock summarized MDH’s rigorous internal process for reviewing and accepting the report to the legislature. She noted that the general instructions for developing the report state that MDH staff may not give or circulate the report to the legislature or to any legislators. The report is to go to the legislative library, where legislative staff can find it and use it. Stakeholders outside of the legislature also read the report. [Note: as it turns out, the 2007 legislation that established the EHTB program requires MDH to distribute the Report to the Legislature to the chairs and ranking members of the environment and health committees in both legislative chambers. We have done this.] Discussion Alan Bender asked what the response to the legislative reports had been in the past? Do legislators read it to your knowledge? Jean said that we haven’t received feedback on a report to the legislature in the past. Aggie added, “We think staff on committees and external organizations may be interested and seek it out to read it.” Chuck Stroebel said that the final PDF of the report would be circulated via our Gov Delivery list, which includes a number of legislators and their staff. East Metro PFC Biomonitoring Follow up: Phase 2 questionnaire analysis Jessica Nelson reported on preliminary data from the Phase 2 analysis of questionnaire data from the East Metro PFC Biomonitoring Follow‐up Project. The Phase 1 analysis measured the 2‐year change in PFC concentrations in blood samples from 164 project participants who had agreed to be contacted again. The analysis found that blood PFC levels in most study participants had declined between 2008 and 2010, demonstrating that removing PFCs from drinking water sources reduced exposure among exposed East Metro residents. Phase 2 was designed to learn more about other sources of PFC exposure, such as work or foods, in the East Metro residents. This presentation was the first of two, the second to be presented in March. The questionnaire requested data on the following:  Water consumption o type of filter, when installed o average cups of tap water per day  Residential history: all addresses in Oakdale, Lake Elmo, Cottage Grove o length of residence o type of water (city/well) o use of unfiltered water  Employment o current status o current employer o ever worked at 3M o past PFC‐related jobs  Diet o home garden: yes/no, how often consumed vegetables, type of vegetable o frequency of food consumption: red meat, eggs, potatoes, fast food meal, hamburger, French fries, sandwich, pizza, microwave popcorn, 52 
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snacks, milk, soft drinks in bottle/can, soft drinks in take‐out cup, coffee in take‐out cup, East Metro fish, East Metro game Product use o carpet and furniture stain‐resistance treatment (within the last year, before 2002) o carpet cleaning within the last year o new carpet last year o new furniture last year o non‐stick cookware use frequency o waterproofing spray last year Health history o height/weight o donated blood last 2 years, frequency o surgeries, blood transfusion, dialysis, pregnant, breastfeeding last 2 years Jessica presented the data distribution of a number of questionnaire variables: Demographics Because the original study had focused on recruiting longer‐term residents, most participants were older (average age 55.8; average length of residence 18.9 years). Forty five percent were men, and 55% were women. Most (65%) were employed, 27% were retired, 4% were homemakers, and 4% were not currently working. Occupational exposure Jobs that might involve exposure to PFCs range from working in fast food stores to printing services, firefighting, or photo processing, to Scotch Guard manufacture. Most (15%) participants who reported one of these jobs had worked in fast food shops, 7% in printing services, 5% in janitorial jobs; and 3% in firefighting. Two percent worked in chemical manufacture, 2% in food packaging, and 2% in electronics manufacture. Very few respondents (1% in each category) worked in other jobs, such as Scotch Guard or Teflon manufacture, airport maintenance, or dry cleaning. Other potential sources of exposure Survey questions also explored whether participants had home gardens (44% did) and ate the produce frequently (32% ate it 2‐4 times/ week, 14% 5‐6 times/week). Only 7 % ate locally caught fish or game. Only 18 participants (11%) never drank the local tap water. Most other participants drank between 1‐2 cups/day (20%) and 7‐8 cups/day (15%); a few drank as many as 10+ cups/day (9%). Other questions assessed the frequency of eating foods (red meat, eggs, potatoes, milk), fast foods (hamburgers, French fries, sandwiches, and pizza), and snack foods (microwave popcorn, snacks, soda in a can or in a cup, and coffee in a cup). Participants were asked about product uses that 53 might involve PFCs: carpet and furniture treatments, carpet cleaning, new carpets or furniture, waterproof spray use, and use of non‐stick cookware. Finally, participants were asked about blood donation and frequency, surgeries, blood transfusions, pregnancies, or breast‐feeding in the last two years. Jessica outlined her analysis plan and asked panel members for comments. The purpose of the questionnaire data analysis is to learn more about predictors of PFC exposure in East Metro residents. The analysis will study differences in the participants’ PFC blood levels measured in 2010 and compare them with the possible sources listed above. In one sub‐analysis, she plans to look at the relationships separately for the participants who had higher PFC concentrations in 2008 (those who likely had significant drinking water exposures) and the participants who had lower 2008 concentrations (those who were closer to background population exposures). A second sub‐analysis will look only at the participants whose PFC levels did not decline from 2008 to 2010. All analyses will consider age, gender, and length of residence. The results of the analysis will be reported in the March meeting. Discussion Lisa commented that, from a public health perspective, it seems as though the analysis should focus on people with levels that are still elevated. Pat McGovern suggested including a discussion about which foods may be confounders to provide a physiological background for including those questions in the analysis. Update on C8 Science Panel findings Jessica briefly reviewed the C8 probable link reports issued by the C8 Science Panel in October 2012. Because of concerns about PFCs among East Metro residents, MDH often gets media inquiries when the C8 science panel releases probable link reports. The C8 Science Panel research program gathered and assessed “information on health status and C8 exposure in Mid‐Ohio Valley communities potentially affected by the releases of C8 (PFOA) from the Washington Works plant in Parkersburg, West Virginia. The Science Panel consists of three epidemiologists who were chosen jointly by the parties to the legal settlement of a case between plaintiffs and DuPont regarding releases of C8 from the plant.”4 The definition of “probable link” is a legal definition, rather than a scientific definition. “A ‘probable link’ in this setting is defined in the Settlement Agreement to mean that given the available scientific evidence, it is more likely than not that among class members a connection exists between PFOA exposure and a particular human disease.”5 4
5
http://www.c8sciencepanel.org/ http://www.c8sciencepanel.org/pdfs/Probable_Link_C8_Kidney_29Oct2012.pdf 54 All probable link reports have now been released, Jessica said. There were six positive findings. Positive Probable Link reports 1) Diagnosed high cholesterol 2) Ulcerative colitis 3) Thyroid disease 4) Testicular and kidney cancer 5) Preeclampsia 6) Pregnancy 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)  19/21 cancers considered: bladder, brain, breast, cervical, colorectal, esophagus, leukemia, liver, lung, lymphoma, melanoma, oral (including larynx/pharynx), ovarian, pancreatic, prostate, soft tissue, stomach, thyroid, uterine  Type II diabetes  birth defects  miscarriage  stillbirth  preterm birth  low birth weight Now that the C8 Science Panel has finished its work, a new panel – the C8 Medical Panel – will determine whether and how medical monitoring should be done in the community for the six “probable link” conditions. At the same time, personal injury lawsuits can now begin. 55 Jessica said that MDH does not plan to change its medical recommendations to the East Metro community, which are simply to continue routine checkups. She then asked whether the panel had any advice on how to present C8 findings to the community, given that MDH cannot carry out a full review and critique of the PFC literature. Discussion Lisa urged staff to distinguish the C8 kind of analysis from what is done in standard science and epidemiology. In the C8 case, you have people who are plaintiffs, and data analysis of [legal] evidence is very different from a scientific analysis. Alan commented that the judge used a different criterion – a legal criterion – to judge the case. He stressed that MDH needs Executive Office approval to decide what the probable link reports mean. We should work on deciding what this information means in Minnesota and approach the legislature with this message with executive office support. It is important to help policy makers understand the difference between a scientific approach and the legal approach. He also stressed the need for a communication strategy for the public and for medical providers. Pat McGovern noted that the communication strategy for healthcare providers will be important, especially since participants may want to go to an individual physician to assess their cholesterol after reading about these findings. Jessica said that Dr. Mary Winnett has served as consulting physician during this project. Jean Johnson asked panel for their suggestions on ways to target these physicians. She commented that staff have done lunch sessions with limited success. Alan suggested that MDH might offer certification and continuing medical education credits (CME). Jill Heins‐Nesvold said that, in working with the MDH asthma program we learned that the time of year and the person who invites the physicians can determine the response rate. The ALA is having success with a peer‐to‐peer relationship with a staff member who is a physician. The ALA typically gets no response in the summer and generally gets a much better response in October and November, but not during flu season. She also recommended translating C8 and PFOA into easy to understand language like that used in Wikipedia’s explanation of PFCs in layman’s English. She agreed with Alan that some kinds of seminars can be part of continuing medical education. Melanie suggested midwives as a good potential target group. Pat suggested that staff work with health plans on mailings because they can help with contacting physicians in Metro area subgroups. She also suggested contacting organizations for such specialties as family medicine and internal medicine. Geary Olsen followed up on the statement on page 9 of the Advisory Panel background book for the December 2012 meeting that “MDH will not be conducting a formal epidemiologic review of the findings,” and that the update will only “be a summary of what the C8 Science Panel found.” Noting that the C8 reports are five to 10 page documents, he asked, “How many people have read them?” He commented that the C8 panel seems to base their probable link statement only on their own data, rather than 56 using the comprehensive literature, including toxicological data. He pointed out, for example, that the thyroid disease probable link is based on hyperthyroidism in females and hypothyroidism in males. He said that this seems to be conflicting evidence, given that 80% of hypothyroidism occurs in women. He recommended that MDH should review the epidemiologic findings or do a formal review in order to comment on these findings, at least on the inconsistencies in the reports. “Is MDH just going to release a summary of six positive findings with no comment (as inferred by page 9 of today’s Question for the Advisory Panel)?” he asked. Jessica added that much of the data used in the C8 probable link reports isn’t even public or available. But she added that MDH staff do not plan to do a literature review, saying that, if staff start to compare the findings to the literature, it makes it appear that they have assessed the literature. Although MDH cannot take on the role of an expert review panel, Alan argued, a distinction exists between providing commentary on C8 findings and having MDH conduct a formal review. What MDH can do, he said, is provide commentary on the conflicts we see in the findings. Lisa agreed, saying that it’s important to show the epidemiologic approach, explain the typical scientific method, and make it clear that C8 is using a different context, a legal context, which is not as rigorous as what scientists would do. If there is a lack of consensus, she added, point that out and explain how scientists do science. Then you could explain the problems with the probable link method. Alan concurred, saying that MDH might not comment on whether the conclusions are correct, for example, but could comment on the methods and study design. He added that a known conflict exists between their list of probable links and the information in the literature. Geary supported the idea that MDH should comment on the process and context, saying that the C8 panel is only three scientists, not a peer review committee. Much of the data presented by the C8 Science Panel has not been published yet. He added that he would be concerned about the approach of presenting a summary of C8 findings with no comment from MDH. But Alan said that MDH can present the findings and list the agency’s concerns. Pat recommended that MDH staff may also want to add talking points on what MDH recommends for the community. What are the standard medical recommendations for the health outcomes listed in the positive probable link reports? Point out that MDH does not recommend doing anything other than what MDH thinks are standard medical recommendations for these health outcomes, so people will know the appropriate action to take. Home and Garden PFC Study – Jim Kelly, Environmental Health Division The East Metro Perfluorochemicals in Home and Garden Study goal was to learn whether PFC‐contaminated groundwater used for garden and lawn watering could contaminate soil and/or home‐grown produce or be tracked into the house on people’s shoes. The study measured PFCs in soil, household dust, and in vegetables grown on 20 57 properties in the three East Metro communities and on three control properties. The study was done in response to questions that came up at meetings with the East Metro community: could home‐grown produce, soil, or household dust be other routes of exposure to PFCs in the East Metro? Soilresults In general, gardens had low PFC levels in the soil. In the control sites, the study found PFCs in almost all samples, but the levels were much lower than in the study area. These chemicals are ubiquitous, but MDH found no direct health implications for residents. The levels seen were thousands of times lower than a level of health concern. The PFCs that bioaccumulate in people were found less frequently than others. The study found PFBA in most water samples, but very low levels in the soil. Produce samples The study detected PFCs in 98% of produce in the study gardens, but the levels were very low and typically PFBA, rather than the bioaccumulators, PFOA & PFOS. Jim listed the five highest produce categories: beans/peas, herbs, peppers, tomatoes, and broccoli/cauliflower. In summing up, he said, PFCs seem to be ubiquitous in the East Metro area in well and city water, soil, and produce, but at low to very low levels. The conclusion is that growing and consuming one’s own produce is not a health concern for the study area. MDH’s advice for the community is that no one needs to limit home gardening and eating homegrown food. We plan to join the EHTB program and meet with the community later in the year. Discussion Greg asked, when was the monitoring done? Jim replied that samples were collected during the summer of 2010, which was a wet summer, so gardeners may not have water as often as they had to do in 2012, which was dry. Greg asked whether Jim had any conclusions about exposure to different parts of the produce. And Lisa asked whether the produce was analyzed as it is typically eaten. That is, for example, were the cucumbers peeled? Jim answered that the study didn’t look at PFC levels in different parts of the produce, such as the vine, stem, or flesh of a tomato, but the produce was tested as it is typically prepared. Jill said that she noticed that the spring harvest was low in PFCs and that the lowest PFC levels were in the root vegetables and asked about PFC levels in produce in the hottest season. The uptake of PFCs is unclear; produce grown in the hottest season did not contain more PFCs than produce grown in the spring. Cathy Villas‐Horns commented that she was pleased to see the study done because of widespread community concerns about garden contamination. 58 Biomonitoring Updates Jean Johnson gave a brief update on a new project, the Riverside Newborn Mercury Project and an update on the Pregnancy and Newborns Exposure Study, a University of Minnesota collaboration. The Riverside Newborn Mercury Project, a proposed collaboration with Logan Spector at the University of Minnesota, will analyze total mercury in banked newborn blood spots collected from participants in the UMN Riverside Birth Study. The results will be compared with results from the Pregnancy and Newborns Exposure Study, part of the University of Minnesota’s TIDES study. If the results are similar, they could be combined to increase the sample size because both studies are looking at the same population. In addition, the mercury results and questionnaire data will be used to assess prenatal mercury exposure and to discern any seasonal pattern to mercury results. These studies are an important first step to exploring newborn mercury exposures outside of the Lake Superior Basin. Jean also reported that the Pregnancy and Newborns Exposure Study had 40 matched cord and newborn spots pairs to date and that 10 remaining mothers would soon give birth. Jim Kelly’s brief update on the Fond du Lac project reported that the project is finally getting underway. Staff are starting to enroll participants. The Great Lakes Sawtooth Clinic Study is just beginning, as a follow‐up study to the Mercury in Newborns in the Lake Superior Basin study. The project received its funding just a month ago and will be testing the effectiveness of interventions to prevent mercury exposure in women of childbearing age before they become pregnant. Staff will develop a survey instrument and then develop fish consumption advice to reduce mercury levels in this population of women of childbearing age. Tracking Updates Chuck Stroebel highlighted the recent CDC strategic planning meeting of the CDC Tracking Network that Jean and Chuck attended. CDC’s Tracking Network is facing a possible $7 million cut and is still operating under a continuing resolution. In addition, sequestration could severely affect federal funding. The discussion revolved around identifying where tracking should focus its efforts over the next six months. What are the unique strengths of our tracking program? What do we do and how do we make a difference? The ideas under discussion included having tracking states provide health outcome data at a finer level – below the county level – to make the data more relevant to communities and, perhaps, to address environmental justice and vulnerable communities. The tracking programs also do custom data analyses in communities on a case by case basis. Data linkage projects could analyze data to better understand relationships between health and environmental data and demonstrate that that tracking is looking at ways to use the data across agencies. Communicating EPHT’s mission and success more effectively was another important concern, one that could partly be addressed with tracking success stories. 59 In an update for MN EPHT, Chuck described several new content areas: 1) Heat related illness data identifies important vulnerable groups and confirms the public health importance of severe heat events. 2) Interactive maps for melanoma and non‐Hodgkin’s lymphoma allow users to see and compare cancer incidence maps side‐by‐side. Geographic trends in incidence highlight the differences in melanoma rates between the two sexes. These maps were developed in collaboration with MDH’s Minnesota Cancer Surveillance System, the Minnesota Cancer Alliance, and the American Cancer Society.  The new interactive melanoma map can be used to inform policy, particularly with respect to the use of tanning booths.  Melanoma has increased nearly twofold since 1988, and MDH is trying to identify strategies to reduce UV exposure. Greg asked if Chuck could give some perspective on CDC’s tracking budget in the context of the president’s budget. What would that mean at both the federal and state program levels? Chuck said that would mean $7 million out of tracking’s $36 million budget. The cut may trickle down to cut funding across all grantees, or the CDC may cut some of the grantees. The funding decisions may be clear by the March meeting. Alan added that the Minnesota EPHT has provided a very useful interface for data access, but has been hit hard by staffing losses. Chuck also asked the panel for feedback and for suggestions for success stories on ways in which tracking data are being used. A Minnesota Biomonitoring Summit Jean outlined an idea for a Minnesota biomonitoring summit that could be held during the legislative session to highlight the program’s achievements. The rationale, she explained, is that the state funding for biomonitoring and tracking will end on June 30, 2013. She asked, in the last six months of our state support, what can we do to draw attention to our work and our recommendations in the legislative report? She presented a suggestion for a biomonitoring summit and asked the panel for ideas and support in reaching local and state public health officials, legislators, NGOs, academics, and business interests. Discussion The panel addressed range of topics from scheduling, to stakeholders, to whether the summit should be aimed at scientists or at stakeholders, citizens, and advocacy groups. Pat asked whether the advisory panel members could recommend adding any people to the list of stakeholders. Who has an interest in using these data? Who in the list of participants would value this information? She suggested adding the Academic Health Center, including public health, medicine, and nursing. Both faculty and students would welcome this opportunity. 60 Greg argued that the summit should have a strong science basis and an attractive keynote speaker. Lisa commented that other states might consider joining the summit via web access if it featured big name speakers, such as Lisa Aylward or Sean Hayes. Pat suggested involving the NIEHS’s Children’s Environmental Health Centers and the specific exposures they study. She also suggested the science and policy program at the Humphrey Institute at the University of Minnesota, and CTSI,6 an organization that works on translation of research into action, such as building infrastructure for translational research. Geary suggested contacting the environmental epidemiology community, including pharmacokinetics experts. He suggested 2 speakers for environmental pharmacokinetics – hard science speakers Matt Longnecker and Harvey Poole. Lisa suggested that the speaker could be a webinar guest star if the budget restricted travel. Pat suggested that the Summit could have concurrent conference sessions to appeal to a diverse audience, such as pharmacokinetics and health policy sessions. Geary pointed out that people attending sessions outside their expertise could encounter difficulties – it would be necessary to figure out how to translate science into policy. Jill Heins‐Nesvold asked whether Jean was proposing a half day or a full day seminar, and Jean said a half day. Fred Anderson commented that holding a half day summit requires a local geography and limits the scope of the audience. He suggested that MDH may want to invite or market to business partners, the media, and science editors to get the story out. Jill asked, is advocacy support one purpose? Jean said yes, she was hoping to hold the summit during the legislative session so that people could talk to their legislators, especially if the legislators have a proposed motion on the floor. Jill noted that state and local public health staff cannot advocate. Instead, we need stakeholders, real advocacy folks, not hard scientists, because they will not motivate people to take action. So we are talking about two different audiences and two different summits. We can’t do both. NGOs and public or business partners will have to advocate for the EHTB program, but those people will not attend if the summit is too scientific. She said that the keynote speaker should be a motivational speaker to get advocates to attend. Pat asked Jean about the intended audience that she would like to attend the summit. Jean said that she would like to hold a stakeholder Summit, but that she would love to do a scientific summit as well. Jill suggested designing a webinar series, in that case, to tailor the message to these two very different audiences. Geary suggested involving the Northland Society of Toxicology meeting as a useful vehicle for our message and advised EHTB to make sure that some biomonitoring reports would be visible to visitors on the MN EPHT website. 6
Clinical & Translational Science Institute 61 Following up on his last suggestion, Geary said that visitors should be able to get information about biomonitoring on the website, as a way to get people interested in the program. But, he said, the biomonitoring information is hard to find. He has had trouble finding full biomonitoring reports online. Jean explained that the website has only three technical reports on biomonitoring, and the rest are community briefs. Geary said he could not find the technical reports, and Jean replied that we would make them more prominent. MDH/MDA meeting on pesticides and health In response to an Advisory Panel request for MDH to meet with the Minnesota Department of Agriculture (MDA) to discuss biomonitoring and health tracking, Cathy Villas‐Horns scheduled an early December meeting among MDA staff, MDH Environmental Health staff, and MDH EHTB staff. At the Advisory Panel meeting, she reported that 13 people from MDA and MDH had met for two hours in a round robin format, sharing information on their current projects and concerns. The topics included: 1) What are agencies hearing about community concerns? MDH and MDA hear about occupational exposures, pesticide drift, birth defects in animals, parental concerns about pesticide application on lawns and playgrounds, and pesticides in water. MDA routinely follows up on complaints about agricultural chemicals. Fifteen percent of the 2012 complaints were about alleged human injuries (eyes, skin, respiratory), strong odors from pesticides, and conditions that were too windy for application of insecticides and fungicides. MDA has more complaints about air applications (planes and helicopters), especially in the urban/rural interface. MDA does a lot outreach, works with growers to help them use best management practices (BMPs), and to reduce the overuse of pesticides and the use of the wrong pesticides. 2) What are the past/current/future biomonitoring projects in Minnesota? Neither MDH nor MDA conduct biomonitoring for current‐use pesticides, and both agencies collaborate on the feasibility of developing nationally consistent data measures for public health tracking. Because the MDA is not the primary agency for evaluation of pesticide health impacts, the agency turns to MDH for advice on any pesticide exposure health concerns. In the Tracking program, MDH is working on arsenic in drinking water and on national and Minnesota Poison Control Center (PCC) pesticide tracking indicators. The CDC’s National Tracking Network reports on the pesticide, atrazine, in public drinking water supplies as a national interest for drinking water tracking indicators. To comply with indicator reporting, MDH will emphasize the extremely rare occurrences of atrazine in public water supplies, rather than submitting large datasets with non‐detection values. In Minnesota, both MDH and MDA are looking at Minnesota PCC data, and the Health Promotion Chronic Disease (HPCD) section is working on occupational pesticide exposures. MDH’s Environmental Health staff receive many calls from citizens with concerns about pesticides, but don’t keep a database of the calls. 62 3) What data are available to evaluate pesticide exposures and what are the known data gaps? Cathy gave examples of MDH/MDA data collected on pesticide exposure. One potential data source for pesticide usage (not necessarily exposure) may involve a right‐to‐know program involving pesticide applicators/applications. MDA works with growers to reduce pesticide drift. 4) What policy initiatives for pesticides are expected in the next legislative session? Past suggestions for policy initiatives have included Right‐to‐Know laws, which MDA believes would be very expensive. Currently the state has 5 million agricultural pesticide applications per year, and such a law would involve extensive outreach and education to applicators, plus keeping records of all pesticide applications. Instead, MDA works with applicators to use BMPs and reduce pesticide drift. Another possible suggestion involves air monitoring of pesticide applications. An organization called PANNA7 collects air monitoring data in the potato growing region of Minnesota. MDA and MDH have reviewed PANNA data and do not dispute it, but MDA and MDH staff have concerns about PANNA’s sample collection methods, interpretation, and the use of certain human health benchmarks in risk screening. Overall, Cathy said, the group found the discussion valuable. Discussion The first question from the panel was, what actions does MDA take to respond to complaints? Cathy answered that MDA works with rural populations and tries to reduce exposure through best management practices (BMP). MDA is also working with the UMN on outreach and on decreasing the overuse or use of the wrong pesticides for bedbugs. Pat asked whether the group will meet regularly or ad hoc. Cathy said the group doesn’t plan to meet regularly, but will meet as needed. Jean noted that the EHTB program has regular connections with MDA: for instance, Joe Zachman participates in monthly Tech Team meetings and attends Advisory Panel meetings. Greg asked whether MDA keeps a record of private applicators in a database, as California does, or does it intend to do so? Cathy answered that MDA currently neither keeps a record of private applicators nor plans to do so without legislative direction and funding. Greg also pointed out that the MPCA is interested in pesticide applications in the context of the agency’s statewide study of air pollution. He commented that nationally licensed pesticides are also licensed in Minnesota. Joe noted that no pesticide can be registered in Minnesota without federal registration, but MDA does not license all pesticides registered by the federal government. Occasionally, MDA has been more restrictive than the federal government. 7
Pesticide Action Network North America 63 Developmental Disabilities (DD) Data Jeannette Sample reviewed existing and future data sources for developmental disabilities (DDs), as recommended by the Advisory Panel in March 2012, to evaluate developmental disabilities as a new content area for Minnesota EPHT. She reviewed the Phase 1 criteria of the MN EPHT evaluation process, which explores prevalence, causality, public health impact, and actionability for developmental disabilities and reviews the available data. Developmental disabilities are common, and affect one in six children. The causes of most developmental disabilities are largely unknown, but some well‐understood toxicants, such as lead and mercury, are known to affect children's developing nervous systems. Thus, understanding the causes of DDs enables public health to take preventive actions. Minnesota has seen some increase in developmental disabilities; between 2001 and 2009/2010, the prevalence of DDs went from 12.4% to 14.3%. The health impacts of DDs are considerable – for instance, it costs twice as much to educate a child with DDs compared to educating a normal child. Do the data exist? In Minnesota, Jeannette said, we will look further at IDEA and also at two national surveys. Phase 2 of the MN EPHT entails data source evaluation. This involves evaluating Minnesota data from the national Individuals with Disabilities Education Act (IDEA) database, as recommended by the Advisory Panel in March, and evaluating Minnesota data from two other national health surveys: the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health. She presented Phase 2 criteria and piloted indicators from IDEA (charts). The data document the number of children receiving special services for four different indicators: 1)
2)
3)
4)
Autism Intellectual disability Developmental delay Specific learning disability (a disorder in one or more psychological ability in using spoken/written language, such as dyslexia) The strengths of IDEA are that the data are publicly available, are collected every year by the state, we can request data by district, and the data are standardized and inclusive. The limitations of IDEA are that we do not have data on the prevalence of DDs, but only on the number of children who receive services. Thus, the classification reflects service needs and involves no clinical diagnosis. In addition, there are questions about uniformity and comparability between districts and over time. Jeannette then presented Phase 2 criteria and piloted three indicators from the National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NSCSHCN): 1) Autism (NSCSHCN only): 9.3 % of Minnesota children with special health care needs 64 2) ADD/ADHD: estimated 5.7% of all children in Minnesota; 30% of children with special health care needs 3) Developmental delay: estimated 2.2% of children in Minnesota, 17% of children with special health care needs. She then summarized the strengths and limitations of these two national surveys as follows: Strengths • 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 • Questions change over time • Survey not conducted yearly • Small sample sizes for each condition • Parental report of health Barbara Dalbec, MDH Children and Youth with Special Health Needs (CYSHN) director, then gave an overview of autism projects in Minnesota in the second part of the joint presentation. She noted three trends: 1) Increasing concern about autism in communities 2) Increasing CDC prevalence data on autism 3) Increasing numbers of children in Minnesota who are in special education programs to receive special services for autism (a 446% increase over 10 years). Receiving special services defines these children as having autism, which she considers a shaky definition. She noted that the community interested in autism is very active, which reflects a huge increase in special education needs, especially in the Somali community. In response there have been several inter‐agency and other efforts to address autism: 1) In 2009, MDH and the Minneapolis public schools tried to find the true prevalence, but were left only with more questions. 2) The federal Race to the Top grant allows Minnesota to do data linkages, assess whether outcomes are improving, identify which data to collect and what questions to ask, and to obtain parental consent. This effort is still in early stages. 3) The University of Minnesota has obtained national funding to assess autism prevalence, with special focus on the Somali population. 65 4) In the 2012 legislative session, the autism task force worked at developing a statewide plan. One goal is to learn the true prevalence, which could become a legislative initiative. Another is a qualitative study of the reasons that people are not diagnosed. Discussion Pat McGovern recommended moving forward to explore the data sources. Melanie asked about accurate medical diagnosis and IDEA data with respect to splitting the data into age categories, especially for developmental delay at the youngest ages. She asked, is this a meaningful distinction, given the complexity of diagnosis? Jeannette answered the group will consider this question, pointing out that ADDM (Autism and Developmental Disabilities Monitoring Network; Minnesota does not take part in this network) evaluates autism at age 8. Jeannette agreed that developmental delay diagnosis at a young age is complex. Barbara Dalbec noted that often disability services put very young children with hearing problems in the developmental delay category at first. She said that most surveys use age 8 for autism diagnosis because most children are diagnosed by then, but she sees a trend toward identifying autism earlier. Jeannette recommended continuing the Phase 2 evaluation of the three data sources presented and plans to come back to the panel in a later meeting to ask for recommendations on which conditions to track. Lisa commented that the data should determine the conditions one should track. She agreed with Jeannette’s proposal to look at both national data surveys as recommended. Pat McGovern would like to see Jeannette and Barbara go back to the three data sources. She wondered whether there is a methodological difference among them, especially with the IDEA data services data, and whether there are any validity studies on the diagnoses. She would like to see staff go back and look at the diagnosis and special services data. Barbara Dalbec recommended using both. At 4 PM, Pat McGovern asked for any new business. Barbara Murdock advised the panel members to look for a draft of the near‐final legislative report in their email. Pat McGovern asked for a motion to adjourn, which was seconded, and adjourned the meeting. 66 EnvironmentalHealthTrackingandBiomonitoring
AdvisoryPanelRoster
As of March 2013 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 67 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 68 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. 69 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. 70 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 Hornsis 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. 71 This page intentionally left blank. 72 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. 73 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. 74 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 75 This page intentionally left blank.
76 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, peer‐
reviewed animal, human, or in vitro studies, and baseline human exposure data, and consists of chemical families or metabolites that are included in the federal Centers for Disease Control and Prevention studies that are known collectively as the National Reports on Human Exposure to Environmental Chemicals Program and any substances specified by the commissioner after receiving recommendations under section 144.998, subdivision 3, clause (6). (i) "Environmental hazard" means a chemical or other substance for which scientific, peer‐
reviewed 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 77 state agencies and organizations, and develop additional procedures as needed to protect individual privacy; (5) organize, analyze, and interpret available data, in order to: (i) characterize statewide and localized trends and geographic patterns of population‐based measures of 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 78 perfluorobutanoic acid. Subd. 2. Base program. (a) By January 15, 2008, the commissioner shall submit a report on the results of the biomonitoring pilot program to the chairs and ranking members of the committees with jurisdiction over health and environment. (b) Following the conclusion of the pilot program, the commissioner shall: (1) work with the advisory panel to assess the usefulness of continuing biomonitoring among members of communities assessed during the pilot program and to identify other communities and other designated chemicals to be assessed via biomonitoring; (2) work with the advisory panel to assess the pilot program, including but not limited to the validity and accuracy of the analytical measurements and adequacy of the guidelines and protocols; (3) communicate the results of the pilot program to the public; and (4) after consideration of the findings and recommendations in clauses (1) and (2), and within 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, 79 community‐based organizations, or experts in a particular field to perform any of the activities described under this section. 144.998 ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING ADVISORY PANEL. Subdivision 1. Creation. The commissioner shall establish the Environmental Health Tracking and Biomonitoring Advisory Panel. The commissioner shall appoint, from the panel's membership, a chair. The panel shall meet as often as it deems necessary but, at a minimum, on a quarterly basis. Members of the panel shall serve without compensation but shall be reimbursed for travel and other necessary expenses incurred through performance of their duties. Members appointed by the commissioner are appointed for a three‐year term and may be reappointed. Legislative appointees serve at the pleasure of the appointing authority. Subd. 2. Members. (a) The commissioner shall appoint eight members, none of whom may be lobbyists registered under chapter 10A, who have backgrounds or training in designing, implementing, and interpreting health tracking and biomonitoring studies or in related fields of science, including epidemiology, biostatistics, environmental health, laboratory sciences, occupational health, industrial hygiene, toxicology, and public health, including: (1) at least two scientists representative of each of the following: (i) nongovernmental organizations with a focus on environmental health, environmental justice, children's health, or on specific chronic diseases; and (ii) statewide business organizations; and (2) at least one scientist who is a representative of the University of Minnesota. (b) Two citizen panel members meeting the scientific qualifications in paragraph (a) shall be appointed, one by the speaker of the house and one by the senate majority leader. (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 80 (iii) disseminating environmental health tracking and biomonitoring findings to the public. Subd. 4. Liability. No member of the panel shall be held civilly or criminally liable for an act or omission by that person if the act or omission was in good faith and within the scope of the member's responsibilities under sections 144.995 to 144.998. INFORMATION SHARING. On or before August 1, 2007, the commissioner of health, the Pollution Control Agency, and the University of Minnesota are requested to jointly develop and sign a memorandum of understanding declaring their intent to share new and existing environmental hazard, exposure, and health outcome data, within applicable data privacy laws, and to cooperate and communicate effectively to ensure sufficient clarity and understanding of the data by divisions and offices within both departments. The signed memorandum of understanding shall be reported to the chairs and ranking members of the senate and house of representatives committees having jurisdiction over judiciary, environment, and health and human services. Effective date: July 1, 2007 This document contains Minnesota Statutes, sections 144.995 to 144.998, as these sections were adopted in Minnesota Session Laws 2007, chapter 57, article 1, sections 143 to 146. The appropriation related to these statutes is in chapter 57, article 1, section 3, subdivision 4. The paragraph about information sharing is in chapter 57, article 1, section 169. The following is a link to chapter 57: http://ros.leg.mn/bin/getpub.php?type=law&ye
ar=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. 81 This page intentionally left blank. 82