October 14, 2014 Advisory Panel Meeting Agenda
Environmental Health Tracking and Biomonitoring Program
1:00 – 4:00 pm at The Lung Association in Minnesota
490 Concordia Avenue, St. Paul, MN
Time
Agenda Items
Presenters
Description/expected outcome
1:00
Welcome &
Introductions
Patricia McGovern,
Chair
Panel members & audience are invited to
introduce themselves.
1:05
Sustaining Minnesota
Biomonitoring:
Workgroup Progress
Report
Jean Johnson
Discussion item: Jean will report on the
Sustaining MN Biomonitoring Workgroup
meetings. Questions to the panel follow
Melissa’s presentation.
1:15
Legislative Process
and the Role of the
Advisory Panel
Melissa Finnegan,
Legislative Policy,
Executive Office
Discussion item: Melissa will present
information on how the legislative process
works and how the panel can become
involved
1:30
Discussion
1:45
PFCs in soil and
produce: Recent
Findings
2:15
Discussion
2:30
Refreshments
Deanna Scher,
Exposure Consultation
Staff, Environmental
Health; Carin Huset,
MDH Public Lab; and
Matt Simcik, Associate
Professor, University
of Minnesota
Environmental Health
Sciences
Questions to the panel:
• What is the role of the panel in the
legislative process?
• What additional support and
resources do they need?
Deanna, along with Carin, and Matt will
present recent findings from analyses of farm
and garden soils and garden produce in the
East Metro for PFCs.
Questions for the panel:
• How should MDH respond to Legislators’
questions about potential exposure to
East Metro farmers? Is it likely to be a
health concern?
• What additional investigation is
recommended?
• Is additional biomonitoring for PFCs
recommended for the East Metro?
Time
Agenda Items
2:45
Tracking Updates
Matthew Montesano
• CDC Award
• Portal Updates
• Urban Air and
Health Project
• The Economic
Burden of the
Environment on
Childhood Disease
in Minnesota
Biomonitoring
Updates
• Lab Update
• East Metro PFC3
Biomonitoring
• East Metro Cancer
Report Update
TIDES Analysis blood
Betsy Edlund, MDH
spots, Mercury Results Public Health
Laboratory
Information Item: Matthew will demonstrate
the portal updates. Other updates are
provided in written form. Panel members are
invited to ask questions and comment on all
updates.
3:20
MN FEET update
Discussion item: Jessica will present an
update on the MN FEET project.
3:30
Discussion
3:50
New Business
3:55
Audience Questions
4:00
Motion to adjourn
3:00
3:05
Presenters
Jessica Nelson
Description/expected outcome
Information Item: Updates are provided in
written form. Panel members are invited to
ask questions and comment on all updates.
Information item: Betsy will review results of
the TIDES study. Mercury results are
presented in written form. Panel members
are invited to ask questions and comment on
this information.
Questions for the panel members
• Staff are recommending that we do not
return individual results for newborn
bloodspot mercury levels. Do you agree
with this recommendation?
• Do you have input on our revised study
design?
• Do you agree with possibly limiting the
total number of bloodspots to a subset?
Note to audience: The panel asks that audience members hold comments and questions on discussion
items until the end of the meeting, 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
Table of Contents
SECTION OVERVIEWS: SUSTAINING MINNESOTA BIOMONITORING: WORKGROUP ........PROGRESS REPORT; AND
LEGISLATIVE PROCESS AND THE ROLE OF THE ADVISORY PANEL ........................................................................... 4
SECTION OVERVIEW: PFCS IN SOIL AND PRODUCE: RECENT FINDINGS .................................................................. 9
SECTION OVERVIEW: TRACKING UPDATES ................................................................................................... 13
SECTION OVERVIEW: BIOMONITORING UPDATES ............................................................................................... 16
SECTION OVERVIEW: CORD BLOOD V. NEWBORN BLOODSPOT EXPERIMENT RESULTS, OTHER MERCURY PROJECT
UPDATES.............................................................................................................................................................. 19
SECTION OVERVIEW: MN FEET UPDATE ............................................................................................................... 23
SECTION OVERVIEW: OTHER INFORMATION ....................................................................................................... 35
3
Section Overviews: Sustaining Minnesota Biomonitoring:
Workgroup Progress Report; and
Legislative Process and the Role of the Advisory Panel
At this Advisory Panel meeting, staff will update panel members on the July 2014 meeting of the
Sustaining Minnesota Biomonitoring Workgroup. This will include a brief review of the recommended
Action Plan for Sustaining Minnesota Biomonitoring and progress towards implementing the plan to
date.
In addition, Melissa Finnegan, Legislative Liaison for MDH, will describe the Legislative Process and the
role of MDH staff in that process. Advisory Panel members are invited to ask questions and to consider
the role of the EHTB Advisory Panel for informing Legislators and others about EHTB, responding to
inquiries, or advocating during the upcoming 2015 Legislative Session.
Questions for the panel to consider and discuss after Melissa’s presentation:
•
•
What is the role of the panel in the legislative process?
What additional support and resources do they need?
4
Sustaining Minnesota Biomonitoring: Workgroup Progress Report
Sustaining Minnesota Biomonitoring Workgroup Update
The EHTB Advisory Panel Workgroup for Sustaining Minnesota Biomonitoring met on July 15, 2014.
Attending the meeting were Lisa Yost, Steven Pederson, Deb Hendricks, Paul Moyer, Mary Manning,
Jean Johnson, Jessica Nelson, Christy Rosebush and Janis Taramelli. The meeting was facilitated by Kris
Van Amber (management consultant).
The purposes of the meeting were to finalize Advisory Panel recommendations for an Action Plan for
achieving sustained funding for MN Biomonitoring and to discuss a role for the workgroup/Advisory
Panel members in the plan going forward. In creating the Action Plan (see attached), workgroup
members reviewed comments from the June Advisory Panel meeting and discussed ideas for four basic
strategies:
1.
2.
3.
4.
Restore ongoing appropriation for base program in state health department funding
Respond to national funding opportunities and build academic collaborations
Research and respond to other short-term opportunities for supplemental funding
Build greater public awareness and interest
Members agreed that restoring an ongoing state appropriation from the general fund has the greatest
potential for sustaining the program long term, which is necessary to fulfill the vision of biomonitoring
as public health surveillance. For shorter term funding, workgroup members volunteered ideas and
assistance for connecting with research organizations and foundation funding sources. Paul Moyer,
manager of the MDH Environmental Laboratory, reported on the status of MDH’s application under a
CDC 5–year funding opportunity for building state laboratory capacity for biomonitoring. A collaborative
intra-agency team of epidemiologists, toxicologists and laboratorians developed the competitive
application. [Subsequent to this meeting staff learned that MDH did not receive the award.]
MN Biomonitoring staff have begun pursuing some of the strategies outlined in the Action Plan. In
spring 2015, we will evaluate progress toward desired funding outcomes. Workgroup members will
work with staff in executing the Action Plan, but the group will no longer convene on a regular basis
unless it becomes necessary. Instead, the Workgroup concluded that the Advisory Panel should further
explore the role of all Panel members in propelling the Action Plan forward. It was felt that the Panel
should be integral in building awareness and interest in MN Biomonitoring among stakeholders,
legislators and the public.
The workgroup also discussed the importance of outreach and communications with the public and
legislators. A communications plan for MN Biomonitoring is summarized below. Task force members
commented that the public, local elected officials and staff from the executive branch should not be
excluded from outreach efforts. As part of the communication plan, MN Biomonitoring developed an
infographic to be distributed publicly by staff and program supporters. We will also complete a
December 2014 report to the legislature on the progress of current projects, the Advisory Panel, and
recommendations for ongoing EHTB work. The workgroup determined that this report should be one
piece of a larger “Legislative Awareness Effort” to communicate the goals, progress, and needs of MN
Biomonitoring to the legislature on an ongoing basis. Group members pointed out that this
communication may be achieved, in part, by the Senate and House appointees to the Advisory Panel.
5
Communications Plan (overview) for Raising Public Awareness of MN Biomonitoring:
1. Continue to enhance and actively promote the MN Biomonitoring Website.
a. Gov.delivery
b. Social media
c. Bookmarks
2. Continue to develop MN Biomonitoring content on the MN Tracking data portal (integration
with Tracking and health data).
3. Develop outreach materials for distribution with public audiences and stakeholder groups.
a. Infographic
b. Legislative Report
4. Present to key stakeholders to communicate capacity, accomplishments, and importance.
a. MPCA, MDA
b. Environmental and health advocacy organizations
c. UM EH sciences faculty and researchers
5. Convey same messages (as in #4) in publications and news media.
a. Press releases
b. Stakeholder newsletter/blog articles
c. Publication in MN Physicians Magazine
d. MDH Commissioner’s “A Public Health Journal” (television show)
6
EHTB Task Force Recommendations:
An Action Plan for Sustaining Minnesota Biomonitoring at MDH, July 2014
Strategies
Action steps
Who (lead)
When (start)
Desired outcome
A
Restore ongoing
appropriation for
base program in
state health
department funding
1
MPCA conversation
to plan for biennium
Meeting
Shannon
Lotthammer
May 2014
PCA supports MDH goals
for a sustained base.
2
MDH staff participate
in agency legislative
process.
To be determined (TBD)
TBD
TBD
Ongoing funding is
restored in state budget.
3
Meet with MDH
Executive Office (EO)
and legislative
liaisons
Meeting and follow up
Jean Johnson
August 2014
Sustained relationship
and EO is informed and
supportive.
Build legislative
awareness of MN
Biomonitoring
•
December 2014
Legislative awareness in
health committees of
program and health
outcomes.
October 2014
Determine overlapping
areas of interest and
strengths of potential
collaborations on grant
proposals.
4
B
1
2
3
Respond to national
funding
opportunities for 3-5
year research or
public health practice
with academic
collaborators
Establish
relationships with
health care systems
researchers for
future collaborations
Paul Moyer
•
•
•
Deliver 2015 Report
to Legislature
Contact Health
Committee staff
Jean Johnson
HealthPartners
Institute for
Education and
Research
Mayo Clinic and
Olmsted Medical
Center
Jessica Nelson
Jessica Nelson
Deb Hendricks
January 2015
Determine areas of
collaborations and
develop joint funding
proposal.
Jessica Nelson
Deb Hendricks
January 2015
Determine areas of
collaboration.
Establish
relationships with
potential academic
partners for future
collaborations
•
•
UMN Institute on
the Environment
UMN Center for
Urban and Regional
Affairs
Establish academic
partners in outstate
MN
•
•
•
UMD
Crookston, Morris
South Dakota State
Melissa
Finnegan
Jean Johnson
C
1
2
Research and
respond to other
short-term funding
opportunities
(supplemental)
Review past
foundation funded
projects, establish
contacts, investigate
barriers
Build relationships
with American Indian
communities
•
•
•
•
3
UMASH –proposal
with Occupational
Health for farm
families pilot
D
Build public
awareness and
interest
1
2
3
Blue Cross Blue
Shield
Northwest
Foundation
Christy
Rosebush
January 2015
Develop relationships,
identify opportunities,
and application plans.
Great Lakes
Intertribal
Epidemiology
Center
Office of Minority
and Multicultural
Health
Jean Johnson
September 2014
Determine areas of
interest and strengths of
potential collaborations.
Jessica Nelson
Review funded projects
and prospective funding
Jessica Nelson
Spring 2015
Determine if funding is
available and develop
proposal pilot project.
Meet with MPCA
Board
Develop materials and
presentations
Jean Johnson
November 2014
Update state agency
stakeholders, seek input.
Meet with MDA
Develop materials and
presentations
Jean Johnson
December 2014
Update and identify
potential for
collaboration.
Develop speaker
materials and
presentations
Jessica Nelson
November 2014
Jean Johnson
February 2015
Stakeholders are
informed and support
ongoing MN
Biomonitoring.
Meet with
stakeholder groups
•
•
•
•
•
MCEA
MPHA
Conservation MN
Healthy Legacy
UM EH Sciences
Jessica Nelson
8
Section Overview: PFCs in Soil and Produce: Recent Findings
Deanna Scher (MDH EH Division) and Carin Huset (MDH PHL Division) will present on the MDH
Perfluorochemicals in Homes and Gardens Study (PIHGS). The aims of PIHGS were to evaluate:
1. whether PFC contamination in public and private water supplies in Lake Elmo, Oakdale, and
Cottage Grove has resulted in residual soil contamination in residential produce gardens;
2. the extent to which common food crops grown in potentially contaminated soil or irrigated with
PFC-contaminated water take up PFCs; and
3. whether use of PFC-contaminated water for yard irrigation contributes to indoor contamination
in house dust via “track-in” from the outside.
Carin will present the analytical methods used to measure PFCs in PIHGS environmental samples.
Deanna will present the main study findings; she will also describe how the results were used in health
risk assessment and how they can help inform broader questions about human exposures to PFCs.
Matt Simcik (University of Minnesota) will present recent findings from analyses of farm and garden
soils and garden produce in the East Metro for PFCs.
Speaker biosketches
Deanna Scher, PhD, epidemiologist in the Environmental Health Division at MDH, is the principal
investigator of the Fond du Lac Community Biomonitoring Study, funded by the US Agency for Toxic
Substances and Disease Registry (ATSDR). Deanna is also involved in an MDH perfluorochemical
exposure study (PFCs in Homes and Gardens Study). Prior to coming to MDH, Deanna conducted
pesticide risk assessment and mitigation at the US EPA Office of Pesticide Programs. Deanna received
her PhD in Environmental Health Sciences from the University of Minnesota, School of Public Health,
where her research involved methods to integrate biomonitoring and biological plausibility into
pesticide risk assessment and epidemiology.
Carin Huset, PhD, is a research scientist in the Environmental Laboratory section of the MDH Public
Health Laboratory since 2007. Carin received her PhD in Chemistry from Oregon State University in
2006, where she studied the fate and transport of perfluorochemicals in aqueous waste systems. In the
MDH PHL, Carin provides and coordinates laboratory expertise and information to program partners
within MDH and other government entities where studies require measuring biomonitoring specimens
or environmental contaminants of emerging concern. In conjunction with these studies, Carin provides
biomonitoring and environmental analytical method development in support of multiple analyses.
Matt Simcik, PhD, MS, is an Associate Professor in the Division of Environmental Health Sciences at the
University of Minnesota School of Public Health. He received an MS in civil engineering from the
University of Minnesota and a PhD in environmental science from Rutgers. His research interests include
the fate and transport of organic contaminants in the atmosphere and waters of the Great Lakes.
Questions for the panel:
•
•
•
How should MDH respond to Legislators’ questions about potential exposure to East Metro
farmers? Is it likely to be a health concern?
What additional investigation is recommended?
Is additional biomonitoring for PFCs recommended for the East Metro?
9
PFCs in Soil and Produce: Recent Findings
Perfluorochemicals (PFCs) in Homes and Gardens Study (PIHGS): Summary of Results
September 2014
Background
Since 2004, local and state agencies have been responding to the presence of perfluorochemicals (PFCs)
in drinking water supplies in several eastern Twin Cities communities. Wells with levels of PFCs
exceeding Minnesota Department of Health (MDH) health-based criteria have been identified and
addressed through installation of granular activated carbon (GAC) filtration systems, or hooked up to
city water. Residents now drink water with no to low levels of PFCs.
Drinking water is safe, but homeowners have expressed concerns about eating fruits and vegetables
that have been grown in soil that contains PFCs. PFCs have been released to the environment by
watering lawns and gardens using water sources that contain PFCs. PFCs stay in the environment for a
long time after they have been released. Water sources used in gardening may still contain PFCs if the
outdoor taps used to water yards and gardens are left unfiltered at homes with private wells. Some PFCs
may also “break through” GAC filters used in private or public water systems.
Laboratory studies show that PFCs in soil-water can be taken up by edible plants. These studies
consistently show that PFCs with short fluorocarbon-chains--such as perfluorobutanoic acid (PFBA)--are
more readily taken up into plants compared to long-chain PFCs –such as perfluorooctane sulfonate
(PFOS) or perfluorooctanoic acid (PFOA).
MDH responds to community concerns
MDH started a study of PFC levels in homegrown produce, garden soil, and outdoor tap water from the
eastern Twin Cities area in 2010. MDH collected samples from twenty homes in Lake Elmo, Oakdale, and
Cottage Grove that have a history of PFCs in the water. A total of 20 water samples, 34 soil samples, and
232 produce samples were analyzed for seven different PFCs.
A total of 3 water samples, 6 soil samples, and 47 produce “reference” samples were collected from
three homes in areas of the Twin Cities that are not affected by the PFC contamination. MDH also
collected two house dust samples from each home. The purpose of collecting the dust samples was to
determine whether PFC-contaminated water used to water yards and gardens contributes to indoor PFC
contamination of house dust when it is “tracked-in” from the outside.
All samples have been analyzed and results have been provided to study participants.
Study Results
Water: PFBA was found in 85% of outdoor tap water samples and found at higher levels than other
PFCs. The median PFBA concentration was 0.98 μg/L. No sample exceeded the Health Risk Limit (HRL)
set by MDH of 7 ug/L. PFBA is the most widespread PFC in East Metro groundwater. It is also difficult to
completely remove PFBA with standard water treatment methods.
Soil: PFCs were detected at low levels in most soil samples. PFOS, PFOA, and PFBA were found in every
sample and at the highest levels. Median concentrations of PFOS, PFOA, and PFBA were 2.65, 0.73, and
0.99 μg/kg respectively. These levels are well below health-based guidelines for PFCs in soil. There was
no evidence that the amount of PFBA in water or the amount of garden watering significantly
contributed to the soil concentration of PFBA.
10
Produce: In produce, PFBA was detected in 98% of samples and found at higher levels than other PFCs.
The median PFBA produce concentration was 0.68 μg/kg. The amount of PFBA in the water, the amount
of garden watering, and the type of produce grown were found to contribute the most to the amount of
PFBA in produce. PFOS and PFOA were found in very few of the produce samples.
House Dust: In each home, MDH collected a dust sample from both a living/family room and an
entryway to the yard. Higher detections and concentrations were found in living room dust compared to
entryway dust for all PFCs. Entryway dust levels were strongly related to living room levels, but not soil
levels. These findings suggest interior sources of PFCs (e.g., consumer products) contribute most to PFCs
in house dust. The one exception was PFOA, where the entryway dust level was more strongly
associated with the soil concentration than the living area dust level.
Health Risk Assessment
MDH conducted a risk assessment that evaluated exposure to the five PFCs for which safe dose levels
have been established. The five PFCs evaluated were PFBA, PFBS, PFOA, PFOS, and PFHxS. The safe
levels used in the assessment provide protection for even the most sensitive people who may be
exposed to PFCs. Three age categories were considered: adults, small children, and infants. Exposure
was combined across four sources (drinking water, homegrown produce, soil, and house dust).
Conclusions
No health risks of concern were found for anyone living in these communities when considering
combined risk from all exposure pathways. Therefore, MDH has determined that the health benefits
provided by growing and eating homegrown produce greatly outweigh any potential risk from low levels
of PFBA or other PFCs in produce.
Findings include:
 The presence of PFBA in water contributes to elevated levels of PFBA in garden produce in the
East Metro.
 PFBA concentrations in produce are low and no health risks of concern were found for infants,
children, or adults living in the study area from exposure to five PFCs in drinking water, soil,
homegrown produce and house dust.
 Although PFOS and PFOA were present in soil at higher or similar levels to PFBA, the results
demonstrate that plant uptake of PFCs is chain-length dependent with highest uptake and
movement of short-chain PFCs by edible plants.
 “Track-in” of PFCs in soil and dust from the outside is not the main contributor to dust levels in
the living spaces of homes.
This “real world” study was conducted at homes in the East Metro with historically high levels of PFCs in
their drinking water, a long history of home gardening, and generally extensive varieties of fruits and
vegetables grown and consumed. Other residents or gardeners in the area–with lower levels of PFCs or
no PFCs in water used for watering lawns and gardens--can expect to have even less exposure to PFCs
through soil and home garden produce.
11
Transport of Perfluorochemicals to Surface and Subsurface Soils: Executive Summary
Feng Xiao, John S. Gulliver, Department of Civil Engineering; Matt Simcik, Department of Public Health;
St. Anthony Falls Laboratory, University of Minnesota
March 2013
Perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) are persistent organic pollutants that
are ubiquitously present in the environment. They are important perfluorochemicals (PFCs), or more
precisely, perfluoroalkyl substances (PFASs), that were manufactured by a variety of companies around
the world and suspected to have chronic effects in humans. These chemicals are resistant to
degradation by physical or chemical mechanisms, and have been detected in human blood and breast
milk at concentrations of concern to health and environmental regulators.
This project aims to determine the extent of PFOS and PFOA migration and how elevated levels of PFOS
and PFOA in soils migrated from known hot spots to other locations. The suspected hot spot of interest
is the 3M manufacturing plant in Cottage Grove, and the possible migration pathways are due to vehicle
traffic, by air and by water.
U.S. Highway 10 runs close to the 3M plant where PFOS and PFOA were manufactured before 2002. Soil
samples at different depths along and perpendicular to U.S. Highway 10 were collected from Cottage
Grove to Big Lake. PFOS and PFOA were regularly quantified in all of our surface soils samples (∑PFCs =
6.0–135.0 ng/g dw; median, 20.4 ng/g dw. The term dw here and below stands for dry weight soil). The
results of the surveying and sampling program and subsequently geo-statistical modeling with the aid of
a Geographic Information System identified two hot spots and supported wind as the primary transport
carrier causing the mitigation of contaminated soils from the hot spots to off-site soils. Circumstantial
evidence also suggests vehicular traffic as an important source or pollutant carrier. This newly proposed
and confirmed soil-to-soil transport pathway appears to be an important and heretofore overlooked
migration mechanism of PFOS and PFOA from contaminated soils.
We also studied the occurrence of PFOS and PFOA in subsurface soil samples and found a general
increase in concentrations with the depth at which soil sample was collected. Since neither PFOS nor
PFOA adsorb strongly to soils, we hypothesize that the compounds are contained in particles that are
transported by wind and vehicular traffic to other locations or by water infiltrating into the soil.
Overall, the results of this study indicate soil-to-soil pathways through wind and vehicular traffic and a
soil-to-groundwater migration pathways of PFOS and PFOA. The observations indicate that PFOS and
PFOA contamination is not contained to a few hot spots, but is migrating with wind and traffic to other
locations. In addition, PFOS and PFOA contamination is migrating toward the groundwater table. We
believe that the source of this contamination is PFOS and PFOA containing particles that can be picked
up by wind and traffic, and by water infiltrating towards the groundwater table.
12
Section Overview: Tracking Updates
The following updates are provided in written form: CDC Award; Urban Air and Health Initiative; and the
Economic Burden of the Environment on Childhood Disease in Minnesota.
Mathew Montesano will demonstrate the portal updates.
Information Item
•
Panel members are invited to comment and ask questions on any of the updates in this section.
13
Tracking Updates
MDH Receives Grant Renewal from CDC National Tracking Network
In July 2014 MDH received a notice of award ($873,000/year) from CDC for maintenance and
enhancement of the MN Tracking Network. This award will allow the MN Tracking Program to
implement an ambitious work plan, including: maintaining and updating the Data Access Portal, periodic
submissions of data to the CDC National Tracking Network, and development of new data and measures
(e.g., childhood obesity, radon, diabetes). The MN Tracking Program currently is updating work plans for
activities to be completed by July 31, 2015.
Two New States Added to the CDC National Tracking Network
In August 2014, CDC added two new states to the National Tracking Network: Michigan and Kentucky.
The total number of grantees is now 26. Minnesota is excited to have another Midwest partner state in
the Network!
Data Access Portal Updates
MN Tracking released a new mobile design for the Data Access Portal. This design automatically adjusts
the portal to the screen size of mobile devices, enhancing its function on smart phones and tablets.
View the Portal at: MDH Data Portal
Additional enhancements since the June Advisory Panel meeting include:
•
County Profiles: new profiles provide an overview of health and environment data by county,
along with state comparison values
•
Interactive maps of asthma and COPD: new maps provide hospitalizations and ED visit data by
ZIP code for the 7-county metro area
•
Cancer data update: cancer incidence data are now available through 2011 for over 17 cancer
types
•
Air quality index: a new indicator for the Air Quality Index is now available (developed in
collaboration with the MPCA)
Urban Air Quality and Health Initiative
MPCA and MDH are working collaboratively to implement the State Urban Air Quality and Health
Initiative by June 30, 2015. Deliverables for this initiative include: (1) a technical report with measures of
air quality impacts on health; (2) a new web-based toolkit to inform target audiences about air quality
and health and actions that they can take; and (3) a Health Impact Assessment that demonstrates how
HIA may be used as a tool to inform communities about air and health. The focus of this initiative is on
the 7-county metro area, and there is a joint MPCA/MDH Steering Committee that guides initiative
activities. For more information or questions about MN Tracking Program’s involvement in this initiative,
please contact Jean Johnson ([email protected], 651-201-5902).
The Economic Burden of the Environment on Childhood Disease in Minnesota
The Economic Burden report is a product of the CDC Tracking data use project team charged with
exploring the economic burden of environmentally-related childhood diseases in Minnesota. We are one
of 7 states participating on the national project team. The report includes estimated costs of childhood
asthma and childhood lead poisoning attributable to the environment and is currently undergoing
review. The Advisory Panel provided feedback on this report at the June 2014 meeting, and the
14
analysis/findings have not changed since that draft. Next steps include graphic design to make the
report more public-friendly and then Executive Office review. The anticipated publication date is
December 2014.
15
Section Overview: Biomonitoring Updates
Biomonitoring updates are provided in written form on the following items: Lab Update and East Metro
PFC3 Biomonitoring Project.
Information Item:
Panel members are invited to comment and ask questions on any of the updates in this section.
16
Biomonitoring Updates
Lab Update
Paul Moyer, MDH Public Health Lab Manager
CDC Biomonitoring Grant Application:
In May 2014, MDH submitted an application in response to the CDC State Biomonitoring Funding
Opportunity Announcement. The MDH application was one of 20 state submissions and included input
from staff from the Environmental Laboratory, Chronic Disease and Environmental Epidemiology, and
Environmental Surveillance and Assessment Sections. The application proposed studies to analyze
samples collected from women and children from rural and urban populations for various chemicals
including metals, pesticides, and compounds found in personal care products. In July, MDH was
informed that while application reviewers found many strengths along with a few weaknesses with the
proposal, the score assigned was not high enough to be one of the six awardees selected. In 2009, the
awardees were New York State, Washington State, and California. In 2014, the awardees were
California, Massachusetts, New Hampshire, New Jersey, Virginia, and the Four Corner States
Biomonitoring Consortium (Utah, Arizona, Colorado, and New Mexico). At this time additional
information related to the proposals and the planned biomonitoring studies has not been made
available.
East Metro PFC3 Biomonitoring Project Update
Recruitment Update
Of the 175 Original Cohort members who agreed to be contacted for future research, 156 (89%) have
consented to participate in PFC3.
Recruitment of New Residents, individuals who moved to Oakdale after the public health intervention, is
ongoing. Of the 402 eligible individuals identified by a household survey sent to Oakdale city water
consumers, 225 people from unique households were selected and invited to participate in PFC3. Since
March 2014, 120 individuals have agreed to participate. Replacements have been selected for those
who refuse participation. Project staff will continue recruitment efforts toward the target of 150 New
Residents through the end of 2014.
New Renters Sample
A New Renters sample was added to the project in Summer 2015 in response to concern that using city
water billing records to recruit New Residents would result in an underrepresentation of renters in the
final study population. The Washington County Housing and Redevelopment Authority (HRA) provided
MDH with a list of Oakdale renters in HRA programs who began their tenancy after the public health
intervention (October 2006).
The protocol for recruiting the New Renters group is similar to that for New Residents. Potential
participants were sent a household survey to enumerate eligible adults in the household. After two
mailings of the survey, 38 households responded. Eligible adults identified by the survey will be invited
to participate in PFC3. We will attempt to recruit 50 New Renters into the study.
Timeline
Blood sample collection for the Original Cohort and New Residents was originally scheduled to be
completed in August 2014. While the majority of consented participants have completed the blood
draw, we will now continue enrolling participants and collecting blood through December 2014.
17
Participants will receive their individual blood PFC results as they become available, potentially in early
2015.
Available aggregate results will be presented to the panel at the February 2015 meeting, with full results
available in June 2015. The panel will be invited to provide feedback before community results and
interpretation are finalized. Community results will include analyses of PFC levels and questionnaire
responses among our study groups and comparisons of levels to the U.S. general population.
18
Section Overview: Cord Blood v. Newborn Bloodspot Experiment Results,
Other Mercury Project Updates
The Pregnancy and Newborns Exposure Study, an EHTB collaboration with the University of Minnesota’s
The Infant Development and Environment Study (TIDES), compared mercury levels in a small number of
paired cord blood and newborn bloodspot samples. The purpose was to assess whether testing newborn
bloodspots, which is a newer lab method that has not been widely used, is a reliable way to measure
mercury exposure in newborns. Staff presented results to the Advisory Panel in the past; findings
showed that cord blood mercury levels were 30% higher on average than newborn bloodspot mercury
levels. This may reflect a biological difference or arise from the differing analytical methods used for the
two sample types.
Staff submitted a manuscript for publication, but the paper was not accepted. One question reviewers
raised was the fact that analyses were not done on split samples from the same blood sample so they
could not truly address the question about the different analytical methods.
The MDH Public Health Laboratory performed a series of experiments to investigate whether the higher
mercury levels found in cord compared to spot blood could be related to the lab method. Betsy Edhlund,
MDH Public Health Laboratory, will review results from these experiments.
Updates on other related mercury projects are presented in written form.
Information Item:
Panel members are invited to comment and ask questions on any of the updates in this section.
19
Cord Blood v. Newborn Bloodspot Experiment Results, Other Mercury Project
Updates
Cord Blood v. Newborn Bloodspot Experiment Results
There are a few distinct differences in the way cord blood and bloodspot samples are analyzed for
mercury. Cord blood samples are diluted and then injected directly onto the instrument for analysis.
Bloodspot samples are mixed with an extraction solution, allowed to sit overnight, and then filtered
before injection. When comparing results for the different samples it is important to understand these
differences and how they might affect the reported analyte value.
In the TIDES study, where both a cord blood and bloodspot sample were analyzed for mercury, it was
determined that there is generally less mercury reported from the bloodspot measurements than from
the cord blood measurements. It is very common for there to be a less than 100% recovery from an
analysis. Many analyses can account for this loss through the use of internal standards. The internal
standard is added to the sample and brought through the complete extraction procedure, effectively
mimicking analyte behavior. Unfortunately, there is no way to add an internal standard directly to the
bloodspot. In this method, the internal standard is in the extraction solution, which will account for loss
during the filtering process or for instrumental variations during analysis.
The TIDES study offered us the opportunity to explore the relationship between these two types of
samples a little deeper. All cord blood samples that had a mercury detect for both the initial cord blood
and bloodspot measurement (n= 15) were spotted onto filter paper and then analyzed for mercury.
Because this analysis was occurring about a year after the initial analyses, both the initial cord blood and
bloodspot samples were reanalyzed. Data is shown in Table 1.
20
Table 1. Cord Blood and Bloodspot Data for 15 Paired Samples
Initial Cord
Initial
Spotted Cord
Sample
Blood
Bloodspot
Blood
Rerun Cord
Blood
Rerun
Bloodspot
612
1.41
0.813
<0.7
1.61
2.16
613
8.34
6.68
4.59
8.11
7.09
614
1.08
0.837
<0.7
1.13
1.02
615
1.39
1.16
<0.7
1.39
1.56
619
1.28
0.910
<0.7
1.41
1.14
623
3.40
1.66
1.00
3.41
1.56
636
1.96
1.11
<0.7
1.92
1.07
638
0.921
1.21
<0.7
1.15
1.80
642
1.25
0.711
<0.7
1.41
0.700
643
0.931
0.711
<0.7
0.923
0.980
650
0.624
0.721
<0.7
0.986
<0.7
654
3.60
2.97
1.56
4.33
2.48
658
1.85
1.04
<0.7
2.13
1.17
677
1.09
0.939
<0.7
1.19
<0.7
678
1.22
2.64
0.820
1.44
1.67
Unfortunately for statistical purposes, the mercury concentrations for this study were pretty low, many
hovering right around the method detection level (MDL; 0.7 µg/L) and most below the report level (RL;
2.42 µg/L) and the sample size is quite small. Only 4 of the 15 spotted cord blood samples had mercury
concentrations above the MDL, and they all had low recoveries when compared to the cord blood
measurement. There is good agreement between samples analyzed a year apart. This confirmed that
the lower recoveries were not due to a change in instrument performance or a degradation of the
sample.
This study did not have a big enough sample size to make any more than general conclusions about
comparing cord blood mercury results to those determined from bloodspots. In general, bloodspot
results appear to underestimate the mercury exposure of patient. However, using bloodspots is a good
screening tool for populations with expected mercury exposures, as it can indicate a high exposure and
trigger follow-up care.
21
Other Mercury Project Updates
Pregnancy and Newborns Exposure Study
We will use the results from the cord blood v. bloodspot experiments that the MDH PHL performed
(described above) to revise our manuscript on the relationship between mercury levels in paired
newborn bloodspot and cord blood samples and will resubmit it this fall/winter. Cord blood samples
with mercury levels >1 µg/L will also be analyzed for speciated mercury. Once all analyses are complete,
we will summarize the results and post them on the web site.
NCS Newborn Mercury Biomarker Validation Supplemental Methodological Study
This project is measuring mercury and other metals in matched cord blood, newborn bloodspot, and
maternal blood samples from National Children’s Study (NCS) participants enrolled by South Dakota
State University’s Original Vanguard Center serving Brookings SD, and Yellow Medicine, Pipestone, and
Lincoln Counties, MN. Lab analyses on all samples – 83 pairs of matched newborn bloodspot and cord
blood samples, and maternal blood samples at birth from 49 of these mothers – are complete, and we
hope to present preliminary results at the Advisory Panel meeting. Data Use Agreements with the NCS
have been finalized, and we are waiting to receive the requested demographic and other exposure
information on participants. Results will be summarized and posted on the web site.
Riverside Newborn Mercury Project
This project is measuring mercury in newborn bloodspots from participants in the University of
Minnesota’s Riverside Birth Study. Laboratory analysis is underway on 160 newborn bloodspot samples
and results are expected soon. Results will be summarized and posted on the web site.
22
Section Overview: MN FEET Update
Jessica Nelson will present an update on study design, methods, and current planning activities for
Minnesota Family Environmental Exposure Tracking (MN FEET), a biomonitoring project that will
measure mercury and other metals in 600 pregnant women and newborns from diverse Minnesota
populations.
Questions for the panel members
•
Given that we are still exploring the relationship between mercury levels in cord blood v.
newborn bloodspots as part of MN FEET, that consent and lab analysis will now come at a later
time for bloodspots (see updates, below), and that participants will receive their individual cord
and urine results, staff recommend that we do not return individual results for newborn
bloodspot mercury levels. Do you agree with this recommendation?
• Do you agree with possibly limiting the number of bloodspots analyzed to a subset of
participants?
23
MN FEET Update
Background
Minnesota Family Environmental Exposure Tracking (MN FEET) will test mercury and other metals in 600
pregnant women and newborns from diverse Minnesota populations. MN FEET will investigate whether
there are disparities in mercury exposures in some Minnesota communities and continue our
assessment of whether testing mercury in newborn bloodspots is a good way to measure newborn
exposures. This write-up provides an update since the June 2014 Advisory Panel meeting.
Update on study design
Participant recruitment. Staff presented two options for recruiting participants at the June meeting.
After more consultation with clinic collaborators, we determined that recruiting women prenatally by
phone is more feasible than recruiting them directly from prenatal clinics. To do this, we will partner
with the research arms of two larger clinic systems:
1) The SoLaHmo Partnership for Health and Wellness, a program of West Side Community Health
Services made up of Somali, Latino, and Hmong community members and health care
professionals. SoLaHmo’s mission is to build upon the unique cultural strengths of Somali,
Latino, and Hmong communities to promote health and wellness through research, education,
and policy.
2) The HealthPartners Institute for Education and Research (HP), a nonprofit organization affiliated
with the larger HealthPartners health care organization that is dedicated to conducting highquality, public-domain health research.
MDH will contract with these two groups for phone recruitment of participants from their clinic patient
lists. More information on how this will work is described below. Women receiving care at the following
clinics, all of which deliver at Regions or Abbott Hospitals, will make up the study population: East Side
Clinic, La Clinica, and McDonough Homes (all West Side Community Health Services clinics); and
HealthPartners St. Paul and Riverside clinics.
Sampling frame, sample size. MN FEET will recruit women from four racial/ethnic groups only: Somali,
Hmong, Latina, and white women. Based on sample size calculations presented at the June meeting and
estimates of the number of pregnant women from these groups seen at West Side and HP clinics, we
determined a final sample size goal of 600 women, with 150 from each group. We explored the option
of taking a random sample of all clinic patients and over-sampling the four groups. While this would
allow us to weight our results to be representative of the entire clinic population, it would decrease our
ability to detect disparities that may exist, given our limited sample size.
Specimen hierarchy, timing of newborn bloodspot consent. We switched the order of which specimens
will be required for study participation and which will be optional. Cord blood and urine samples will
now be required and collected from all participants (except in cases where this is not possible, such as
last-minute deliveries at a different hospital). Consent to test the leftover newborn screening bloodspot
will now be optional. In fact, we will ask for consent to test the bloodspot at a totally separate time than
the cord and urine consent –newborn bloodspot consent will now happen after birth. And, depending
on budgetary constraints, we may only seek consent for bloodspot testing from a subset of participants.
We may focus on getting bloodspot consents from participants who had detectable levels of mercury in
cord blood.
24
We made these changes for a few reasons. We learned from the MDH Legal Affairs Unit that a full
written informed consent form containing certain elements required by state law is necessary for the
bloodspot testing. For the rest of the study, we are able to do a verbal consent over the phone with a
brief written informed consent “short form” signed by the participant and returned to us (pending IRB
approval). Due to a recent state law, this is not possible with the bloodspot consent. We are concerned
that if we include the bloodspot consent initially, its length and technical nature will deter people from
participating. Also, recruitment is no longer happening in clinics, where it could be linked to education
from the woman’s health care provider about the larger Newborn Screening Program. With phone
recruitment, we cannot assume that a woman has heard about the Newborn Screening Program by a
certain point in pregnancy, and so we would have to explain many details. A final reason for this shift in
priorities is the recognition that, at this point, cord blood and urine are more established, reliable ways
to measure exposure to mercury; there are still unanswered questions about the utility of using
newborn bloodspots as a way to characterize exposure in this population. An important purpose of MN
FEET is to continue to study these methodological questions, which we will still be able to do if we get
consent after birth. Restricting newborn bloodspot participants to those with higher cord mercury levels
would increase our efficiency.
Study methods –participant recruitment and informed consent
In the new MN FEET study design, staff at SoLaHmo and HP will draw from information in their patient
lists to select potentially eligible women for contact. This selection process will use an algorithm based
on patient race/ethnicity, language, and last name to identify women most likely to be in the four target
groups. Staff at SoLaHmo and HP will develop four calling lists, which will be randomized. SoLaHmo and
HP will have a target number of women from each group to recruit each month.
Women will first receive a letter from their clinic stating that they will be called and invited into the
study. If possible, their provider will mention the study during a prenatal visit. Fliers describing the study
will be available in clinic waiting areas in multiple languages.
Trained SoLaHmo and HP interviewers who speak the appropriate languages will contact potentially
eligible participants via phone, using a phone script. After determining eligibility, the interviewer will
introduce the project, describe what is involved, and ask for consent to participate. Informed consent
will ask for permission to:
•
•
Allow a cord blood sample and maternal urine sample to be collected by hospital staff after
birth. Urine will be tested for mercury, and cord blood for mercury, lead, and cadmium.
Administer a short set of questions about possible exposure sources and background.
Participants will give verbal consent over the phone and answer survey questions, but will be told that
they must send back a signed study consent “short form” in order to participate. Participants can receive
up to three gift cards from MDH as compensation for their involvement. They will receive a $25 gift card
once the signed short form is received, an additional $25 gift card when cord/urine samples are
received, and a final $25 gift card if they consent to testing of the leftover newborn bloodspot after
birth. They will also receive a small baby gift (a digital thermometer).
After birth, we will send a letter asking for consent to test the newborn bloodspot with phone follow-up.
Study methods – specimen collection
Babies from the study population clinics are delivered at Regions and Abbott Hospitals. Each hospital will
follow the same procedure for specimen collection. MDH will provide complete sample kits to the
hospital, including a blood tube and urine collection cups. These will be pre-screened for metal content.
25
If a woman has consented to participate, this will be flagged in her electronic chart. When a participant
is admitted to the hospital, the nurse will see the flag in her chart and know that she is a participant. The
nurse will then retrieve a sample kit, which will stay with the woman.
At birth, the attending midwife/OB will draw a second tube of cord blood (the hospitals already
routinely collect one tube of cord blood from every patient) using their standard protocol. Within 24
hours, the nurse will visit the woman’s room and ask for her urine sample. If a woman consents to the
newborn bloodspot testing, the Newborn Screening Program will transfer leftover bloodspot samples to
the Environmental Lab.
Current activities
Contracts. We are working to finalize contracts with HP and SoLaHmo. Contracts should be in place by
early October.
Materials development and review. We are developing materials for the project, including a one-page
overview of the study, phone script, consent documents, and survey. As part of our contract with
SoLaHmo, researchers from each of our target communities will review and give feedback on all
materials for usability, effectiveness, and cultural appropriateness. Materials will be translated into
Somali, Spanish, and Hmong once IRB approval is obtained.
Protocol completion. There are still a number of outstanding pieces to be finalized before the protocol is
complete. These include confirming the logistics of specimen collection with hospitals, providers, and
the MDH Newborn Screening Program; getting more input from MDH Legal Affairs Unit; and completing
our plan for reporting elevated results to participants and ensuring that follow-up is available. We hope
to submit the protocol to the HP and MDH Institutional Review Boards in late October
.
Timeline
FY15
9 10 11
12
1
FY16
2
3
4
5
6
7
8
9
10 11 12 1
FY17
2
3
4
5
6
7
8
9
10 11 12 1
2
3
4
5
6
IRB
Community
outreach
Pilot phase
Full recruitment
Births
Lab analysis
Report individual results
Analyze, interpret, communicate
26
Section Overview: Other Information
This section contains documents that may be of interest to panel members.
•
•
•
•
•
•
2015 Upcoming Advisory Panel Meeting dates
June 10, 2014 Advisory Panel Meeting Summary
Advisory Panel Roster
Biographical Sketches of Advisory Panel Members
Biographical Sketches of Staff
Environmental Health Tracking and Biomonitoring Legislation
35
2015 Advisory Panel Meetings
Tuesday, February 10, 2015
Tuesday, June 9, 2015
Tuesday, October 13, 2015
All meetings for 2015 will take place from 1 – 4 pm at
The American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota
36
June 10, 2014 Advisory Panel Meeting Summary
Environmental Health Tracking & Biomonitoring Program:
Advisory Panel: Alan Bender, David De Groote, Melanie Ferris, Jill Heins Nesvold, Steven Pedersen,
Gregory Pratt, Cathy Villas-Horns, Lisa Yost
MDH staff: Jeanne Ayers, Joanne Bartkus, Betsy Edhlund, Jim Kelly, Jean Johnson, Aggie Leitheiser,
MaryJeanne Levitt, Mary Manning, Pat McCann, Paul Moyer, Jessica Nelson, Christina Rosebush, Chuck
Stroebel, Janis Taramelli
MAD consultant: Kris Van Amber
Others: Charlene Muzyka and Mika Hyden, Minneapolis Health Department; Ned Brooks, Minnesota
Pollution Control Agency
Welcome and introductions
Lisa Yost, filling in for chair Patricia McGovern, welcomed the attendees and invited the panel members
and audience to introduce themselves. Newly appointed Advisory Panel member Steven Pedersen
introduced himself as the Senate appointee on the panel.
Aggie Leitheiser and Jeanne Ayers introduced the Minneapolis Health Department guests, Charlene
Muzyka and Mika Hyden, part of the Minneapolis Health and Family Support Program. Both are working
with the Healthy Communities Transformation Initiative (HCTI) funded through HUD’s Office of Healthy
Homes and Lead Hazard Control.
Sustaining Minnesota Biomonitoring: Workgroup Progress Report
Kristin Van Amber, Senior Management Consultant, Management Analysis Division, Minnesota
Management & Budget, reported on the Sustaining MN Biomonitoring Workgroup meetings. The
background material can be found on pages 5-12 of the June 10, 2014 Advisory Panel Meeting book.
Discussion: The following questions were posed to the panel:
•
•
What advice would you give the workgroup as they set out to develop an action plan?
Are there other sources of funding not listed here that they should consider?
Steven Pedersen questioned whether the Department of Health received a certain percentage of the
Clean Water Legacy funding that could be used. Jean responded that no Legacy funds are used for
biomonitoring. He added that foundations were a way to get short term funding. Assistant
Commissioner Aggie Leitheiser noted that she did not see any reference to the MDH general fund
money in the plan. Al Bender stated that in order to take a long-term approach, legislators will have be
to educated about the importance of this work and the necessity of these projects. He believed we
would not be able to get outside funds without legislative backing.
Aggie Leitheiser added that it is always good for any program to have multiple funding sources, as much
of the money the Department of Health receives is given out in grants. Jill Heins added that multiple
funders make you more sustainable for two to three year chunks, but most government entities are not
eligible to apply for foundation funding. She added that state funding is the most sustainable. Steven
Pedersen offered to use his position as a Senate appointee of the panel to give a presentation to the
Senate.
Greg Pratt felt that stronger messaging on why it is good to put money toward the program is needed—
the successes. Al Bender added that we have six years of success stories; we need to pick the ones that
37
everyone can identify with in order to move this forward. Jill Heins noted that some of this is urgent and
that we need to plan less and do more, especially in the communications area.
Steven Pedersen wondered if we had worked with the Inter Agency Research Group, the executive
branch, assistant commissioner-level group that discusses priorities that cut across all agencies.
Melanie Ferris added that partners are important, and it may be more appropriate for us to partner with
health equity and community organizations who have concerns around certain chemicals in an area. She
added, then we are back to proposing a project rather than sustainable funding.
Kris Van Amber noted that the next two years were critical to making connections and educating people.
The next step was planning the actions around this goal: the who, when, and resources necessary to get
a strategy in place.
MN FEET Protocol Review
Dr. Jessica Nelson reviewed progress on planning for MN Family Environmental Exposure Tracking (MN
FEET). Background material can be found on pages 13-17 of the June 10, 2014 AP Book.
As a new development, Jessica presented the following two options for project design:
Option 1, which the Panel has heard about before and is summarized in Figure 1 of the AP Book, would
recruit participants through staff from 3 Metro clinics. Enrollment would be open to all women, but
there would be target numbers for certain groups. We pared back what we would ask clinic staff to do
based on feedback from them; the current plan would have them ask eligible women for consent to test
the leftover newborn bloodspot and receive a follow-up phone call from MDH. A trained interviewer
would call the woman, administer the survey, and ask for additional consent to collect and test cord
blood and urine samples. All three samples would be collected at the hospital around the time of birth,
the cord and urine samples by hospital staff and the bloodspots as part of the MDH Newborn Screening
Program.
A variation on this design, Option 2, has emerged as staff have had more meetings with clinics. In this
approach, participants would be recruited primarily by phone. We would contract with two larger clinic
systems to identify potentially eligible patients. Because women would be selected from the larger clinic
system’s patient list, women from certain clinics, racial/ethnic backgrounds, and stages of pregnancy
could be randomly chosen. Women would receive a letter from the clinic saying they will be called, and
then trained researchers from the clinic system would conduct calls in the appropriate language. The
caller would introduce the project, ask for consent for all aspects of the project, and, if a woman
consents, conduct the phone survey. Specimen collection would be the same as in Option 1.
Jessica noted that, while we are pursuing both options, it looks like Option 2 is more feasible.
Jeanne Ayers was surprised to learn of cord blood collection and storage routinely being done in
hospitals. Lisa Yost questioned whether it was de-identified. Jean explained it is for diagnostic/health
care purposes only, so not de-identified in the hospital. David DeGroote asked whether we would need
to get consent to use cord blood. Jessica said yes. Al Bender thought it would be difficult to get consent
in writing, and Jessica added that biomonitoring projects have conducted consents over the phone in
the past, but that, of course, the IRB would have to approve.
Jill Heins questioned the timeline to recruit 500 participants. She had concerns based on her past
experiences. The clinics go in with the best intention and foresee no problems, but it does not happen
this way. If the clinics are using an electronic medical record (EMR), they do not have race/ethnicity
information and there is no way for a clinic to identify patients in their third trimester. She hoped one of
38
the options would work, but they have not had success with recruiting people through clinics. Jill offered
to share everything they have learned about what did not work.
Jeanne Ayers thought some clinics did collect race/ethnicity data, but there was no standardized format
for collecting or reporting the data. Jessica responded that they are working with the Health Partners
Institute for Education and Research and West Side Community Health Services, both of whom were
very encouraging about Option 2. There are certainly more details to work out, but, based on
information shared so far, both clinic systems do collect race/ethnicity data and can identify a woman’s
stage of pregnancy.
Jeanne Ayers wondered if, in Option 2, we would have to pay the contractors. Jessica responded that
the MN FEET budget includes contracts with clinics, but those conversations have just begun.
Jessica also presented the data analysis plan, with five main goals.
•
•
•
•
•
The first is to characterize exposure to mercury for all three sample types, and to compare to
results from MDH and other studies.
The second is to assess whether ethnic/racial disparities in exposure exist.
The third purpose is to investigate sources of mercury exposure using survey responses and
speciation.
The fourth is to extend our examination of whether newborn bloodspots are a good way to
assess newborn mercury exposure by comparing bloodspot v. cord blood v. maternal urine
results.
The fifth is to measure and perform similar analyses as above for lead and cadmium in cord
blood.
Jessica explained that we are primarily considering disparities by race/ethnicity, but will also look at
socioeconomic status. The question is, given our sample size, which racial/ethnic groups can we
consider? We want to design our study so that we have confidence we will be able to detect a disparity
if it exists. Two options under consideration are: 150 each of Somali, Hmong, Latina, and white women;
or, 200 each of Somali, Hmong, and white women. There could be other options as well. To address this
question, Jessica presented sample size calculations which show, for different-sized groups, the
statistically significant difference in mean mercury concentrations that MN FEET could detect (below).
Jessica showed these for different standard deviations to give a sense for the range; we don’t know
what this will be in our population. For some perspective, she also presented differences in means seen
by race/ethnicity in other studies (below). Jessica concluded that MN FEET probably will not be able to
capture more subtle differences, but should be able to detect larger ones.
39
Mean difference (µg/L) we could detect between groups (80% power)
TIDES bloodspot (GSD=1.8)
NHANES whole blood (GSD=2)
UT bloodspot (GSD=3.1)
n=150
0.6
0.65
0.97
n=200
0.5
0.57
0.85
n=300
0.4
0.47
0.72
Differences in other surveys
Blood mercury (µg/L)
NHANES 1999-2010, women 16-49
N
GM (CI)
95th %ile (CI)
Non-Hispanic White
4043
0.81 (0.76-0.87)
4.63 (4.11-5.2)
Non-Hispanic Black
2230
1.02 (0.94-1.1)
4.42 (3.8-5.15)
Mexican American
2589
0.68 (0.64-0.73)
2.87 (2.58-3.2)
Other Hispanic
751
0.98 (0.85-1.14)
4.32 (3.56-5.23)
Other Race
474
1.5 (1.3-1.74)
8.68 (6.55-11.51)
Non-Hispanic White
Non-Hispanic Black
Non-Hispanic Asian
Hispanic
NYC HANES 2004, all adults
529
2.83 (2.62-3.07) 10.85 (9.36-14.21)
390
2.61 (2.36-2.88) 9.26 (7.77-12.26)
231
4.11 (3.24-5.21) 19.19 (14.03-23.95)
630
2.27 (2.11-2.43)
8.46 (7.03-9.93)
Al Bender stated that this is a classic argument between sample size and budget. If you only studied two
groups, you would have a much greater chance of detecting a difference, because you had a larger
sample of both.
David DeGroote asked whether in past analysis we had looked at all of these racial categories: Somali,
African, Hmong, Latino? Is there any previous evidence that one or two of the groups would be more
likely to show disparities? Jessica responded that we are concerned about these groups, as well as other
groups, including African Americans, because there is evidence anecdotally and from other studies that
they may have higher exposures. But, we do not have any information on their exposures in Minnesota.
Lisa Yost wondered whether NHANES looks at socioeconomic status and whether there is an
intersection there that could be helpful. Jill Heins asked whether participants self-identify their
race/ethnicity, and what will happen if they associate themselves with multiple races. Jessica said that
we still need to decide what to do in this case. There is new language being proposed MDH-wide about
how to ask about race/ethnicity. Al Bender suggested that you may also have an opportunity, in the
post-data collection phase, to pool groups. He added that the reason to do this would be because the
joint confidence interval of the differences gets smaller.
Steven Pedersen wondered where cadmium fit in and whether you had considered expanding the risk
factors in the survey questions to diet. Jessica explained that the survey needs to be relatively short, but
added that we may have the space to add one or two key questions about exposures to cadmium or
lead. Steven Pedersen suggested adding a question about leafy vegetables, which take up cadmium.
Even if there is not a strong association, it would answer the question of whether some groups have
different dietary habits than others.
40
Greg Pratt mentioned herbal medicines because some of the Asian medicines contain metals. Jessica
replied that we are considering this question and have talked to a couple groups about suggested
wording. Greg Pratt did not have specific language in mind. Jean Ayers asked if use of ‘herbal/
traditional’ would work. Jessica thought different wording might apply to different groups. She has seen
‘folk remedies’ used, but got feedback that this is not ideal. Jill Heins suggested physician Naomi Duke as
an expert source to consult for studying traditional medicines in certain racial/ethnic groups. Jessica
added that MDH/Environmental Health has also worked on this issue.
Next, Jessica discussed the timeline, which has been extended for this project. The hope is to establish
clinic contracts and submit protocols to IRBs by the end of August. Recruitment would begin in
September and last for one year. Births would be staggered a few months later, and lab analysis and
individual results reporting would follow. Final data analysis and reporting should happen by Dec. 2016.
Alan Bender asked about contracts executed and whether the concept and principals were established.
Jessica responded that contracts were still being developed.
Melanie Ferris asked whether we know if use of skin-lightening creams is more frequent among new
immigrant or refugee women. She wondered whether length of time living in the U.S. should be a
screening question for eligibility. She added that with consent over the telephone and in a follow-up
mailing, it could be a challenge to be sure that the consent is really understood. Jessica assured her that
we have been working on this; the draft consent has been shortened to one page, and will be included
with a short description in plain language. We may also mail a consent, but have not made a final
decision about these procedures.
Jill Heins felt that at the clinic level, it is complicated to engage hospitals to get the blood draw. Jessica
responded that we will get the leftover bloodspot directly from the Newborn Screening Program, but
the cord blood and urine samples, which the Advisory panel has strongly advised we include, can only be
collected through hospitals. Which hospitals will depend on the clinics we choose and where their
babies are delivered; we know we can work with no more than two hospitals. The hospitals we have
spoken with have conducted these kinds of studies. In one example, the clinic/hospital flagged the EMR
of participants to indicate that a cord blood needed to be collected. There are a lot of logistics to figure
out.
Lisa Yost commented that one of the purposes is to better characterize the relationship between
bloodspots and body burden. This is separate from the disparity question. The disparity question is very
important and is an ultimate question, but it may be a lot harder to answer. To answer the question
about the relationship between bloodspots and body burden, you need numbers. If you can get that,
then you can work on the second question. You still need some level of permission to use the
bloodspots, but it becomes much easier than trying to get all three pieces in that triangle. Lisa suggested
trying to go for numbers in that first round.
Melanie Ferris underlined the importance of getting feedback on how we report results at the end of
the study – this will be important for the community, as will partnering with the clinics/hospitals or
community groups.
Biomonitoring Updates
Dr. Paul Moyer, Environmental Manager of the Public Health Laboratory gave an update on the MDH
Public Health lab. Background material can be found on pages 18-22 of the June 10, 2014 Advisory Panel
Meeting Book.
Dr. Moyer shared information on the water damage that occurred last winter, the expedited recovery
process completed in April, current Environmental Lab projects, and the CDC Biomonitoring Application.
41
The lab has analyzed cord and maternal blood samples from the National Children’s Study. The next
priority is the Riverside blood spot analyses and The Infant Development and Environment Study (TIDES
Study) whole blood vs. blood spot methodology.
The lab also has the Great Lakes Restoration Initiative under way and the Fish are Important for Superior
Health (FISH) study on the horizon for the Environmental Health Division.
The CDC Biomonitoring Application process was described by Dr. Moyer as a three-fold effort of the
Minnesota Department of Health’s Public Health Lab, as well as the Chronic Disease and Environmental
Epidemiology, and Environmental Surveillance and Assessment sections. The grant application was
submitted in early May, and we should know the result by September 1st.
Christina Rosebush gave a brief update on the PFC3 project. Written updates on the following mercury
projects were also included in the panel’s book (all updates can be found on pages 23-24 of the June 10,
2014 Advisory Panel Meeting Book):
•
•
•
Pregnancy and Newborns Exposure Study
NCS Newborn Mercury Biomarker Validation Supplemental Methodological Study and
Riverside Newborn Mercury Project
Panel members were invited to ask questions and comment on all updates.
Following the PFC3 update, Lisa Yost commented that the new residents who moved in after 2006 seem
like a more difficult recruitment effort because they, presumably, would not have any exposure to the
contaminated water. She asked how they are being recruited and what message is conveyed to them.
Christina Rosebush described the recruitment packet, which includes a fact sheet, a colorful flyer , a
letter, consents and questionnaire. Lisa added that the response rate was pretty good considering what
you were up against. Christina replied that recruitment involved three mailings, the third being a
reminder postcard that seemed to be effective. We also had phone numbers for about 60% of the
residents on the water billing records list and phone contact was very effective. Jean Johnson added that
there is an incentive; a $25 gift card. Christina said it remains to be seen if we will reach our recruitment
target; right now we have about 60-65 new resident participants.
Steven Pedersen presumed that we were looking at post-2006 because we do not think we will detect
heightened exposures in new Oakdale residents. He asked if we will look at where participants have
lived to see if they may have come from an area that had heightened PFC levels. Christina replied that
we will to a limited extent—we do not have information on PFC exposures in every area of Minnesota
and certainly not outside of the state. We ask participants about previous residences in Cottage Grove
and Lake Elmo, which were included in our original cohort populations. Steven Pedersen remarked that
you could have skewed results. Christina acknowledged that the results could reflect previous
exposures.
MN Tracking report: The Economic Burden of the Environment on Childhood Disease in
Minnesota
After a brief refreshment break, Jean Johnson began the Tracking portion of the meeting with a brief
overview of the purpose, findings, and limitations of the report: The Economic Burden of the
Environment on Childhood Disease in Minnesota. Background materials can be found on pages 25-35 of
the June 10, 2014 Advisory Panel Meeting Book.
About a year ago, the CDC directed Tracking grantee states to focus more effort on projects that
demonstrate ways that Tracking data can be used to inform policy and public health action. This report
42
is one such data use demonstration project and is being done in collaboration with five other states and
the CDC. The project looks at costs for 2 specific child health outcomes that are known to be causally
associated with environmental risk factors: asthma exacerbations and blood lead poisoning. We did
consider other outcomes (childhood cancer costs and neurodevelopmental disease costs). Although
other states are going to be reporting costs for these additional diseases, MDH decided to report on the
two that we felt were more defensible in terms of having an established environment-disease causal
connection.
The report uses methods first published by Landrigan et al in 1992 and updated in 2011. Landrigan
derived a range of environmental attributable fractions, or EAFs, for several childhood diseases by
consulting with experts and using a Delphi process. For asthma the EAF we used was 30% (range 1035%), and for blood lead poisoning the EAF is 100%.
MDH also used definitions for “environmental” factors consistent with Landrigan’s paper, which are
defined as human-origin, non-biological factors, and specifically exclude naturally occurring risks (such
as radon, indoor mold, pests) as well as behavioral risks such as diet and smoking.
After describing report and the results, Jean invited MDH epidemiologists Dr. Stephanie Yendell and Dr.
Wendy Brunner to comment on how they see this report being used by their programs.
Dr. Wendy Brunner, Epidemiologist with the Asthma Program, said this report will be useful in terms of
demonstrating the environmental burden of asthma in Minnesota, in grant writing, and in
communicating with our partners. We also expect that the findings are going to be useful to our
partners at the MPCA. We often interact with them about questions about what is the potential impact
of this facility on my community in terms of asthma. We also think it might be of particular interest to
local public health agencies in the metro area as well as organizations like Minnesota Environmental
Initiative, whom we’ve collaborated with in the past.
Dr. Stephanie Yendell, Epidemiologist with the Lead and Healthy Homes Program, reported that in terms
of blood lead, there’s a couple misconceptions about blood lead that this report helps to address. One is
that we’re “done with lead” in public health, because we’ve made great strides in reducing the numbers
in kids with exposure to lead. We want to show that although we have had a great public health success
in reducing exposure to lead, the costs remain very large and it still does require monitoring and funding
support. Also, this helps put a number on some of the costs associated with very low levels of lead. We
know through the literature that there is no level of exposure to lead where we cannot detect health
effects.
Mary Manning, MDH Chronic Disease Division Director, asked whether the California report used the
same definition for “environment”, looking at man-made pollution only or did California have a broader
definition. Jean answered that they are writing up their report now, so we are not sure what they used.
However, most states have adopted the same general definition. California did review studies
conducted in California and they calculated their own California-specific EAFs for asthma and childhood
cancers (different from Landrigan’s).
Jean noted that MDH will be adding another section for the report to discuss the policies and actions
currently being implemented to address these costs, but that the report will not promote any particular
policy initiative.
Discussion: The following questions were asked of the panel:
•
Given the limitations, what is the primary value of this report? How well does it serve its
intended purpose?
43
•
Should this report be updated or modified in the future to add other diseases or conditions? If
so, what changes are needed?
Gregory Pratt wondered if it was a correct interpretation to say that the asthma-related costs were
annualized, whereas the lead-based costs were lifetime costs, to which Jean agreed. Gregory continued
that to show those numbers side by side could be misleading, if you assume a 70-year lifetime. It might
be best to consider presenting this in an apples-to-apples comparison of cost. Jean agreed, adding that
each of those outcome costs is a little different in how they were done.
Stephanie Yendell clarified that the lead costs were per birth cohort year, for all the kids born in that
particular year throughout their lifetime, and so for 2010, it wasn’t all the kids that were under 6, it was
the kids who turned six in 2010. Gregory Pratt noted that if the lead exposure trend continues
downward, costs will go down, to which Stephanie agreed
Jill Heins Nesvold commented that she thought it was very valuable. She added that she approved of
mentioning some program things that MDH is already doing in the report, but she did not think there
could be use of the asthma home visit example because it only impacts the things that the EAF doesn’t
take into account. So, no matter if there was an increase in asthma home visits, the EAF (which is limited
to outdoor pollutants) can’t be impacted.
Jill Heins Nesvold continued that she would be very interested in COPD in the future. Even though it
does not involve kids, and it is more the end of the life, it has more connection to environment than
asthma does, and it’s more expensive. She offered to help in whatever way that she could; she would be
very interested in seeing the costs of COPD.
Alan Bender commented that this report caused him to think about this in much greater detail,
particularly relative to the issue of childhood cancer. He stated that he is starting to believe that perhaps
we should not be putting this out for any disease, because these are advocacy statements. The purpose
is to put issues in front of people and it implies their importance to public health, when in fact, there’s a
whole range of other attributable factors that are not considered. It would be more honest to put out
what the best estimates of the cost of the various diseases are and then, put out the range of all
statements of the EAF in the literature. Childhood cancers are the most problematic. You have the one
EAF (10%) from Landrigan, but also there are statements from the National Cancer Institute, from the
American Society of Clinical Oncology, and from the American Cancer Society, which says we don’t know
enough to make these estimates about childhood cancer. Let people apply whatever EAF percentage
they want to support their own advocacy statement.
Alan Bender noted that there are some punitive exposures that may actually decrease the risk of
cancers. For example, pesticide application reduces the general costs of fresh fruits and vegetables so
that certain populations have more access to them. Overall, the population attributable cumulative
cancer risk for pesticides may be negative (preventative).
Jill Heins Nesvold added her agreement. We know that asthma rates started to go up in the US with the
advent of the Mickey Mouse show. It was the first after-school tv program; kids started spending more
time inside; they were more sedentary. Our housing stock also got tighter and at that point we saw an
explosion of asthma rates. So there’s really lack of consensus in the expert community to the causal
factor of asthma. One thinks that there is an environmental component that might be causing it, but
there’s an equal amount of data that shows that there are environmental factors that are protective for
children. For instance, there’s a good amount of research showing that kids that grow up on farms rarely
have asthma because they have that kind of constant exposure, possibly some kind of protective factor.
44
Jill stated, “If we continue to spur the debate and continue to push the research agenda, I think that’s
wonderful.”
Jeanne Ayers commented that she didn’t think we should do anything that dampens appropriate
advocacy. When it came to the end of the report, where people would generally put policy
recommendations, we should be talking about the principles around the kinds of recommendations that
could be considered. It could be that based upon this understanding of the costs, rudimentary or flawed
as it may be, we should be continuing to explore both more understanding of the risks and any actions
that could decrease the environmental exposure because we’re going to need them both.
Gregory Pratt noted that to him, the problem with isolating one factor, is that many of the
environmental stressors are auto-correlated. If people are more likely to be exposed to one risk factor,
they’re often more likely to be exposed to many others. There’s also evidence that it’s the challenge of
multiple stressors that reduces the ability to respond to a single stress. Some studies have shown that
the number one issue in terms of susceptibility to stress is poverty, so that’s another part of the picture.
Lisa Yost liked the idea of decoupling the economic costs from the factors which are uncertain and
variable. She felt that did a better job of allowing multiple diseases, because you don’t know how they
correlate and inter correlate, that just becomes incredibly complex. She thought if you give people some
kind of review of the range that has been identified, then they could make their own decision. She
added that not only the legislature, but the general public also thinks about things in dollars. They may
not be able to understand the whole report, but they will definitely see the big numbers.
Alan Bender stated that one of the reasons he strongly recommended that childhood cancer be
excluded from this report was that, if you look at all the components of the analysis, the levels of
uncertainty for virtually all of them was so much higher than they were quantitatively different. He used
the example of childhood cancer and the unmeasurable impact on the family of the child with cancer-what that means to their earning and their livelihood in terms of the treatment and the follow up. Jill
Heins Nesvold agreed that it would be a problem accounting for all these factors; one being a lifetime
cost and one being an annual cost.
Jeanne Ayers commented these diseases are multifactorial, so saying (in the report) that there has to be
multifactorial approaches; they have to be thought about together and we have data to suggest that
there are some areas that are amenable to intervention and others that need further exploration.
Mary Manning added that the things that could be done, even though they were behavioral, rather than
environmental, had to be addressed. Jill Heins Nesvold agreed that home visiting, the home assessment,
and remediation was vital to asthma; they were 50% of the puzzle. But that’s all been taken out of the
Landrigan definition. Mary Manning agreed that acknowledging the indoor environment is critical for
addressing asthma.
Alan Bender added that our social resolve to deal with particular risks plays a big role in this, far more
than any of the uncertainty of the scientific relationships. So it’s a very complicated issue when we get
to speaking to advocacy and we just have to be cautious as to what we’re saying.
Jill Heins Nesvold commented that in light of the sustainability conversation at the beginning of the
meeting, the report contains so many excellent points and sound bites that it could be used by your
communications group on a daily basis. Jean replied that they had plans for breaking the report down
into infographics.
Melanie Ferris offered to pass the report onto her staff economist. She said she was curious, for the
blood lead poisoning, why some of the short-term cause, the direct treatment, and assessments weren’t
included. The challenge of these kind of calculations in general is that the assumptions are not always
45
clear. Decisions do have to be made around the quality of evidence. So while it still is very difficult and
there are limitations, being able to describe that and present, in this complicated landscape, a
conservative estimate based on our best information. It’s important for the department to lead the way
in showing how to sift through these complicated issues.
Jeanne Ayers asked if there would be a section describing the assumptions that were used, or
conclusions. Melanie Ferris explained that just being able to be very explicit and transparent is covering
that, but to the general public, that may be a hard thing to be able to sift through.
Stephanie Yendell clarified that one of the papers that we looked at had included direct costs for lead. It
was approximately 2 orders of magnitude smaller than the IQ loss. So it basically ended up dropping out
from rounding error. That was one of the reasons we didn’t include it. Also there’s very few cases that
ended up being hospitalized or treated. There are costs for local public health to do education and to do
the environmental assessments, but a lot of our costs are in the surveillance, which isn’t directly related
to how high the blood lead levels are.
Cathy Villas-Horns commented that it was very valuable to do this, even with all the imperfections in
coming up with the numbers. It was unusual in that we haven’t often tried to quantify the ‘what if we
don’t do something?’ In light of all the arguments against doing things, this showed us what the cost,
collectively, would be if we don’t do the things we’re doing in prevention of these things and the
cleanup. MDH could present the information with all the precautions and It would still be very useful to
have these numbers.
David DeGroote agreed, noting that too much of the time it has been all anecdotes heard in public or in
the legislature. This provided a cost, “warts and all”. Maybe keep some things around how we had
gotten there and some things we’ve done about what these problems are. So that, whether it’s
childhood cancer, or whether it’s asthma, COPD, there were real costs and here was our best estimate,
and if we don’t continue to do something about the problem, the costs are still going to be there.
Steven Pedersen commented that what was missing was the question of what to do with this
information? It was his feeling that the legislature would ask, “what do you want us to do?” He noted
that this is a first step to a policy position, but legislators want to know what is this risk in relation to and
where is my money best spent for protecting children. Is there some place else? If there is, well, talk to
me about that. If there isn’t, then tell me what you want me to do.
Wendy Brunner asked to make a quick clarification just to make sure everybody is clear that for asthma,
this report is measuring the environmental cost related to exacerbation, so not whether you have
asthma or not because that science is not clear at all. There’s some evidence that air pollution is
associated with the development of asthma in the first place, but that’s not consensus. There’s certainly
consensus that air pollution, as referred to in the environmental attributable fraction, is connected with
outdoor air and with exacerbations.
Jean thanked everyone. Staff will take all comments into consideration and will complete the report.
Environmental Justice in Minnesota: MPCA’s Approach
Ned Brooks, Environmental Justice Coordinator at the MPCA, gave an overview of a new Environmental
Justice Initiative at the MPCA. The background materials for this topic are found on pages 36-40 of the
June 10, 2014 Advisory Panel Meeting Book.
Ned welcomed the opportunity to present an overview of what the MPCA is doing and, more
importantly, stimulate thoughts and discussion among panel members about how the EHTB program
can work with the PCA and how we can support each other.
46
First, Ned provided background and definitions about what the MPCA means by “environmental
justice.” Ned mentioned the Dayton Administration’s focus on reducing disparities across all state
government’s programs and outcomes; that it’s closely related to the health disparity work of the health
department. Ned added that there’s a more organized local and national environmental justice
movement, and the PCA Commissioner is also very passionate about the issue, so we are working very
hard to do a much better job than we have before.
There are the two pillars of environmental justice: fair treatment and meaningful involvement. Fair
treatment is about exposure to pollutions. PCA’s mission is to protect and improve the environment, but
also to enhance human health. When PCA talks about environmental justice, it’s mostly about the health
component—to make sure there is not disproportionate exposure to harmful pollutants. Multiple
exposures on top of overburdened people is another part of environmental justice, as well as the lack of
voice and political clout in the process—that’s another tenet of environmental justice’s meaningful
involvement. PCA strives to make sure that all Minnesotans have an opportunity to be involved in
decisions that are going to affect them.
Ned explained that they had recently included environmental justice as a goal in the PCA strategic plan
for the first time (one of 15 goals). The initial focus has been to analyze how MPCA’s program activities
may have an effect on reducing disproportionate impacts and provide opportunities to more
meaningfully involve Minnesotans.
MPCA is also working to develop external relationships with communities. Many times there will be a
contentious issue, and that’s the first time people meet MPCA staff, when they’re angry, and that’s not a
great place to start. Building relationships, identifying various members of the community, particularly
those that represent lower income and minority groups, and also working to coordinate among state
government, because many of us are struggling with the same issues, is key.
Ned continued that the MPCA is developing a framework with a goal of having something similar to
EPA’s Environmental Justice Action Plan for 2014. There’s five areas listed: stakeholder engagement;
outreach around specific actions, such as permitting actions; talking about ways to characterize, identify
which communities are considered more overburdened or are a potential concern for environmental
justice. Ned shared examples of how the components of the framework are being developed.
And to transition towards the thinking of the Environmental Health Tracking, he talked about how
they’re trying to measure effectiveness. Tracking and monitoring levels of pollution in environmental
justice areas would be especially helpful, and an opportunity for linking further with EHT.
Ned hoped he’d stimulated some thinking on the panel’s part on how the Health Tracking program and
PCA could work together.
Discussion: The following questions were asked of the panel:
• How can the MN Tracking program best support the MPCA’s work?
• What data would be beneficial for informing the screening process and the evaluation of
outcomes that is planned?
Jeanne Ayers wondered if Ned had thoughts about what data would be beneficial from the Health
Department that would facilitate the kind of more robust community decision making that he was
envisioning? Ned replied that some help, in particular in asthma, with what the best measure is. There is
a controversy as to whether it is about hospitalizations or emergency room visits; that sort of thing.
What health outcomes can they measure that are due to exposures and how can they track those over
time? To the extent that there is data available to correlate environmental exposures to health
outcomes that could be parsed out by the census tract or areas like that, that would be most useful. Jill
47
Heins Nesvold responded that asthma hospitalizations was the better measure. Emergency room visits
for asthma were too volatile and were based on Medicaid coverage in the State of Minnesota, so when
there’s more generous coverage policies for individuals on Medicaid, asthma emergency department
visits go down and when it tightens up, emergency department visits go up because that’s their primary
care at that time, so it’s too volatile, so you are right on track with hospitalizations. Jill continued that If
you are looking for other data sources, if you are going to select asthma hospitalizations, you need to
look at COPD hospitalizations as well. Certainly without a doubt the environment relates to COPD
exacerbations.
Ned mentioned a joint initiative to work with the Health Department to identify ways where we could
have an influence in reducing air pollution related issues, and respiratory disease in environmental
justice areas. It included health impact assessment and report on the health of twin citians related to air
pollution.
Shannon Lotthammer, MPCA Director of Environmental Analysis & Outcomes, introduced herself, after
arriving late from another meeting. She noted that the Health Tracking Program is already supporting
the PCA’s work by providing the kind of information that Ned discussed. Shannon noted that MPCA is
striving to engage communities in conversations in advance of permitting decisions. She shared a
specific example of how MPCA is using health outcome data to help communicate with permittees
about the need for greater community engagement and to look for opportunities to reduce impacts on
vulnerable communities that go beyond meeting standards and permitting requirements. So having this
kind of information really helps PCA, and that’s also a two way street. As PCA gets further into this and
identifies needs or opportunities, having the partnership with the Department of Health and having this
group here will allow PCA to bring ideas forward. The more data can be shared, the better informed
policy decisions will be made to move forward to achieve those health outcomes that we are all trying to
move towards.
Jeanne Ayers commented that she really appreciated the approach of the MPCA; the recognition that it
was not just whatever is happening in the community, but it was the level of vulnerability of the
community. There are particular communities which you are addressing that are more vulnerable, which
would suggest that we should actually have more supports and protective approaches in those
communities versus the kind of clustering of hazards that sometimes does happen in those
communities. This is consistent with what we’re trying to lift up with the MDH health equity report. She
really appreciated this pilot that we’re going to learn together.
Tracking Updates
The following tracking updates were provided in report form on pages 41-45 of the June 10, 2014
Advisory Panel Meeting Book. Panel members were invited to ask questions or comment on the
following updates:
•
•
•
•
•
CDC Renewal Application
Portal Updates
New HIA Toolkit
Health and Climate Video
Urban Air and Health Project
New Business
There was no new business.
Audience Questions
48
Visitor Charlene Muzyka, Minneapolis Health Department commented on the last discussion about
presenting data together in a user-friendly format that has overlays and rankings of smaller geographic
areas—that is what the Healthy Communities Transformation Initiative is trying to do for Minneapolis.
We are one of 4 pilot cities in the country. We want this tool to be piloted by different organizations and
people in Minneapolis within the next year. We hope to get feedback on how it’s used to have these
types of conversations and to effect different policy decisions. Charlene added that the website is not up
yet, but, at a later date, she would be happy to present to this group, if interested. The pilot group will
upload the data.
Jeanne Ayers added that there was a steering committee that spent a lot of time looking for indicators
that were commonly available.
Adjournment
Lisa Yost adjourned the meeting at 4:00 p.m. The next Advisory Panel meeting will be held on October
14, 2014, from 1:00–4:00 p.m. at the American Lung Association in Minnesota.
49
Environmental Health Tracking and Biomonitoring Advisory Panel Roster
As of April 2014
Bruce Alexander, PhD
School of Public Health
University of Minnesota
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
Dept. of Public Health & 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 & 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
Pat McGovern, PhD, MPH
School of Public Health
University of Minnesota
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
50
Steven Pedersen, MPH
8403 Mississippi Boulevard NW
Coon Rapids, MN 55433
612-850-1058
[email protected]
Minnesota Senate appointee
Gregory Pratt, PhD
Minnesota Pollution Control Agency
Environmental Analysis & Outcomes Division
520 Lafayette Road
St. Paul, MN 55155-4194
651-757-2655
[email protected]
MPCA appointee
Cathy Villas-Horns, MS, PG
Minnesota Dept. of Agriculture
Pesticide & Fertilizer Management Division
625 Robert Street North
St. Paul, Minnesota 55155-2538
651-201-6697
[email protected]
MDA appointee
Lisa Yost, MPH, DABT
ENVIRON International Corporation
333 West Wacker Drive, Suite 2700
Chicago, IL 60606
Local office
479 Iglehart
St. Paul, Minnesota 55103
Phone: 651-225-1592
Cell: 651-470-9284
[email protected]
At-large representative
51
Biographical sketches of advisory panel members
Bruce H. Alexander is a 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’s 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, MPH, 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 in the areas of 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.
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
52
influenza. Jill holds a master’s degree in health management and a short-course master’s degree in
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.
Steven Pedersen is a retired Environment, Health, and Safety (EHS) scientist who worked for BAE
Systems in Fridley, MN. He completed his Masters in Public Health at the University of Minnesota, with a
specialization in environmental health. He has thirty-five years’ experience working on EHS issues;
focusing on environmental compliance and the development and implementation of a management
system compliant with the requirements of the international standards. He has worked in EHS project
management at a number of aerospace companies in Minnesota, Washington, and California. He
worked on environmental legislative and regulatory issues and is an expert on the requirements of the
Toxic Substances Control Act as it affects article-manufacturing companies. He was the project manager
implementing an enterprise-wide Occupational Safety, Health, and Environment (OSHENs) illness &
injury data-management system. Recently he was a Governor-appointed member, representing the
business community, of the State's Clean Water Council.
Gregory Pratt is a research scientist at the Minnesota Pollution Control Agency. He holds a Ph.D. in Plant
Physiology from the University of Minnesota, where he worked on the effects of air pollution on
vegetation. Since 1984 he has worked for the MPCA on a wide variety of issues including acid
deposition, stratospheric ozone depletion, climate change, atmospheric fate and dispersion of air
pollution, monitoring and occurrence of air pollution, statewide modeling of air pollution risks, and
personal exposure to air pollution. He is presently cooperating with the Minnesota Department of
Health on a research project on the Development of Environmental Health Outcome Indicators: Air
Quality Improvements and Community Health Impacts.
Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU) within the Pesticide
and Fertilizer Management Unit of the Minnesota Department of Agriculture. Cathy holds a Master of
Science in Geology from the University of Delaware and a Bachelor of Science in Geology from Carleton
College and is a licensed Professional Geologist in MN. The IRU oversees or conducts the investigation
and cleanup of point source releases of agricultural chemicals (fertilizers and pesticides including
herbicides, insecticides, fungicides, etc. as well as wood treatment chemicals) through several different
programs. Cathy has worked on complex sites with Minnesota Department of Health and MPCA staff,
and continues to work with interagency committees on contaminant issues. She previously worked as a
senior hydrogeologist within the IRU, and as a hydrogeologist at the Minnesota Pollution Control Agency
and an environmental consulting firm.
53
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.
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Staff Biosketches
Wendy Brunner, PhD, serves as surveillance epidemiologist for the MDH Asthma Program since 2002,
and joined Minnesota’s Environmental Public Health Tracking and Biomonitoring Program (MN Tracking)
program on a part-time basis in fall 2009. Previously, she worked on occupational respiratory disease
studies for MDH. She has a master’s degree in Science and Technology Studies from Rensselaer
Polytechnic Institute and a master’s degree in Environmental and Occupational Health from the
University of Minnesota. She received her doctorate in the Division of Epidemiology and Community
Health at the University of Minnesota.
Betsy Edhlund, PhD, is a research scientist in the Environmental Section of the Public Health Laboratory
at the Minnesota Department of Health. She works in the metals laboratory developing methods and
analyzing samples for both biomonitoring programs and emergency response. Betsy received her PhD in
chemistry from the University of Minnesota where her research focused on the photochemistry of
natural waters.
Carin Huset, PhD, has been a research scientist in the Environmental Laboratory section of the MDH
Public Health Laboratory since 2007. Carin received her PhD in Chemistry from Oregon State University
in 2006 where she studied the fate and transport of perfluorochemicals in aqueous waste systems. In
the MDH PHL, Carin provides and coordinates laboratory expertise and information to program partners
within MDH and other government entities where studies require measuring biomonitoring specimens
or environmental contaminants of emerging concern. In conjunction with these studies, Carin provides
biomonitoring and environmental analytical method development in support of multiple analyses.
Jean Johnson, PhD, MS, is Program Director/Principal Investigator for MN Tracking. Dr. Johnson
received her Ph.D. and M.S. degrees from the University of Minnesota, School of Public Health in
Environmental Health and has 25 years of experience working with the state of Minnesota in the
environmental health field. As an environmental epidemiologist at MDH, her work has focused on
special investigations of population exposure and health, including studies of chronic diseases related to
air pollution and asbestos exposure, and exposure to drinking water contaminants. She is currently the
Principal Investigator on an EPA grant to develop methods for measuring the public health impacts of
population exposure to particulate matter (PM) in air. She is also an adjunct faculty member at the
University of Minnesota School of Public Health.
Tess Konen, MPH, graduated from the University of Michigan’s School of Public Health with a master’s
in Occupational Environmental Epidemiology. She completed her thesis on the effects of heat on
hospitalizations in Michigan. She currently is a CSTE/CDC Epidemiology Fellow in MN Tracking working
on birth defects, pesticides, climate change, and a follow-up study of the Northeast Minneapolis
Community Vermiculite Investigation cohort.
Mary Jeanne Levitt, MBC, is the communications coordinator with MN Tracking. She has a Master’s in
Business Communications and has worked for over 20 years in both the public and non-profit sector in
project management of research and training grants, communications and marketing strategies, focus
groups and evaluations of educational needs of public health professionals. She serves on 3 institutional
review boards which specialize in academic research, oncology research, and overall clinical research.
Paula Lindgren, MS, received her Masters 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 MN Tracking 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
55
addition to her work for MN Tracking, she works for various programs within Chronic Disease and
Environmental Epidemiology including the Asthma program, Center for Occupation Health and Safety,
Minnesota Cancer Surveillance System, and Cancer Control section.
Matthew Montesano, the Data Portal Coordinator with the Minnesota Tracking Program, is responsible
for the Data Portal’s content strategy, ensuring that its utility is maximized through evidence-based
health and science communications practices. He has expertise in communicating health and science to
lay audiences and developing strategic web-based public health material. He is an advocate for the use
of plain language and data visualization techniques that increase users’ understanding of complex
information. He has over 8 years of nonprofit and public health experience with community
programming, research, and evaluation.
Jessica Nelson, PhD, is an epidemiologist with MN Tracking, 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.
Christina Rosebush, MPH, is an epidemiologist with MN Tracking. Her work includes the development
and coordination of biomonitoring projects that assess perfluorochemicals (PFCs) and mercury in
Minnesota communities. She also works on collection and statistical analysis of public health
surveillance data for MN Tracking, with a focus on behavioral risk factors. Christina received her
Master’s degree in epidemiology from the University of Minnesota’s School of Public Health, completing
research in PFC biomonitoring for the Minnesota Department of Health in partial fulfillment of her
degree.
Jeannette M. Sample, MPH, is an epidemiologist with MN Tracking at the Minnesota Department of
Health, working primarily with the collection and statistical analysis of public health surveillance data for
MN Tracking. She also works on research collaborations with academic partners relating to reproductive
outcomes and birth defects. Prior to joining MN Tracking, she was a CSTE/CDC Applied Epidemiology
Fellow with the MDH Birth Defect Information System. Jeannette received her Master’s degree in
epidemiology and biostatistics from The George Washington University in Washington, DC
Blair Sevcik, MPH, is an epidemiologist with MN Tracking at the Minnesota Department of Health,
where she works on the collection and statistical analysis of public health surveillance data for .MN
Tracking. Prior to joining MN Tracking 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.
Chuck Stroebel, MSPH, is the MN Tracking 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 Masters of Public Health in
Environmental Health Sciences from the University of North Carolina (Chapel Hill). He has over 15 years
of expertise in environmental health, including areas of air quality, pesticides, climate change, risk
assessment, and toxicology. 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 Minnesota EPHT Technical and Communications Teams.
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Janis Taramelli, TTS, is the Community Outreach Coordinator for MN Biomonitoring, responsible for
communications with the MN Tracking Advisory Panel and study participants. A tobacco treatment
specialist, she has 20 years of experience working on research studies, surveys, group facilitation, and
one-on-one counseling in both the public and private sectors. Her background includes development
and coordination of statewide QUITPLAN at Work programs, metro area QUITPLAN centers, and piloting
tobacco cessation and heart healthy programs for Minnesota’s Sage (Breast and Cervical Cancer
Screening) and SagePlus (Heart Health Screening) programs, funded by the Centers for Disease Control.
Allan N. Williams, MPH, PhD, is an environmental and occupational epidemiologist in the Chronic
Disease and Environmental Epidemiology Section at the Minnesota Department of Health. He is the
supervisor for the MDH Center for Occupational Health and Safety. For over 25 years, he has worked on
issues relating to environmental and occupational cancer, cancer clusters, work-related respiratory
diseases, and the surveillance and prevention of work-related injuries among adolescents. He has served
as the PI on two NIOSH R01 grants, 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.
57
Environmental Health Tracking and Biomonitoring Statute
$1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount, $900,000
each year is for transfer to the Minnesota Department of Health. The base appropriation for this
program for fiscal year 2010 and later is $500,000.
144.995 DEFINITIONS; ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING
given.
(a) For purposes of sections 144.995 to 144.998, the terms in this section have the meanings
(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, peerreviewed studies of humans, animals, or cells have demonstrated that the chemical is known or
reasonably anticipated to adversely impact human health.
(j) "Environmental health tracking" means collection, integration, analysis, and dissemination of
data on human exposures to chemicals in the environment and on diseases potentially caused or
aggravated by those chemicals.
144.996 ENVIRONMENTAL HEALTH TRACKING; BIOMONITORING.
Subdivision 1. Environmental health tracking. In cooperation with the commissioner of the
Pollution Control Agency, the commissioner shall establish an environmental health tracking program
to:
(1) coordinate data collection with the Pollution Control Agency, Department of Agriculture,
University of Minnesota, and any other relevant state agency and work to promote the sharing of and
access to health and environmental databases to develop an environmental health tracking system for
Minnesota, consistent with applicable data practices laws;
(2) facilitate the dissemination of aggregate public health tracking data to the public and
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researchers in accessible format;
(3) develop a strategic plan that includes a mission statement, the identification of core
priorities for research and epidemiologic surveillance, and the identification of internal and external
stakeholders, and a work plan describing future program development and addressing issues having to
do with compatibility with the Centers for Disease Control and Prevention's National Environmental
Public Health Tracking Program;
(4) develop written data sharing agreements as needed with the Pollution Control Agency,
Department of Agriculture, and other relevant state agencies and organizations, and develop additional
procedures as needed to protect individual privacy;
(5) organize, analyze, and interpret available data, in order to:
(i) characterize statewide and localized trends 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.
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144.997 BIOMONITORING PILOT PROGRAM.
Subdivision 1. Pilot program. With advice from the advisory panel, and after the program
guidelines in subdivision 4 are developed, the commissioner shall implement a biomonitoring pilot
program. The program shall collect one biospecimen from each of the voluntary participants. The
biospecimen selected must be the biospecimen that most accurately represents body concentration of
the chemical of interest. Each biospecimen from the voluntary participants must be analyzed for one
type or class of related chemicals. The commissioner shall determine the chemical or class of chemicals
to which community members were most likely exposed. The program shall collect and assess
biospecimens in accordance with the following:
(1) 30 voluntary participants from each of three communities that the commissioner identifies
as likely to have been exposed to a designated chemical;
(2) 100 voluntary participants from each of two communities:
(i) that the commissioner identifies as likely to have been exposed to arsenic; and (ii) that the
commissioner identifies as likely to have been exposed to mercury; and
(3) 100 voluntary participants from each of two communities that the commissioner identifies as
likely to have been exposed to perfluorinated chemicals, including perfluorobutanoic acid.
Subd. 2. Base program. (a) By January 15, 2008, the commissioner shall submit a report on the
results of the biomonitoring pilot program to the chairs and ranking members of the committees with
jurisdiction over health and environment.
(b) Following the conclusion of the pilot program, the commissioner shall:
(1) work with the advisory panel to assess the usefulness of continuing biomonitoring among
members of communities assessed during the pilot program and to identify other communities and
other designated chemicals to be assessed via biomonitoring;
(2) work with the advisory panel to assess the pilot program, including but not limited to the
validity and accuracy of the analytical measurements and adequacy of the guidelines and protocols;
(3) communicate the results of the pilot program to the public; and
(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
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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, communitybased 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.
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Subd. 3. Duties. The advisory panel shall make recommendations to the commissioner and the
legislature on:
(1) priorities for health tracking;
(2) priorities for biomonitoring that are based on sound science and practice, and that will
advance the state of public health in Minnesota;
(3) specific chronic diseases to study under the environmental health tracking system;
(4) specific environmental hazard exposures to study under the environmental health tracking
system, with the agreement of at least nine of the advisory panel members;
(5) specific communities and geographic areas on which to focus environmental health tracking
and biomonitoring efforts;
(6) specific chemicals to study under the biomonitoring program, with the agreement of at least
nine of the advisory panel members; in making these recommendations, the panel may consider the
following criteria:
(i) the degree of potential exposure to the public or specific subgroups, including, but not limited
to, occupational;
(ii) the likelihood of a chemical being a carcinogen or toxicant based on peer-reviewed health
data, the chemical structure, or the toxicology of chemically related compounds;
(iii) the limits of laboratory detection for the chemical, including the ability to detect the chemical
at low enough levels that could be expected in the general population;
(iv) exposure or potential exposure to the public or specific subgroups;
(v) the known or suspected health effects resulting from the same level of exposure based on
peer-reviewed scientific studies;
(vi) the need to assess the efficacy of public health actions to reduce exposure to a chemical;
(vii) the availability of a biomonitoring analytical method with adequate accuracy, precision,
sensitivity, specificity, and speed;
(viii) the availability of adequate biospecimen samples; or
(ix) other criteria that the panel may agree to; and
(7) other aspects of the design, implementation, and evaluation of the environmental health
tracking and biomonitoring system, including, but not limited to:
(i) identifying possible community partners and sources of additional public or private funding;
(ii) developing outreach and educational methods and materials; and
(iii) disseminating environmental health tracking and biomonitoring findings to the public.
Subd. 4. Liability. No member of the panel shall be held civilly or criminally liable for an act or
omission by that person if the act or omission was in good faith and within the scope of the member's
responsibilities under sections 144.995 to 144.998.
INFORMATION SHARING.
On or before August 1, 2007, the commissioner of health, the Pollution Control Agency, and the
University of Minnesota are requested to jointly develop and sign a memorandum of understanding
declaring their intent to share new and existing environmental hazard, exposure, and health outcome
data, within applicable data privacy laws, and to cooperate and communicate effectively to ensure
sufficient clarity and understanding of the data by divisions and offices within both departments. The
signed memorandum of understanding shall be reported to the chairs and ranking members of the
senate and house of representatives committees having jurisdiction over judiciary, environment, and
health and human services.
Effective date: July 1, 2007
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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.
Current Appropriation for EHTB
Office of the Revisor of Statutes
88th Legislature, 2013, Regular Session,
Chapter 114 Minnesota Session Laws
Subd. 2. Water
25,453,000
25,454,000
3,737,000
3,737,000
75,000
75,000
21,641,000
21,642,000
Appropriations by Fund
General
State Government Special Revenue
Environmental
$913,000 the first year and $913,000 the second year are from the environmental fund to continue
perfluorochemical biomonitoring in eastern metropolitan communities, as recommended by the
Environmental Health Tracking and Biomonitoring Advisory Panel, and address other environmental
health risks, including air quality. Of this amount, $812,000 the first year and $812,000 the second year
are for transfer to the Department of Health.
NEW 2014 Legislation
20.28 Sec. 13. CLARIFICATION OF CONTINUED EXISTENCE.
20.29 This section clarifies that the groups listed in this section did not expire June 30,
20.30 2009. Actions taken by the groups listed in this section and public funds spent on behalf
20.31 of these groups since June 30, 2009, are valid:
21.1
(1) Medical Assistance Drug Formulary Committee, created in Minnesota Statutes,
21.2
section 256B.0625, subdivision 13c:
21.3
(2) Environmental Health Tracking & Biomonitoring Advisory Panel, created
21.4
in Minnesota Statutes, section 144.998:
21.5
(3) Water Supply Systems and Wastewater Treatment Facilities Advisory Council,
21.6
created in Minnesota Statutes, section 115.741; and
21.7
(4) Prescription Electronic Reporting Advisory Committee, created in Minnesota
21.8
Statutes, section 152.126, subdivision 3,
21.9
EFFECTIVE DATE: This section is effective the day following final enactment
21.10 and applies retroactively from June 30, 2009.
63