10/13/2015 AGENDA
Health Promotion & Chronic
Disease, Environmental
Epidemiology, PO Box 6482
St. Paul, MN 55164-0882
651-201-5900
www.health.state.mn.us
Meeting of the Advisory Panel to the
Environmental Health Tracking and Biomonitoring Program
1:00 – 4:00 pm at the American Lung Association in Minnesota
490 Concordia Avenue, St. Paul, MN
Time
Agenda Items
Presenters
Description/expected outcome
1:00
Welcome & Introductions
Pat McGovern, Chair
Panel members & audience are invited to
introduce themselves.
1:05
Tracking Updates
Chuck Stroebel
Information item: Chuck will provide a brief
update on the tracking program. Other updates
are provided in written form. Panel members
are invited to ask questions and comment on
these updates.
Jessica Nelson
Discussion item:
•
•
•
•
•
1:10
1:25
Grant year planning
underway: 20152016
Communications
Plan Updated
New topic added to
Data Access Portal
Data updates
Be Air Aware web
site launch
MN FEET Sub-study
comparing mercury test
methods
Jessica will review the proposed protocol for a
sub-study of the MN FEET population
comparing mercury levels in matched newborn
blood spots and umbilical cord blood.
Questions for the panel:
Discussion
•
•
•
1:40
Information item: These updates are provided
in written form. Panel members are invited to
ask questions and comment on these written
updates.
Biomonitoring Updates
•
•
PFC3 Project
MN FEET Project
1:45
PFC Conference Recap:
Recent Epidemiology and
Toxicology
1:55
Refreshments
Do you agree with the protocol as it is
presented?
What suggestions do you have for our
recruitment messaging?
What suggestions do you have for the
proposed analysis plan?
Christina Rosebush and
Helen Goeden
Information item: Christy and Helen will recap
the recent PFC Conference. This presentation is
for information only. Panel members are
invited to ask questions and comment on this
presentation.
1
Time
Agenda Items
Presenters
Description/expected outcome
2:10
Update on Joint MDH/MPCA
Air and Health Initiative
Jim Kelly, Manager,
Environmental Health
Division
Information item: Jim will present an update
on the release of the Life and Breath Report,
the Be Air Aware website, and plans for FY16.
Panel members are invited to ask questions
and comment on this update.
2:20
Inequities in air pollution
exposure and risk
Greg Pratt, Minnesota
Pollution Control
Agency
Information Item: Greg will present
information on his 2015 paper on Inequities in
air pollution exposure and risk in Minnesota.
Panel members are invited to ask questions
and discuss this topic after the next
presentation.
2:40
Monitoring air pollution at
the local level.
Kristie Ellickson,
Minnesota Pollution
Control Agency
Discussion item:
Staff from the MPCA will present information
on two projects currently monitoring air
pollution at the local level to better
characterize exposure inequities.
•
3:00
3:25
Roving monitors in the
Twin Cities area
• Community PAH
monitoring
Discussion
Proposed measures of
traffic for MN Tracking
•
•
3:40
Traffic Density –
map
Proximity to roads
Discussion
Questions for the panel:
• What conclusions can we make about
variation in air pollution levels within ZIP
codes? Are the differences likely to impact
community health?
• What can EHTB do to better describe
exposure disparities for informing public
health policy and action?
Jean Johnson and
Paula Lindgren
Discussion Item:
Jean will describe complimentary work
proposed by MN Tracking. Paula will
demonstrate two proposed population-based
measures of traffic exposure.
Question for the panel:
•
3:50
3:55
Public Comments and
Audience Questions
New Business
4:00
Motion to adjourn
What metric is most useful for tracking
population exposure to traffic-related air
pollutants?
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 OVERVIEW: TRACKING UPDATES ............................................................................................................. 4
SECTION OVERVIEW: MN FEET SUB-STUDY COMPARING MERCURY TEST METHODS ............................................. 8
SECTION OVERVIEW: BIOMONITORING UPDATES ................................................................................................. 8
SECTION OVERVIEW: PFC CONFERENCE RECAP: RECENT EPIDEMIOLOGY AND TOXICOLOGY ............................... 10
SECTION OVERVIEW: UPDATE ON JOINT MDH/MPCA AIR AND HEALTH INITIATIVE ............................................ 11
SECTION OVERVIEW: INEQUITIES IN AIR POLLUTION EXPOSURE AND RISK ......................................................... 12
SECTION OVERVIEW: MONITORING AIR POLLUTION AT THE LOCAL LEVEL. ......................................................... 15
SECTION OVERVIEW: PROPOSED MEASURES OF TRAFFIC FOR MN TRACKING ..................................................... 17
SECTION OVERVIEW: OTHER INFORMATION ....................................................................................................... 20
3
Section Overview: Tracking Updates
Chuck Stroebel will provide a brief update on the tracking program. Other updates are provided
in written form:
•
•
•
•
•
Grant Year Planning Underway: 2015-2016
Communications Plan Updated
New portal topic: Lyme Disease
Data Updates
Be Air Aware Web Site Launch
Information item:
Panel members are invited to ask questions and comment on these updates.
4
Tracking Updates
New Grant Year Started!
MDH received another year of funding with renewal of our cooperative agreement with the
CDC National Tracking Network. This funding is consistent with previous years, supporting a
new work plan for activities conducted from August 1, 2015 to July 31, 2016. While emphasis
continues to be maintenance and enhancements to the MN Tracking Data portal, several new
indicators will be developed/explored including:
•
•
•
•
•
•
Radon (new)
Childhood obesity (sub-county)
Smoking – youth (new)
Traffic (new)
Public water systems, contaminants (system level)
Birth outcomes (sub-county)
In addition, we will continue our collaborative project with the Great Lakes Inter-Tribal
epidemiology Center, Fond du Lac Tribal Community, and CDC.
Communications Plan Updated
Along with a new grant year comes a request for a new Communications Plan. The purpose of
the MN Tracking’s outreach and communication plan is to increase awareness, use and support
of the MN Tracking Data portal and resources for public health actions. MN Tracking’s
Communications Plan for the 2015-2016 grant year includes enhanced outreach to health care
organizations that conduct community assessments as required by the Affordable Care Act;
continued outreach to local public health, policy-makers, students, faculty and librarians; new
outreach to the media for building environmental public health literacy; expanded outreach to
nonprofit/non-governmental organizations that serve MN communities concerned about health
and environmental issues and Minnesota communities engaged in health impact assessments.
The plan includes building and maintaining relationships with stakeholders, conducting inperson demonstrations and trainings that promote use of Tracking Network data, promoting
and developing public health action stories through key informant interviews for the Tracking
Network that identify efficient and effective use of the portal data, utilizing social media and
developing communication materials. Finally, MN Tracking’s Communication Plan incorporates
activities that address the state of Minnesota’s initiatives advancing health equity and plain
language.
Lyme Disease Data Added to Portal
The MN Tracking Program launched new Lyme disease data on the Data Access Portal. Data
include state-level charts, as well as a static map with county-level data.
These data show that Lyme disease is increasing in Minnesota, highlighting the importance of
taking steps to prevent exposure.
6
Minnesota has joined some other states in the Tracking Network that have added Lyme disease
data to their state portals. Currently, Minnesota is participating in a national content
workgroup to evaluate/develop new climate change indicators, which include Lyme disease.
MN Tracking developed Lyme disease data in collaboration with the Vector-borne Disease Unit
at MDH. View Lyme disease data at: https://apps.health.state.mn.us/mndata/lyme
Data Updates
MN Tracking has been actively working to update data on the portal. Since the June Advisory
Panel meeting, updated data topics include: heart attacks, drinking water (community water
systems), heat-related illness, carbon monoxide poisonings, reproductive and birth outcomes,
environmental tobacco smoke exposure (adults), cancer incidence, and pesticide poisonings.
Updates for poverty and childhood lead poisoning are in progress and scheduled for release this
Fall.
Be Air Aware web site
In July 2015 the MPCA and MDH launched the new inter-agency web site, Be Air Aware
(https://beairawaremn.org/). This web site or “community toolkit” provides information about
how people can protect their health from air pollution (indoors and outdoors) and improve air
quality. The emphasis of this toolkit is on actions people can take, access to health and air
quality data, and what we can collectively better protect vulnerable populations. The primary
audiences identified for the site are: individuals and families, local officials and communities,
and businesses and employers.
A new inter-agency web site maintenance team meets regularly to maintain and update
content in the site, including news items and current events. This site is a part of the MN Air
and Health Initiative, which was funded through the MPCA Environmental Risks Initiative, and
includes in-kind contributions by the MN Tracking Program.
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Section Overview: MN FEET Sub-study comparing mercury test methods
Jessica will review the proposed protocol for a sub-study of the MN FEET population comparing
mercury levels in matched newborn blood spots and umbilical cord blood.
Introduction
Fetal exposure to mercury is of public health concern since even small amounts of mercury can
damage the developing brain and nervous system (1). A novel method of measuring fetal
mercury exposure is through testing of newborn bloodspots, small amounts of blood collected
from a newborn’s heel on a filter card soon after birth. Bloodspots are routinely collected for
state newborn screening programs to test for treatable health conditions not evident at birth.
Compared to the standard measures of prenatal exposure to mercury that test cord blood or
maternal blood, biomonitoring using bloodspots offers advantages of ease of collection,
storage, and decreased cost. Due to these advantages, interest in using newborn bloodspots
for biomonitoring is growing for a variety of exposures; recent studies have measured mercury
and other metals, cotinine, and perfluorochemicals in this specimen type (2-6). But, this type of
biomonitoring is a relatively new approach and involves a novel laboratory method. MDH is one
of a few state health agencies that have reported measuring mercury in newborn bloodspots.
The first MDH study, conducted by the Fish Consumption Advisory Program, measured mercury
in newborn bloodspots from infants born to mothers living around the Lake Superior Basin and
found that 10% of the 1,126 Minnesota infants tested had mercury concentrations greater than
the level corresponding to the U.S. Environmental Protection Agency’s (EPA) reference dose
(RfD) for methyl-mercury of 5.8 µg/L (3). This study raised questions about the extent of
mercury exposure in other parts of the state and whether the bloodspot lab methodology is a
valid and reliable measure of newborn exposure to mercury for purposes of public health
surveillance. The EHTB Advisory Panel agreed, and recommended that MDH continue
biomonitoring of newborn bloodspots to further evaluate the bloodspot method.
A recent MN Biomonitoring study conducted in collaboration with the University of
Minnesota’s The Infant Development and Environment Study (TIDES) began to address this
question by comparing mercury concentrations in newborn bloodspots to those measured in
cord blood samples from the same babies. Results were limited by a small sample size, but
indicated that mercury levels in newborn bloodspots were strongly correlated with levels in
paired cord blood, but that bloodspot measurements may systematically underestimate
mercury exposure compared to cord blood measures (see past Advisory Panel meeting notes;
manuscript under review). We concluded that the relationship between cord blood and
newborn bloodspot should be explored in future studies of larger populations and those with
higher mercury exposures.
Questions for the panel:
• Do you agree with the protocol as it is presented?
• What suggestions do you have for our recruitment messaging?
What suggestions do you have for the proposed analysis plan?
8
MN FEET Sub-study comparing mercury test methods
Protocol: MN FEET SUB-study
Rationale and goals
Minnesota Family Environmental Exposure Tracking (MN FEET), a biomonitoring project MN
Biomonitoring is conducting, collecting cord blood and urine samples from around 600 women
and their newborns from the Twin Cities Metro Area. Participants are from certain populations
that may be at risk for higher mercury exposures, including Hmong, Latina, Somali, and White
women and babies. The purposes of MN FEET are to assess exposure to mercury, lead, and
cadmium in these groups; identify disparities that may exist; investigate sources of exposure;
and help women, families, and communities learn how to protect babies from these chemicals.
MN FEET Sub-Study proposes to measure mercury in the residual portion of newborn
bloodspots collected for the MDH Newborn Screening Program from a subset of MN FEET
participants who consent to the testing. Rather than invite all MN FEET participants into MN
FEET Sub-Study, we will invite only those who had detectable mercury in their cord blood
sample. This design offers an efficient way to get a large sample size for the cord bloodnewborn bloodspot comparison. As the bloodspot lab method is more time-consuming and
costly than measuring mercury in cord blood, is it more efficient to restrict bloodspot testing to
those women with detectable cord blood mercury.
This design will allow us to collect paired cord blood, newborn bloodspot and urine samples
from the same mother-baby pairs. This large study population will allow for robust statistical
analysis of the study questions. Based on the TIDES findings, we would expect around 50-60%
of MN FEET participants to have detectable mercury levels in their cord blood; after
recruitment, we expect this to amount to 200-300 women in MN FEET Sub-Study.
MN FEET Sub-Study has the following goals:
1.
2.
3.
Continue to investigate the relationship between mercury levels in newborn
bloodspot v. cord blood as a way to assess the usefulness of the newborn bloodspot
method.
Conduct this investigation in a much larger and more diverse population, and in one
with a greater prevalence of detectable mercury exposures.
Assess whether newborn bloodspot biomonitoring for mercury exposure has utility
as a public health surveillance activity.
Study Design
Study population
The study population will comprise a subset of MN FEET participants, based on the eligibility
criteria below. MN FEET participants are Hmong, Latina, Somali, and White women receiving
prenatal care at certain Metro-area HealthPartners and West Side Community Health Services
clinics who plan to deliver at Regions Hospital. Women are being recruited prenatally through
collaboration with the HealthPartners Institute for Education and Research and SoLaHmo
4
Partnership for Health and Wellness, a community-based participatory research arm of West
Side Community Health Services. Expansion of MN FEET to include women planning to give
birth at Abbott Hospital is planned in the near future. Based on past studies, we estimate the
total MN FEET Sub-Study sample size will be roughly 200-300 women.
Eligibility
MN FEET participants will be eligible to participate in MN FEET Sub-Study according to these
two criteria: they gave a cord blood sample and they had detectable levels of mercury in their
cord blood sample.
Study methods
Participant recruitment and informed consent
Written informed consent was obtained from all MN FEET participants. As part of this, women
were informed that they may be contacted by MDH to ask if they want to be part of a follow-up
health study, and that they could decide at that time whether they wished to join.
Eligible women will receive a letter from MDH inviting them to participate, along with a consent
form and return envelope. If MDH does not receive their consent form by mail within two
weeks, staff will follow-up with them by phone in appropriate languages.
The consent form will meet all legal requirements for the research use of Newborn Screening
dried bloodspots, and will be reviewed by the MDH Newborn Screening Program and Legal
Affairs Unit.
Participants will be told that they will receive an additional $25 gift card for participating in MN
FEET Sub-Study.
Obtaining bloodspot samples from the Newborn Screening Program
MN Biomonitoring staff will securely transmit a list of consented mothers’ names to designated
MDH Newborn Screening Program staff, along with baby’s date of birth (i.e. date cord blood
was collected) and hospital of birth. Newborn Screening Program staff will match these
variables to the baby’s newborn bloodspot sample and will take 4 punches from the bloodspot,
along with appropriate QA/QC measures (4 blank punches from each card, periodic duplicates).
They will transfer the samples to the MDH Public Health Laboratory’s (PHL) Environmental Lab
using appropriate chain of custody forms. Only participant ID will be provided to the
Environmental Lab.
Laboratory analysis methods
The PHL Environmental Lab will perform laboratory analyses. Two 3-mm filter paper disks
containing dried blood, punched by the Newborn Screening Program from blood spots on the
filter paper card, will be placed into a 96-well filter plate containing a reagent solution to
extract the mercury. After extraction, contents will be filtered into a 96-well plate and analyzed
using Inductively Coupled Plasma-Mass Spectrometery (ICP-MS) against a five-point aqueous
standard calibration curve. All procedures will be conducted in a clean room facility.
5
Data management and analysis
Individual analytical results identified only by participant and specimen ID will be sent by PHL
Environmental Lab to MN Biomonitoring staff for entry into a secure database. The database
will be housed on a secure server on a secure floor of the MDH building. All physical copies of
study data will be kept by the project coordinator in a locked file cabinet on a secure floor.
The components of the data analysis will be:
1. Determine the relationship between mercury concentrations in paired samples. We
will analyze the relationship between mercury concentrations in paired newborn
bloodspot-cord blood-urine samples. We will examine ratios as well as correlations.
2. Assess effectiveness of newborn bloodspot biomonitoring as a public health
surveillance tool for identifying exposure levels that exceed a threshold. Using cord
blood mercury concentrations as the “gold standard,” we will assess the sensitivity,
specificity, and positive predictive value of the bloodspot testing methodology for
identifying newborns with elevated mercury levels above a threshold.
3. Assess effectiveness of newborn bloodspot biomonitoring as a public health
surveillance tool for characterizing population exposure. We will also examine the
validity of descriptive measures of population exposure derived from the two methods,
eg. the percent detection, geometric mean, median, and upper percentiles of bloodspot
mercury concentrations.
4. Examine different statistical methods for managing non-detect values. Because blood
spots have a higher detection limit compared to cord blood, we may find that a
significant portion of blood spots will be non-detects. We will investigate and compare
results using different statistical methods for dealing with non-detect values in summary
statistics.
5. Compare results with other surveillance or research studies. Where feasible, we will
compare results to other studies, including newborn bloodspot results from other
populations in Minnesota and with a statewide sample in Utah (6).
Communication of results to participants
The methodology of testing newborn bloodspots for mercury is still experimental. As described,
the major purpose of MN FEET Sub-Study is to assess how well this method works compared to
other well-established methods such as testing mercury in cord blood. Given this, and the fact
that all MN FEET Sub-Study participants will have already received their cord blood and urine
mercury results a number of months earlier, we will not return individual newborn bloodspot
results to participants. Participants will be informed in the consent process that they can
request their individual results from us if they choose and will be given instructions on how to
make this request. Participants will also receive a summary of the overall results when the
project is complete.
Data privacy
All data collected for this study which identifies individuals are classified as private health data
under the Minnesota Government Data Practices Act. No individuals will be identified in any
6
reports or publications. Only summary information that does not identify individuals will be
public.
Limitations
While we can make a rough estimate of the participation rate and sample size we can expect
based on past results of a small study, we are not certain about the number of eligible
participants we will be able to recruit. A smaller than expected sample size could limit the
statistical power of the study to detect significant differences between groups. We also do not
know whether we will have a wide distribution of mercury concentrations among participants,
which would be ideal for statistical analysis.
Risks and benefits
There is no health risk to mother or baby. Collection of the newborn bloodspot has already
occurred as part of the MDH Newborn Screening Program. The main benefit is to the larger
communities involved in the project and to public health exposure reduction efforts. Results
will be used to help improve public health surveillance of mercury exposures.
References
1. NRC, Toxicological Effects of Methylmercury. National Academy Press, Washington, DC,
2000.
2. Chaudhuri SN, Butala SJ, Ball RW, Braniff CT, Rocky Mountain Biomonitoring C. Pilot study
for utilization of dried blood spots for screening of lead, mercury and cadmium in
newborns. Journal of exposure science & environmental epidemiology. 2009 Mar;19(3):298316.
3. Minnesota Department of Health Division of Environmental Health. Mercury Levels in Blood
from Newborns in the Lake Superior Basin. St. Paul, MN: Minnesota Department of Health;
2011. Available from:
http://www.health.state.mn.us/divs/eh/hazardous/topics/studies/glnpo.pdf.
4. Spector LG, Hecht SS, Ognjanovic S, Carmella SG, Ross JA. Detection of cotinine in newborn
dried blood spots. Cancer epidemiology, biomarkers & prevention : a publication of the
American Association for Cancer Research, cosponsored by the American Society of
Preventive Oncology. 2007 Sep;16(9):1902-5.
5. Spliethoff HM, Tao L, Shaver SM, Aldous KM, Pass KA, Kannan K, et al. Use of newborn
screening program blood spots for exposure assessment: declining levels of perluorinated
compounds in New York State infants. Environmental science & technology. 2008 Jul
15;42(14):5361-7.
6. Utah Department of Health Environmental Epidemiology Program. Utah Statewide
Investigation of Neonatal Blood Mercury Levels Using Newborn Blood Spot Specimens. Salt
Lake City, UT: Utah Department of Health; 2014. Available from:
http://health.utah.gov/enviroepi/healthyhomes/epht/Surveillance_Mercury.pdf
7
Section Overview: Biomonitoring Updates
These updates on the East Metro PFC3 and MN FEET projects are provided in written form.
Information item:
Panel members are invited to ask questions and comment on these written updates.
8
Biomonitoring Updates
PFC Biomonitoring Update
In June, staff presented the results of the preliminary analysis of the PFC3 biomonitoring
project to the Advisory Panel. Based on the recommendations of the panel, staff are
conducting additional analyses looking at variables in the exposure survey (e.g. dietary factors),
and final results are almost complete. Next, staff will proceed with writing a Report to the
Community, sharing results with Local Public Health in the East Metro, and presenting results to
the community. Following completion of community outreach efforts, MN Biomonitoring staff
and MDH collaborators in the Public Health Laboratory and Environmental Health will develop a
plan for publishing PFC2 and PFC3 results.
MN FEET Current Status
The Minnesota Family Environmental Exposure Tracking (MN FEET) project was launched in July
2015 with the first mailings to potentially eligible pregnant women (24-28 weeks) from our
clinic partners. As the three-month (July-September) pilot phase of the project winds down, we
are evaluating the success of our study recruitment methods and will submit revised materials
to the various IRBs involved as needed.
Bi-weekly check-ins with our study partners, HealthPartners Institute for Education and
Research and SoLaHmo, have been instrumental in informing these improvements. After nearly
three months of recruitment, we have about 60 participants who have given their verbal
consent to join MN FEET, 40 written consents and six births. We also piloted the use of REDCap
as a secure, web-based database management system during this pilot period.
We expect to increase our recruitment pool of eligible women for the study with the addition of
Abbott Northwestern Hospital as a sample collection site, which opens up more clinics,
particularly HealthPartners Riverside, to recruitment. This addition is expected to occur shortly
after the pilot phase concludes, pending Allina’s IRB approval of revised study materials.
4
Section Overview: FLUOROS 2015 Conference Summary of Recent PFC
Epidemiology and Toxicology
FLUOROS 2015 was hosted by the Colorado School of the Mines and drew 200 registrants from
around the world. Its diverse sponsors included 3M, FluoroCouncil, and the Wellington
Laboratories. This event built on the success of the first FLUOROS meeting hosted by the
University of Toronto in 2005.
MDH staff Carin Huset (chemist, Public Health Laboratory), Ginny Yingling (hydrologist,
Environmental Health), Helen Goeden (toxicologist, Environmental Health), and Christina
Rosebush (epidemiologist, MN Biomonitoring) attended the conference. Christina Rosebush
and Carin Huset presented a poster summarizing results from the three East Metro PFC
Biomonitoring projects (2008-2015). Ginny Yingling presented a poster on transport history and
the genesis of the PFC “megaplume” in the East Metro. Poster presenters also included
representatives from 3M and Chemours, a Dupont fluoroproducts spin-off. PFC research in
China, Sweden, and Canada, among other countries, was highlighted in oral and poster
presentations. Panel member Dr. Geary Olsen served on the planning committee.
MDH staff also attended a pre-conference symposium hosted by the Green Policy Science
Institute. This California-based non-profit was largely involved in drafting the Madrid
Statement, a “scientific consensus regarding the persistence and potential harm for poly- and
perfluoroalkyl substances.” The full statement was published in May 2015 in Environmental
Health Perspectives: http://ehp.niehs.nih.gov/1509934/.
Christina Rosebush and Helen Goeden will briefly summarize epidemiology and toxicology
highlights from the PFC Conference sessions that they attended. This presentation is for
information only.
Information item:
Panel members are invited to ask questions and comment on this presentation.
10
Section Overview: Update on Joint MDH/MPCA Air and Health Initiative
During the June 2015 Advisory Panel meeting, we reported on the work of the State Air and
Health Initiative, a joint Minnesota Pollution Control Agency/MDH project funded by the 2013
Minnesota Legislature. The Air and Health Initiative was proposed to inform decisions for
protecting public health from air pollution, and had 3 primary deliverables:
•
•
•
A technical report: released July 13, 2015, called Life and Breath: How Air Pollution
Affects Public Health in the Twin Cities. This report estimated the health burden of air
pollution (particulate matter and ozone) in the 7-county metro area population.
A community toolkit: This website, called Be Air Aware (Know what you are breathing),
was designed to provide integrated information about air quality and health for the
public. It was also launched July 13, 2015. Target audiences are individuals and families,
businesses and employers, and local officials and communities. It focuses on actions,
data and tools that may be used to protect health and improve the air.
Health impact assessment (HIA): The assessment was conducted in partnership with a
variety of community-based organizations and focused on the potential health impact of
green zone designations for neighborhoods in South Minneapolis that face the
cumulative effects of environmental, social, political, and economic vulnerability. A
report of this HIA is expected soon.
A coordinated communications plan for the release of the report and the Be Air Aware website
in July 2015 was very successful. Following a press release and public announcement by
Commissioners Ed Ehlinger (MDH) and John Linc Stine (MPCA), several media outlets reported
the results to the public. In addition, MPCA held meetings with several stakeholder groups,
including Clean Air Minnesota.
MDH and MPCA are currently planning for the next steps in this initiative with new deliverables
to be determined. A new HIA process is being planned and implemented to engage with at least
one additional community. The MPCA is planning for additional local air monitoring efforts and
community outreach. The MDH MN Tracking program is planning to conduct updated
epidemiological analyses of air monitoring and public health data for renewing our local
estimates of the concentration response function used for future impact assessments. MN
Tracking will also work closely with MPCA on maintaining and enhancing information for the
public on the Be Air Aware website.
Jim Kelly, Manager of Environmental Surveillance and Assessment at MDH, will present a brief
update on the successes of the initiative described above and will describe plans for the future
(FY16).
Information item:
Panel members are invited to ask questions and comment on this update.
11
Section Overview: Inequities in air pollution exposure and risk
Greg Pratt, Minnesota Pollution Control Agency, will present information on his recently
published 2015 paper on Inequities in air pollution exposure and risk in Minnesota. A copy of
the abstract and a link to the full paper are on the next page.
This paper is presented to help inform the discussion in the next section regarding the extent to
which local variation in exposure to air pollution contributes to health impact disparities in
diverse and low-income communities. We will examine this paper, along with the recent
findings from local air monitoring in Twin Cities metro communities. We will also look at
potential new measures of traffic exposure. Panel members will be asked to consider what
additional data or information is needed, and to recommend next steps for the EHTB program
for exploring new data sources.
Information item:
Panel members are invited to ask questions and discuss this topic after the next presentation.
12
Inequities in air pollution exposure and risk
The following Abstract is from the Int. J. Environ. Res. Public Health 2015, 12(5), 5355-5372;
doi:10.3390/ijerph120505355
The full article can be found at http://www.mdpi.com/1660-4601/12/5/5355/htm
Traffic, Air Pollution, Minority and Socio-Economic Status: Addressing Inequities
in Exposure and Risk
Gregory C. Pratt 1,2,†,* , Monika L. Vadali 1,†, Dorian L. Kvale 1,† and Kristie M. Ellickson 1,†
1
Environmental Analysis and Outcomes Division, Minnesota Pollution Control Agency, 520
Lafayette Road, St Paul, MN 55155, USA 2 Division of Environmental Health Sciences, School of
Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA †
These authors contributed equally to this work.
* Author to whom correspondence should be addressed.
Received: 14 April 2015 / Revised: 11 May 2015 / Accepted: 13 May 2015 / Published: 19 May
2015
(This article belongs to the Special Issue Transport Impacts on Public Health)
AbstractHigher levels of nearby traffic increase exposure to air pollution and adversely affect
health outcomes. Populations with lower socio-economic status (SES) are particularly
vulnerable to stressors like air pollution. We investigated cumulative exposures and risks from
traffic and from MNRiskS-modeled air pollution in multiple source categories across
demographic groups. Exposures and risks, especially from on-road sources, were higher than
the mean for minorities and low SES populations and lower than the mean for white and high
SES populations. Owning multiple vehicles and driving alone were linked to lower household
exposures and risks. Those not owning a vehicle and walking or using transit had higher
household exposures and risks. These results confirm for our study location that populations on
the lower end of the socio-economic spectrum and minorities are disproportionately exposed
to traffic and air pollution and at higher risk for adverse health outcomes. A major source of
disparities appears to be the transportation infrastructure. Those outside the urban core had
lower risks but drove more, while those living nearer the urban core tended to drive less but
had higher exposures and risks from on-road sources. We suggest policy considerations for
addressing these inequities.
Keywords: traffic; socio-economic status; air pollution risk; environmental justice
13
14
Section Overview: Monitoring air pollution at the local level
Research shows that ambient air pollution, even at low and moderate levels, can have adverse
effects on public health, specifically on respiratory and cardiovascular health. In a recent
report, presented to the Panel in June and released July 2015, called Life and Breath: How Air
Pollution Affects Public Health in the Twin Cities, MDH and the Minnesota Pollution Control
Agency reported the results of an analysis linking modeled 2008 air pollution data from the
Twin Cities metro area with data on respiratory and cardiovascular disease hospitalizations, ED
visits and deaths for the same time period. Key findings showed that, at 2008 levels, fine
particles and ground-level ozone were estimated to have contributed to about 2,000 deaths,
400 hospitalizations, about 600 emergency department visits during that year.
The Life and Breath report also examined the question of whether these impacts on health are
distributed equally across the Twin Cities metro area, or whether disparities are seen. This was
done by conducting these linkages at the zipcode level and looking for differences. Results
showed little difference in average ambient air pollution levels between zipcodes. However, a
key limitation of the study is that it does not address exposure variation that may be occurring
within zipcodes at the neighborhood or block level. Ambient air monitors (usually located on
rooftops) do not capture the finer levels of exposure variation due to mobile sources (on-road
and off road) or other local sources that emit air pollution.
In this session, Kristie Ellickson, environmental research scientist with the MPCA will speak
about two special monitoring projects being conducted at the MPCA. These are:
•
•
The Community Air Monitoring Project (CAMP) - a roving monitor has been measuring
local exposures to air pollution in low-income and minority communities over the past
year.
Community Air Toxics EPA Grant Project – “Calibrating Concern about PAHs (Polycyclic
Aromatic Hydrocarbons) in Air Using Monitoring and Modeling”. Sources of PAH
exposure include combustion engine exhaust from mobile sources and wood smoke.
The future in air monitoring includes the use of real time air pollution sensor technologies that
sync with cell phones or automatically upload to crowd sourced platforms. These devices are
becoming more affordable and are currently being used by the general public to inform air
pollution maps. Kristie will demonstrate one such device called Air Beam. These are not used
for collecting regulatory data however and may not have the accuracy or detection level that
regulatory monitors can achieve.
Questions for the panel:
•
•
What conclusions can we make about variation in air pollution levels within ZIP codes?
Are the differences likely to impact community health?
What can EHTB do to better describe community exposure to air pollution for informing
public health policy and action? What additional data or information are needed?
15
Monitoring air pollution at the local level.
A general outline of Kristie’s presentation follows:
•
•
•
MPCA ambient air network monitoring in comparison to Special Studies
CAMP project in brief
o Monitor placement
o Monitoring results
o Primary limitations of this type of study
o Future for this project
PAHs Air Monitoring Project
o Monitor placement
o Monitoring methodologies
o Preliminary results
Information about the MPCA ambient air network plan may be found at this website:
http://www.pca.state.mn.us/pyrifa3. These plans are written annually and are open for public
comment during the summer. There are some web applications on the MPCA website to gain a
better understanding of this data set:
Monitor Locations: Go to this website: http://www.pca.state.mn.us/ruu6fhw, scroll down to
“Minnesota Air monitoring Sites”.
Air Toxics Data: Go to this website: http://www.pca.state.mn.us/ruu6fhw, scroll down to
“Minnesota Air Toxics Data Explorer”.
The CAMP website (http://www.pca.state.mn.us/9xc4ahc) has many reports and lots of
information on it, including the legislative language that funded the project (scroll to how sites
are being selected). The monitoring has been completed, and many but not all of the data
reports are in the accordion style portion of this website under Community Monitoring Site
Updates.
The PAH monitoring study has just completed monitoring and 1 year of data have been
chemically analyzed. The website at http://www.pca.state.mn.us/yqq4pfk does not yet have
any data on it, but will in the near future. The site does have a map of the monitoring locations.
Pictures of the monitoring methodologies have been included below.
16
Section Overview: Proposed measures of traffic for MN Tracking
Jean Johnson will describe the rationale and purpose of complimentary work proposed by MN
Tracking to explore and develop new trackable measures of population exposure to mobile
sources of pollution, or traffic.
Paula Lindgren will describe and show two proposed population-based measures of traffic
exposure that can be measured by county, zipcode or other geographic units:
1. Percent of the population living within 300 m of busy roads
2. Average traffic density
Questions for the panel:
Passive Monitoring
Active Monitoring
• Is a traffic indicator a valuable addition to the MN Tracking data portal?
• How would the data be used?
1. Which metric is most useful for tracking population exposure to traffic-related
air pollutants?
17
Proposed measures of traffic for MN Tracking
Purpose and Rationale
People living in close proximity to busy roadways are more likely to be exposed to harmful
contaminants in vehicle exhaust, such as particulate, ozone, carbon monoxide, hydrocarbons,
nitrogen oxides, sulfur dioxide, and other air toxics. In fact, today motor vehicles are the
primary source of air pollution in many communities, including the Twin Cities metro area.
People living near roadways are also more likely to experience the adverse health impacts from
these pollutants including breathing problems, and asthma exacerbations (Health Effects
Institute HEI Panel on the Health Effects of Traffic-related Air Pollution, 2010). Some studies
have linked childhood cancers to living in proximity to heavy traffic. Diesel exhaust, in
particular, is a major source of fine particles and is carcinogenic. Other carcinogenic
components of vehicle exhaust include polycyclic aromatic hydrocarbons (PAHs) and benzene.
Tracking traffic, as an indicator of exposure to mobile sources of air pollution (vehicle exhaust),
offers a potentially useful method for examining the time trends and geographical variability of
an important environmental health hazard that affects nearly all Minnesotans. Traffic exposure
data at the community level may help to inform decisions by local health officials, city planners,
and citizens who are planning for healthier communities. A measure of traffic that is easy to
understand and monitor over time will help to evaluate the efficacy of the actions communities
are taking to reduce this exposure. Communities are working to reduce fossil fuel consumption
through mass transit, improved walkability, installing safe bike lanes, locating schools and
senior centers away from major roadways, and other similar policies.
Traffic in communities also represents a potential source of population inequity in exposure
and is useful in epidemiological studies. In a study conducted by MDH in collaboration with
MPCA in 2009, we developed a set of traffic-related exposure indicators for Olmsted County
using traffic count data from MNDOT. We used vehicle kilometers traveled (VKT) calculations
and summed total VKT for all roadway segments within a buffer zone (250 and 500 meters)
around the residential location of each asthma case in the study (see Pratt et al. Quantifying
Traffic). We were able to examine the associations between traffic, poverty and asthma
exacerbations.
Exploring new indicator measures
MN Tracking is exploring the feasibility of developing new trackable measures of population
exposure to traffic in our urban communities. At this meeting Paula Lindgren will present a brief
overview of two proposed measures and their methods. The primary data sources for these
measures is the Minnesota Department of Transportation (MN DOT) database which can be
found at:
MNDOT data products (Forecasting and Analysis) and MNDOT Interactive Traffic data tool
Percent of the population living within 300 meters of busy roadways
This environmental public health indicator was developed by a working group of the Council of
State and Territorial Epidemiologists (CSTE) and has been piloted by several states.
18
The method involves the following steps:
1. Average Annual Daily Traffic (AADT) for road segments across Minnesota are
obtained from the MN DOT database.
2. Segments with AADT greater than 10,000 are selected.
3. A buffer of 300 meters from the roads are created within census block groups.
4. The percent of area within 300 meters is calculated as area within 300 meters
divided by total block group area.
5. This percentage is then multiplied by the block group population.
6. The values are aggregated up to the county level.
For an example of how this indicator is displayed on another state Tracking data portal see
California’s site: California Tracking display of CSTE indicator
1. Traffic density displayed by zipcode (or other geography)
1. AADT values for all road segments are used.
2. Segment data are converted to points.
3. Smoothing algorithm is used to cover the surface with traffic data.
4. Average traffic density value by zipcode is obtained and shown on a map.
See an example displayed here: California Tracking display of zipcode level traffic
Other possibilities include Point level estimates of traffic exposure and measure of the traffic
proximity: California Tracking Interactive traffic address tool
19
Section Overview: Other Information
This section contains documents that may be of interest to panel members.
•
•
•
•
•
2016 Upcoming Advisory Panel Meeting dates
June 9, 2015 Advisory Panel Meeting Summary
Advisory Panel Roster
Biographical Sketches of Advisory Panel Members
Biographical Sketches of Staff
20
2016 Advisory Panel Meetings
Tuesday, February 9, 2016
Tuesday, June 14, 2016
October 11, 2016
All meetings for 2015 will take place from 1-4 pm at
The American Lung Association of Minnesota
490 Concordia Avenue
St. Paul, Minnesota
21
6/9/2015 Meeting Summary
Attendees: Bruce Alexander, Jill Heins Nesvold, Melanie Ferris, Geary Olsen, Gregory
Pratt, Andrea Todd-Harlin, Cathy Villas-Horns, Lisa Yost
Regrets: Fred Anderson, Alan Bender, Thomas Hawkinson, Pat McGovern and Steven
Pedersen
Staff: Paul Allwood; Jeanne Ayers, Betsy Edhlund, Carin Huset, Jean Johnson, Jim Kelly,
Tess Konen, MaryJeanne Levitt, Matthew Montesano, Paul Moyer, Christina Rosebush,
Jeannette Sample, Blair Sevcik, Chuck Stroebel, Paul Swedenborg, Janis Taramelli, Addis
Teshome, Linden Weiswerda and Ginny Yingling.
Guests: David Bael, Mary Dymond and Frank Kohlasch, Minnesota Pollution Control
Agency.
Welcome and Introductions
Lisa Yost chaired the meeting for Pat McGovern, who was unable to attend. She
welcomed everyone and announced that the company she worked for had recently
merged and the new company name was Ramboll Environ. Lisa invited everyone to
introduce themselves.
2015 Legislative Report
Paul Allwood, Assistant Commissioner for the Minnesota Department of Health,
presented a summary of the 2015 session and noted that there would be a special
session scheduled soon. He reviewed the finance bill that was vetoed by the Governor
and observed that the language for the bill submitted for the special session was
identical, with the exception that continued biomonitoring must include Hmong and
immigrant farmers. There was also no indication of a “$0” balance for EHTB in 2018, as
had been previously implied. He explained that the Hmong farmer language had been
added due to concerns that Representatives Clark and Wagenius had expressed that
farmers renting plots in the area were not included, so that was an opportunity to
achieve higher levels of comprehensiveness in the monitoring efforts.
Hearing no questions from the panel, Paul asked Jim Kelly, Environmental Surveillance &
Assessment Director at Environmental Health of MDH, if he had any comments. Jim
agreed with Paul’s assessment of the session, adding that the new bill would fund
continuing biomonitoring efforts and also the air pollution and health work.
Jean Johnson noted that MN Biomonitoring was including the Hmong community in the
mercury, lead and cadmium study (MN FEET). We also have plans to conduct
community engagement with the Hmong farming community in the East Metro. Jean
introduced the 2015 Legislative Report fulfilling a suggested element of the panel’s
Sustaining MN Biomonitoring Subcommittee communications plan.
East Metro PFC3 Biomonitoring Project Results Analysis
55
Christina Rosebush updated the panel on the East Metro PFC3 Project. The background
materials can be found on pages 5-14 of the June 9, 2015 Advisory Panel Meeting book.
Christina noted that individual results had been sent out to participants in early April,
along with an informational brochure about PFCs. The brochure answered the
questions:
• What do my PFC test results mean?
• What can I do to avoid PFC exposure? and
• Do PFCs cause health problems?
The brochure stressed that water systems were still tested regularly, and PFCs in water
were below safety limits set by the Minnesota Department of Health. It explained how
to interpret the geometric mean and 95th percentile and summarized what is known
about PFCs and health. It included information that the C8 study in West Virginia/Ohio
had found probable links between PFOA and some health conditions but not others and
that the IARC classified PFOA as possibly carcinogenic based on limited findings in
humans and animals. It concluded that research continues on PFCs and health effects
such as birth outcomes, hormone balance, cholesterol levels and immune response.
Eighteen participants returned postcards requesting a study physician phone call and
were often Original Cohort (OC) members whose results went up. Study physician Dr.
Winnett explained to participants the possible reasons for increases, such as laboratory
uncertainty or new exposures and took the opportunity to emphasize usual preventive
care.
In response to a question about the number of OC participants in the tables, Christina
agreed that tables and charts showing PFC levels over time should only include the 149
individuals who participated in all three projects. She offered to send an updated table
to Panel members via e-mail.
The overall results were being presented for panel feedback on the community report.
Christina reviewed the key questions the study was hoping to answer:
•
•
•
Have PFC levels continued to decline in long-term East Metro residents?
In new Oakdale residents, are PFC levels comparable to U.S. general
population?
Is there an association between length of residence in Oakdale since Oct
2006 and PFC levels?
Christina reminded the panel that no subgroup analysis was possible in the Renters
group, as there were only 19 participants. The New Resident homeowners and renters
were combined into one group of New Residents (NR) with a size slightly lower than her
previous presentation (156) due to a few new residents not completing all study
requirements.
The OC and NR were truly two distinct groups, even though each had 156 participants.
They came from entirely different source populations. Because eligibility criteria were
different, compared to the NR, the OC was older [OC=59.1 yrs. vs NR=45.9 yrs.], had
56
lived in the East Metro longer [OC=24.8 yrs. vs NR=3.7 yrs.], and was less diverse [OC=98
percent vs NR=84 percent White, non-Hispanic; OC=2 percent vs NR=16 percent Other].
Income was slightly higher in the OC [OC=56 percent vs NR=44 percent≥$75,000/year],
though a larger proportion of NR were College graduates [OC=41 percent vs NR=57
percent).
In the OC, levels of the most commonly detected PFCs significantly decreased between
2010 and 2014. They were still higher than general U.S. population levels from the
NHANES 2011 and 2012. Of note, levels of these PFCs were continuing to decline in the
U.S. population as well.
A small group of participants had increases in levels of PFOS (15), PFOA (2) and PFHxS
(17). For the most part, participants who had increases between 2010 and 2014 were
not the same as those who had increases between 2008 and 2010.
Looking at geometric means, levels of PFOS and PFHxS were slightly higher in NR
compared to NHANES, but these differences were not significant. All confidence
intervals overlapped, indicating no differences between PFC3 NR and the NHANES
subsample. Comparing the 95th percentiles, no significant differences were seen.
Using geometric means and average interval between blood draws, the rates of
elimination were 6.3 years for PFOS, 3.2 years for PFOA and 8.3 years for PFHxS. The
rates of elimination using individual PFC results and intervals between blood draws: 7.2
years for PFOS, 3.4 years for PFOA and 8.3 years for PFHxS.
Published half-lives were for groups with higher levels of exposure (3M occupational
and C8 with PFOA levels over 50 ug/L). More blood draws were taken over time for
these studies. The PFC3 rates of elimination were not true half-lives because all sources
of exposure were not known or controlled for. However, they were very close to
published half-lives.
Washington County residents may have been included in the NHANES 2011-12
biomonitoring subsample, but they were unlikely to have comprised a large amount,
perhaps 3-6 percent of the subsample.
The final NR model was adjusted for age and sex, since levels of PFCs increased with age
and were higher in men compared to women. No associations were seen between
blood donation history and PFC levels.
In final adjusted models, there was no difference in PFC levels between homeowners
and renters. The complete analyses for NR will include diet and health history.
Christina described the community outreach plan. The Community Report will be mailed
to participants. Then MN Biomonitoring will work with partners in Oakdale, Lake Elmo
and Cottage Grove to make results available on city websites, attend city council
meetings and assess opportunities to join other local meetings. Another step would be
to make the results available to renters through the HRA, and finally, include the latest
PFC work from Environmental Health.
57
Christina asked for feedback for the community report of the overall results. Questions
presented to the panel were:
•
•
•
•
Are there panel recommendations for additional analyses before presenting
these results to the public?
What key messages are most important for informing the community about
these findings?
Is presenting the percent change in geometric mean over time or mean
change in individual PFC level over time best for communicating with the
public?
Is the inclusion of Washington County residents in the NHANES subsample
concerning? Should MN Biomonitoring pursue additional information on the
Washington County subsample from NHANES?
Discussion: Bruce Alexander wanted more information about the people who had
increases and what might have contributed to those increases. If these increases had
occurred all in people with lower PFC levels possibly due to lab uncertainties, then that
may concern the reliability of the other results. Gregory Pratt commented that if he
were one of the persons in the 95th percentile or above, he would want more info about
what he could do to lower his levels. Lisa Yost suggested looking at the message of
ongoing decline that we did expect and also questioned whether there was any way to
estimate the potential impact of the Washington County/NHANES overlap. How many
people from Washington County were expected to be in the sample, and if they all were
at the high level, what is the largest impact that those people would be able to have.
They were sampled in 2011, so that would have been five years after the water switched
over, so you would know something about what people would look like by the PFC2
biomonitoring. Christina agreed that it may be possible to assess the impact on the
NHANES results by assuming (worst case) that 6 percent of Washington County had
been in NHANES and had the highest levels.
Lisa asked about the NHANES 2011-12 sample size. Geary Olsen responded that
generally NHANES was 3 or 4,000 sampling per sampling cycle for two years for any of
these compounds; it was a rolling subsample across the 30,000 people. It was a very
small subsample and we were not sure if Washington County residents had been tested
for PFCs. Lisa commented that NHANES may be able to answer, “Did the Washington
County 2011 people get tested for PFCs?”
Regarding the question for the Panel about selecting the best calculation for percent
change, Geary commented that showing geometric means over time for the sample of
149 and percent change were both important. The average age of participants was 59
years. Harvey Clewell had recently given an MDH presentation showing that there were
clearance issues with these chemicals that made doing a half-life calculation –or
expected change calculation—hard to interpret.
Geary added that it was important to keep in mind with these half-life estimations that
there is no
58
right number because they are all bounded by confidence intervals. Geary suggested
using geometric mean half-lives, from his 2007 publication for calculation of predicted
percent change in the PFC3 cohort.
Geary asked about PFBA and the observation that concentrations were similar between
New Residents and the Original Cohort. Geary asked if the granular activated carbon
(GAC) filters were working well, then are exposures from multiple sources, not
necessarily the water. Jim Kelly replied that that was certainly one possibility.
Paul Allwood asked about the averages that were discussed—geometric means vs.
arithmetic means and asked what the spread was like in the numbers of people that had
been sampled for the geometric means—was it clustered very closely? Also, for
arithmetic means, was there wide variation? Geary Olsen answered by giving the
following highest values: PFOS was 448 nanograms/ml in 2008 compared to 180 today;
PFOA was 177 in 2008 and today it was down to 47. Those were not necessarily the
same people. For PFHxS, the highest value was 316 in 2008; today it was 140. The
highest ones were coming down. There was an identical distribution between the
people who had been exposed drinking the water and the residents who had not been
exposed.
Paul Allwood asked whether there had been any change in the untreated ground water
over time. Was there any attenuation of the plume before it went into the municipal
treatment system? Ginny Yingling, Site Assessment & Consult with Environmental
Health at MDH, answered that the Pollution Control Agency had done additional
remediation of all three of the major disposal areas and we were seeing some
improvement of the water quality as a result of that work and the potential ongoing
migration. By and large the plumes were stable and we had seen some slight decreases
in some areas and slight increases in some areas.
Jeanne Ayers offered the following questions that she anticipated may come up at
public meetings: “What could I do to decrease my level? Would a decrease in my level
make a difference? Would an exposure make a difference in health impact?” She
wondered what we knew about whether or not the health impact of the exposure might
not actually be responsive to a decrease. Lisa offered the following potential response
to those questions, “You were already below the threshold—it was reassuring to see
that levels continued to decrease, but remember, you were already at levels that were
considered to be safe from what we know about the health effects of these chemicals”.
Biomonitoring Updates
Biomonitoring Updates were provided on the current status of the MN FEET project and
additional analyses of the East Metro Cancer Report in written form on pages 15-20 of
the June 9, 2015 Advisory Panel book. Panel members were invited to ask questions of
staff and comment on all updates.
Jean noted that we were getting very close to launching the MN FEET (Minnesota Family
Environmental Exposure Tracking) project within the next two weeks. The project will
work with Hmong, Somali, Latina and White communities and will be recruiting through
59
West Side Clinic and HealthPartners. We will be recruiting pregnant women and
measuring maternal urine and cord blood. Recruitment for that study would be 12-15
months, so results would not be available until 2017.
Jean noted that at the last meeting we had Kenneth Adams from the MCSS program
presenting the analysis of cancer rates in the East Metro. One of the findings had been
an elevation in breast cancer, so the recommendations from this panel were to go back
and look at other data that might help us answer questions about why that might have
occurred. Kenneth has included in your book an analysis of staging data and mortality.
Mary Manning commented that we did not see early detection or screening as a reason,
based on the analysis that Kenneth completed. She added that if we looked at the
literature, you would see that higher affluence and the lower number of pregnancies
among the women in this area as possible explanations. Jean Johnson added the use of
hormone replacement therapies as another risk factor. Mary stated that for many
people, there would be the question of whether or not the PFCs were related. The
literature did not show that to be the case, but we could not rule that out, either. Lisa
Yost thought that articulating the other known risk factors would be helpful, since there
may be natural concern upon seeing the cancer information.
Geary Olsen wondered whether MDH was prepared to speak to the public on this. Mary
answered that they were prepared and these were the type of findings that could
possibly be found all over the state. In response to a question about a press release,
Mary was not certain that there would be a press release on this. Jean Johnson added
that Environmental Epidemiology planned to have this report available when PFC results
were presented to the community, to answer questions that might come up about what
the cancer rates were in the community. Lisa Yost commented that since it was out
there, maybe having a short summary that interpreted these findings and also set them
in context with other known risk factors would be helpful. Mary thanked everyone for
the feedback and said that Kenneth Adams of MCSS was the MDH point of contact for
people who wanted to discuss the report further.
State Air and Health Initiative
Jeannette Sample presented highlights from a new technical report on the impacts of air
pollution on the health of Twin Cities’ area residents. Background materials can be
found on pages 21-23 of the June 9, 2015 Advisory Panel book.
Jeannette began by introducing the Initiative coordinator, Mary Dymond, along with
coauthor David Bael, both with the MPCA, and Linden Weiswerda and Chuck Stroebel,
both with MDH.
Jeannette gave a brief background of the joint MPCA and MDH initiative that arose out
of concern about air quality and health in the Twin Cities area. There were three joint
deliverables: a technical report that she would cover; a community toolkit that Chuck
would present and a health impact assessment (HIA) that Linden conducted. Jeannette
added that Linden would not report on the HIA today, but he was the contact person
and was available for questions about the HIA.
60
The new title Life & Breath: How air affects health in the Twin Cities was an update from
the title in the background materials book, Jeannette announced. It used the EPA’s
BenMAP (Benefits Mapping and Analysis Program) tool to estimate health effects of air
pollution; the number of health impacts resulting from changes in air quality.
Fine particle-and ozone-related health impacts had been estimated for each of the 165
ZIP codes that lay entirely or partly within the seven-county Twin Cities metro area,
Jeannette explained. The seven-county Twin Cities metro area included the following
conties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington. ZIP code
level impacts had been summed to provide metro area estimates.
In BenMAP, impacts were calculated using the equation [∆𝑌𝑌 = 𝑌𝑌0 �1 − 𝑒𝑒 −𝛽𝛽∆𝐴𝐴𝐴𝐴 � ∗ 𝑃𝑃𝑃𝑃p],
with input data from the Twin Cities metro area by ZIP code. The following definitions
for the equation were explained by Jeannette: ∆𝑌𝑌 was the predicted number of health
outcomes attributable to the level of air pollution in the ZIP code, a measure of health
impact. 𝑌𝑌0 was the baseline number of health events in the ZIP code, i.e., the 2006-2010
number of hospitalizations, ED visits or deaths. 𝛽𝛽 was the concentration response
function (effect estimate) as determined by epidemiological studies. ∆𝐴𝐴𝑄𝑄 was the
change in air pollutant concentration in the ZIP code (either PM2.5 or ozone), i.e., 2008
average concentration minus naturally occurring background or a 10 percent reduction
from 2008 average concentration. 𝑃𝑃𝑜𝑜𝑝𝑝 was the size of the population in the ZIP code of
the relevant age group (e.g., 65 and older for estimating cardiovascular hospitalizations).
In the 2008 Downscaler annual average, the pattern for PM2.5 was higher concentration
in the central cities, Jeannette continued. For 03 there was an opposite effect, where it
was higher in the south and the east of the metro area, due to how ozone formed and
was oxidized. There was not a huge spread in concentration; Jeannette noted,
Minnesota has had fairly good air quality compared to the New York City, the city this
report was modeled after; our levels were lower.
For health data, Jeannette indicated they had used hospital discharge data: asthma
emergency department visits, asthma hospitalizations, respiratory hospitalizations and
cardiovascular hospitalizations. For the mortality data, they looked at all-cause mortality
and cardiovascular deaths. Results showed that in 2008, 6-12% of all metro area deaths
(about 2,000 deaths) were attributable to PM2.5 and ozone pollution, and about 2-5% of
hospital admissions and emergency room visits (hundreds of hospitalizations and ER
visits) for heart and lung conditions were attributable to PM2.5 and ozone pollution. If
levels of PM2.5 and ozone were reduced by 10%, which was the goal of Clean Air
Minnesota, it would prevent hundreds of deaths, hospitalizations and emergency
department visits due to heart and lung conditions every year.
Jeannette explained that looking at ZIP code levels; they found that the air pollution
levels across the metro area were not very different. What was driving differences in
rates were mostly the underlying health rates, so areas that had health disparities were
also having air pollution attributable health rate disparities.
61
With mortality rates, looking at PM2.5 attributable mortality, Jeannette said the report
shows that some of the higher mortality rates were outside the central twin cities,
because of the mortality pattern in the twin cities area. The report shows that impacts
of air pollution fell disproportionately on children and the elderly.
The ZIP code-level percentiles of poverty and populations of color, had also been looked
at. According to Jeannette, there was little variation in average air pollution levels, but
for ZIP codes with larger populations of people of color and residents living in poverty,
there were higher rates of hospitalization for heart and lung conditions, asthma ED visits
and death related to air pollution.
Key messages to present with this report had been drafted, and the key messages were:
breathing polluted air could cause a variety of health problems; and everyone could be
affected by breathing polluted air, but some were impacted more than others due to
underlying rates of diseases. Jeannette added that to reduce the health impacts of air
pollution, we needed to improve air quality, but we also needed to address the
underlying causes of health disparities in order to address disparities in air pollution
effects.
Chuck Stroebel introduced the second deliverable in the initiative, the Community
Toolkit, or the Be Air Aware website. He began by noting that the website addressed the
need for more communication with the public, providing access to health and air quality
data, as well as what they could do about it. This had been a joint initiative between
MDH and MPCA. Mary Dymond was the lead coordinator, with consultation and input
provided by several MDH programs.
Chuck added that they began with a series of key informant interviews with target
audiences to identify content gaps on the web. They had found an interest in a better
understanding of the relationship between air and health, accessing tools and data, and
what could be done.
Chuck noted that the focus was on the data, who was affected and actions that could be
taken. The mock-up site had a banner for news items, highlights, reports, tools, new
initiatives and activities. There was an area to access data on current air quality
conditions from the MPCA air monitoring network, the Air Quality Index, which was
near real time data. Chuck added that indoor air quality had been included, since people
spend 85-90% of their time inside, and often levels of air pollution were higher indoors,
such as tobacco smoke and radon. The goal was to put together the silos of indoor air
and outdoor air data, with a focus on what the reader could do to improve health and
improve air quality for those target groups.
For local officials, Chuck continued, success stories were being developed about local
actions that could be replicated by other communities. One example was the Health
Impact Assessment (HIA) that could be used to address community concerns to better
inform decision making about land use.
In terms of communication and outreach, Chuck stated that they were conducting prerelease stakeholder outreach with CleanAir Minnesota, local health officials and state
62
agency staff. Chuck informed the panel that the press release of the website and the
report for the public would be July 15th with an ongoing communications & outreach
plan to follow.
Chuck presented the following questions to the panel for discussion:
•
•
•
What key findings from the Public Health Impacts of Air Pollution technical
report are most important for public communications?
How might the results/products of this initiative be used by agencies,
organizations, and our partners?
What suggestions do you have to inform future work on this initiative, including
additional technical analyses and data updates, and/or communications and
outreach activities?
Discussion: Cathy Villas-Horns asked how the authors knew that the hospital admissions
were from the air pollution that day. Jeannette responded that these were estimates;
they had looked at an annual average air pollution level and a five-year annual average
for health events. A concentration response function (beta) from the published
literature was used. So they could not say that a certain health event had been caused
by pollution, but overall, 6-12% of deaths based on the literature would be attributable
to our level of air pollution in the metro area in 2008.
Lisa Yost agreed with Cathy Villas-Horn, adding that the report needed to be careful to
say that it was an estimate, not actual, and that the basis for the estimate was well
described. Jeannette replied that there had been discussion about the use of
percentages or numbers, and there were confidence intervals around these numbers.
She also addressed the question whether these numbers were directly attributable to
air pollution, and, as you could see from the elderly people or the people with
preexisting conditions, it could have been an event that caused a cascade of events
leading to death.
Geary Olsen commented that the way this was presented, it looked like 10% of people
die from breathing bad air. It needed to be clear, saying that bad air contributed to a
cascade effect and ultimate death. He asked that Jeannette rephrase what the 6-12%
actually meant from her standpoint. Jeannette answered that it was not a direct cause.
It could be someone with COPD who would have had COPD on their death certificate.
They may not have died that day, but it was precipitated by an event (premature death.
Geary agreed and added that he understood it was a very difficult message to
communicate to the public.
Lisa Yost noted that it was a very challenging task to communicate that air pollution was
a contributor, especially in populations at risk, leading to death. Mary Dymond
responded that this was where the questions usually came in response to the report.
She commented that the authors had thought of using the word “premature mortality”,
which in a sense meant that people, because of exposure to air pollution, died a little
sooner than they would have otherwise, partially related to the underlying conditions as
well. Lisa thought it would help to lay out the model that establishes a predicted
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relationship and use that model to get to premature death, or increased likelihood of an
emergency room visit.
Greg Pratt noted that the response function was based upon a broad spectrum of
studies done across the country. We conducted studies here in Minnesota and it might
be useful to bring that information to the table for comparison in this discussion.
Paul Allwood added that, regarding disparities, there were members of our community
that had high sensitivity and high susceptibility to the effects of air pollution. The
number may seem high, but if you looked across the entire population, from an
ecological view rather than specific populations, it may not be that unreasonable.
Jean Johnson elaborated on the study that Greg Pratt referred to, presented to the
panel in 2012, where EHTB calculated the concentration response function linking the
health data with the MPCA pollution data. The difference was that we used an average
of the monitors, so the method was different. The attributable fraction for
hospitalizations was about the same at approximately 2%. Geary asked what that 2%
meant from a pathological process that led to death. What part was actually attributed
to air pollution versus smoking versus any other event? The definition of attributable
fraction, Jean Johnson responded, was what portion would have been prevented if this
exposure were removed to background, to the lowest achievable level (or how many
deaths would have been prevented if we removed all the human-caused pollution).
Jean noted that we wrestled with how to explain ‘attributable fraction’ to the public.
Geary Olsen asked if that meant that those people would not have died. Greg Pratt used
the example of someone who had died in a car crash, whose death certificate would
have said blunt force trauma. If they died of a heart attack, a stroke, COPD or asthma, it
would list one of those as the cause of death. Air pollution might have contributed in
the long term to that condition; it also might have contributed in the short term to an
event that caused death at that time. But you were not going to see ‘air pollution’ on
the death certificate. Geary agreed; his concern was about the use of “would not have
occurred”, because likely many would have occurred without the air pollution,
regardless. He asked, “Was there a calculation that said that the deaths would not have
happened because of not having the air pollution present”? If someone had
emphysema, this contributed to a premature death, but did that mean that a death
would not have occurred, based on how these things were calculated. Jean responded
that it did come back to premature deaths. The literature would have characterized it as
“premature”; it would not have occurred on that day, it might have occurred later, just
not at that time, at that place.
Lisa Yost commented that the report may need a better description of the sections,
‘where did we get that data’, ‘how were we using data on attributable fraction’ and
‘what kinds of studies were used to come up with that’. We have to tell people how it
worked. Jeannette added that one of the things they struggled with was looking at a
one- or five-year average. With a five-year annual average, it was hard to say whether
that was premature because it was such a big time frame, so we thought it would be
easier to describe if we just said ‘deaths’ rather than ‘premature deaths’ to the public.
64
She added that the messaging had been very challenging. The report itself had been
challenging, but the group had been spending many months figuring out a way to
convey the results.
Lisa Yost asked about the messaging regarding the use of 2008 data and today’s
comparison with air pollution. Jeannette responded that they had addressed that in the
report; the level had come down, and David Bael added that the level actually came
down closer to 10% and that we had already achieved the goal we set. But at the time
we did this analysis, the 2008 data was the most recent data that covered the 7-county
metro area. Jeannette added that the next step would be to use the most recent data to
see if we achieved the benefits we predicted.
Melanie Ferris commented that the other difficult messaging was that air pollution
levels did not really vary that much across the metro, but there were notable inequities
in health outcomes. So she was wondering if there was a way to be more deliberate in
calling that out in the website. That better air was important to all of us, but if we
wanted to address these disparities, which was what would get people’s attention, here
were some of the things that did contribute to those inequities. Jeannette agreed that
air pollution may be causing some of the disparities, but there were other things that
were contributing to that, too, such as health equality, poverty and various other things.
Greg Pratt explained that fine particles, PM2.5, were quite uniform spatially, and it was a
rather gross measure of air pollution. When we have had high PM2.5 levels, we generally
have had transported air that was mixed, so there was a uniform air mass across the
metro area, with uniform concentrations. But there were other measures of fine
particles and other measures of air pollution. Current thinking was that even smaller
particles, the ultra-fine and even nanoparticle, were more responsible for health effects.
Those particles were better transported into the lower lung; they were better
transferred into the bloodstream, so they could move throughout the body. Greg
continued that those very fine particles often occurred in very fresh combustion
processes. A classic example would be getting very close to car exhaust. The car exhaust
had gaseous, very fine particles, and as you moved just within a few feet of the exhaust,
those particles began to accumulate into larger particles. As you were breathing that
fresh exhaust, you would have a lot of very small particles easily transported into the
body. Also, they would have a lot of products of incomplete combustion if you had an
internal combustion engine, for example. You could see that occurring near busy
roadways, right near sources of air pollution. There was a disparities question there as
well, because people with low income and minorities tended to live near busy roads.
Greg offered to share a paper in the future that he had just published on this topic.
Jeanne Ayers commented that what she found interesting in the data was that in many
areas of prevention, when we implemented a universal preventive strategy, the benefit
accrued greatest to the communities who were most privileged. This was actually an
opportunity to lead with something where preventive strategies would benefit
communities that were experiencing the greatest health disparities. So this was a great
opportunity to lead with prevention around something that was going to make a bigger
65
difference for a lot of people who were suffering. Paul Allwood added that Jeanne had
made an excellent point; he would just add that part of the messaging had to be the
idea of community, that everyone had concern and compassion for everyone else; that
everyone benefited when everyone benefited.
Tracking Updates and Program Evaluation
Matthew Montesano demonstrated the new Air, Health, and Poverty data visualizer on
the Data Access portal. Portal updates were provided in written form on pages 24-26 of
the June 9, 2015 background materials book. Panel members were invited to ask
questions and comment on all updates.
Matthew began by giving some background: the CDC established the national tracking
network to look at environmental health changes and related health outcomes
together, but often data sets were examined separately. This data visualizer was part of
a move toward “co-displays” that showed related datasets together.
With the joint work of the MPCA and MDH on the Air and Health Initiative, there was an
opportunity to put together a data visualizer to connect many different data sets on Air
Quality, Health and Poverty. Matthew explained that this data visualizer had been soft
launched, and he described the elements and how they worked together to show the
relationships, the context and the specifics of the data. Matthew thought MN Tracking
had been the first in the tracking network to develop this tool.
Greg Pratt commented that MPCA had been working on similar tools, and asked about
the software used for the site; Matthew responded that it was Primefaces and jqplot.
Lisa Yost wondered about the text that was on the page and whether it was associated
with each of the boxes checked. Matthew responded that the text was static, regardless
of the selections, and was an indication of known facts, as well as the definitions of
terms found in the data. Lisa thought it was a great program and wondered whether
there was output for others to use the data. Matthew said that for all the features that
we are adding to the program, there was also a table generated. There was not a
download data button yet, but that would be added during the next round of upgrades.
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Mercury Impact Analysis for Informing Reduction Initiatives
Jean Johnson introduced a recent MN Tracking analysis of the economic burden of
mercury in newborns, an extension of the previous burden report on childhood asthma
and lead poisoning, thanking Frank Kohlasch and David Bael of the MPCA for their
assistance in the project. Written information on the analysis can be found on pages 2737 of the June 9th advisory panel background book.
Jean explained the purpose of the report, which was to provide health impact and cost
estimates to inform the public and policy makers about the scale and cost of children’s
diseases from environmental causes in the state. This can be used to track the progress
of the programs aimed at disease prevention in terms of costs, lives saved and diseases
prevented. For the tracking program, this also demonstrated the relevant use of the
data for informing policy. The original report was a collaboration of several states, each
using similar methods to come up with their estimates. The Minnesota report was
published in December 2014, entitled
“The Economic Burden of the Environment on Two Childhood Diseases: Asthma and
Lead Poisoning in Minnesota”, and is available on our website. We are one of two states
who have published the report.
We chose mercury as our chemical of interest since methylmercury toxicity was second
only to lead in the national statistics looking at contributions to pediatric environmental
illness; it was estimated to be a $5.1 million cost by Landrigan. It was also an important
issue for Minnesota, highlighted by the pilot study done in Lake Superior that showed
elevations in prenatal mercury exposure in the state, and we were now conducting
biomonitoring work with the MN FEET project. MPCA has a very active program working
on mercury reduction and the state also has a very active fish monitoring and fish
advisory program.
Blair Sevcik reviewed the methods used for the analysis of prenatal mercury exposure
(found on pages 30 –36 of the June 9, 2015 background materials book):
Economic Burden: Disease counts x cost per case x environmentally attributable fraction
(EAF)
where Disease/case counts = average mercury level; Cost per case = lost lifetime
earnings due to IQ deficit; and EAF = 70%
Environmentally attributable fraction (EAF) was the “portion of a particular disease that
would be eliminated if environmental factors were reduced to their lowest feasible
levels”. In other words, an EAF of 70 percent meant that 70 percent of mercury toxicity
cases, where elevated mercury caused IQ deficits, could be prevented if mercury of
human origin in the environment was reduced to the lowest possible level.
Blair explained that there was not a representative sample of mercury levels in
Minnesota newborns or women, so they had used the most recent NHANES sample of
childbearing-aged women as a proxy for pregnant women and a newborn’s exposure to
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mercury during brain development. They measured average mercury levels in women
that had a level above a threshold.
The prenatal mercury exposure method used was similar to the childhood lead
poisoning method from our 2014 burden report. Similar to lead, we measured an IQ
deficit as a result of mercury exposure and the subsequent loss of lifetime earnings. But,
mercury method differed in three important ways: 1) The EAF was less than 100% for
mercury; 2)We measured mercury levels above a reference level rather than measure
any level above zero; and 3)We used nation-al biomonitoring data as opposed to the
MN surveillance data we had available to us for lead.
Before she showed the data tables, Blair explained where the threshold of 3.4
micrograms per liter had come from (5.8 micrograms of mercury per liter of cord blood).
Research has shown that the average ratio of mercury in newborn’s cord blood
compared to maternal blood was 1.7. So mercury levels were 1.7-times higher in a
newborn than in maternal blood. Studies have converted the EPA reference level cord
and arrived at a threshold of 3.4 micrograms per liter in women of childbearing age to
estimate the number of newborns affected by elevated mercury.
Blair then recapped tables 1-3, the results and the limitations of the analysis, found on
pages 31-36 of the June 9th background materials book. The next steps, she explained,
were to ask the Advisory Panel, Minnesota Pollution Control Agency and other
stakeholders for input on this report’s value and how it would be used; explore the
differences by race/ethnicity (since we had national data on race/ethnicity from
NHANES) and expand upon policy implications (for example, addressing not just the
policy implications in Minnesota, but also that global emissions of mercury played a
huge role in Minnesota) and create a public friendly report using this more scientific
report as a basis—to accompany the 2014 burden report.
Greg Pratt wondered whether there had been a consideration of using a 100 percent
EAF or had the 70 percent been used right away. He added that exposure was going to
vary by geography and diet, so was there evidence that there were IQ effects at 3.4 or
even lower. He continued with the observation that there were also natural sources of
lead in the environment, but 100 percent EAF had been used there. He was wondering
whether a similar argument could have been made for using 100 percent EAF for
mercury. Blair responded that with lead, there was no safe level, but with mercury, we
followed a published method and that method assumed a safe exposure level and an
EAF of 70%. This had also been supported by two Minnesota papers. Greg commented
that the economic impact would be higher if you assumed a different percent. Blair
agreed.
Next, Frank Kohlasch, Section Manager of the Environmental Analysis & Outcomes
Section at the Minnesota Pollution Control Agency, gave a brief presentation on
“Actions Addressing Mercury in Minnesota’s Environment” which can be found on page
37 of the June 9, 2015 Advisory Panel background materials book. He recognized the
value of the analyses done and discussed the economic burden of mercury, especially in
informing the value of proposed reduction efforts.
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Frank described Minnesota’s leadership in the plan to reduce mercury releases in the
state by 2025; the mercury pollution control process at coal plants. He stated that in
Minnesota the impacts were significant. Frank also discussed the biggest challenge of
finding better ways to intervene in the mercury being released through the waste and
recycling stream, due to there being multiple sources of mercury (attributed to humancaused activity).
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The following questions were presented to the panel:
•
•
•
How can MDH-EHTB continue to support and inform the MPCA’s mercury
reduction initiatives?
Given the limitations, how well does the economic burden analysis serve its
intended purpose?
What additional information would be most helpful going forward?
Discussion: Lisa Yost wondered how representative NHANES was of Minnesota. She
added that if what we had done at MPCA had been effective, then it could be lower
than the national numbers. Blair responded that it would definitely be useful to
measure mercury levels in Minnesota women or, better yet, Minnesota newborns, but
we only had a national estimate. Also, MN Biomonitoring has focused on at-risk groups,
so it was not representative of the state. Jean Johnson said that the national data does
not always represent Minnesota; there are disparities. Frank Kohlasch added that
Minnesota had more subsistence fishing, so exposure issues could be higher, but that
did not mean that the mercury emission policies had not been successful. We could
show that they have been effective. In answer to Greg Pratt’s question about whether
the Public Utilities Commission had set an externality value for power plants that they
regulate, Frank replied that they had not and mercury was not one of their
considerations at this time.
Geary Olsen commented that the economic analysis was based on Landrigan’s paper,
which was 12-14 years old at this time; were there any more up-to-date papers on this,
since it plays such a major role in your economic burden equation? Blair replied that
Trasande’s 2011 paper had used the 2002 Landrigan paper for its equation to calculate
economic burden; also, it had repeated the 2002 paper’s estimate of IQ deficit on
earnings. Geary suggested a review of Landrigan’s numbers to see if they were reliable.
Blair agreed to look into this. Lisa Yost added that it seemed so tenuous that a single
point deficit in IQ could make such a difference in lifetime earnings, especially in such a
linear fashion. There had been a different way to calculate it for lead, but not for
mercury, Blair responded. She agreed to explore categorical IQ deficits based on
mercury ranges.
Lisa Yost thought that in conveying this, the first talking point had to be that it was
based on NHANES. That based on NHANES, Minnesota might be experiencing this. Jean
Johnson added that they had discussed whether to reanalyze this based on the newborn
levels from the four groups we would have at the end of the MN FEET project.
Separately, NHANES contained racial data, and there had been discussion about
reanalyzing this across different groups.
Melanie Ferris wondered about mercury accumulation and whether some mercury does
leave the body? Jean responded that the half-life was 60 days for methylmercury. Paul
Allwood wondered if that were true about all forms of mercury. Melanie said the policy
implications for annual checkups and medical appointments for women of childbearing
age might be handled in a different way.
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Jean said the message regarding fish consumption was tricky, specifically on the effects
of higher levels of mercury. The main message was to encourage people to eat fish, but
it was a balancing act because the benefits of fatty acids sometimes outweighed the
risks of mercury. Jim Kelly agreed that the effects were more concerning at higher levels
of exposure than lower levels of exposure, which was where the benefits of eating fish
were going to outweigh the risks. These messages needed to be balanced very carefully.
They wanted to encourage people to eat fish, because it was a great source of protein
and it had lots of other nutrients that were good for moms and for kids, so they did not
want to scare people off from eating what, for them, was a healthy source of protein.
Melanie Ferris was curious about what kind of feedback had been received from the
report on asthma and lead; who had been using it and how. Blair responded that in
March they had presented a well-attended webinar focused on the lead portion of the
report. The Healthy Homes and Lead Poisoning Prevention Program planned to use the
cost of lead poisoning from that report for future reports. Asthma had shared the report
widely with all their stakeholders and there had been interest, but Blair was not sure of
any actions or media response at this time. Jean Johnson added that funding had been
restored for blood lead and for asthma. Melanie liked the webinar idea as a distribution
strategy, since it allowed for some back and forth in clarification of details of the report.
She believed it was another great tactic in getting the word out to stakeholders.
Hearing no public comments or questions from the audience and no new business, the
meeting was adjourned at 3:50 pm.
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Environmental Health Tracking and Biomonitoring
Advisory Panel Roster
As of July 2015
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
Melanie Ferris, MPH
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 organization
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
[email protected]
MDH appointee
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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
Steven Pedersen, MPH
8403 Mississippi Boulevard NW
Coon Rapids, MN 55433
612-850-1058
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
RAMBOLL ENVIRON
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
[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
Andrea Todd-Harlin, MSc
Medical Research Advisors
1491 McCarthy Road
Eagan, MN 55121
651-341-3444
[email protected]
Minnesota House of Representatives
appointee
73
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.
Melanie Ferris is a Research Scientist at Wilder Research, a nonprofit research organization
based in St. Paul, Minnesota. She conducts a variety of program evaluation and applied
research projects focused primarily 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
74
(COPD), lung cancer, and 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 enterprisewide 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.
Andrea Todd-Harlin is an epidemiologist with 15 years experience in both the public and
private sectors. She holds a Master of Science in Environmental Epidemiology & Policy from the
London School of Hygiene and Tropical Medicine and a Bachelors of Science in Health &
Wellness from the University of Minnesota. Andrea began her career at the Minnesota
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Department of Health in the Chronic Disease and Environmental Epidemiology section where
she worked on grants researching serious traumatic work-related injury and childhood asthma.
She then moved into applied practice serving as the Director of Research and Education at the
private medical practice, Sports and Orthopaedic Specialists. Andrea has also served as adjunct
faculty at St. Catherine University and Argosy University teaching microbiology, biostatistics and
epidemiology and risk management. She currently operates her own medical research
consulting firm, Medical Research Advisors.
Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU) within the
Pesticide and Fertilizer Management Unit of the Minnesota Department of Agriculture. Cathy
holds a Master of Science in Geology from the University of Delaware and a Bachelor of Science
in Geology from Carleton College and is a licensed Professional Geologist in MN. The IRU
oversees or conducts the investigation and cleanup of point source releases of agricultural
chemicals (fertilizers and pesticides including herbicides, insecticides, fungicides, etc. as well as
wood treatment chemicals) through several different programs. Cathy has worked on complex
sites with Minnesota Department of Health and MPCA staff, and continues to work with
interagency committees on contaminant issues. She previously worked as a senior
hydrogeologist within the IRU, and as a hydrogeologist at the Minnesota Pollution Control
Agency and an environmental consulting firm.
•
Lisa Yost is a Principal Consultant at RAMBOLL 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
Kenneth F Adams, PhD, is an epidemiologist with the Minnesota Cancer Surveillance System
(MCSS), Minnesota’s central cancer registry. His day-to-day work includes estimation of cancer
rates, performance of record linkages between MCSS and other data, responding to citizen
cancer concerns, and data collection for a screening colonoscopy research study. He was
formerly a postdoctoral fellow in the US National Cancer Institute Division of Cancer
Epidemiology and Genetics, and a research investigator at HealthPartners Institute. He received
a PhD in epidemiology from the University of Washington in 2003.
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 occupation-al 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.
Kristie Ellickson, PhD, is a research scientist with the MN Pollution Control Agency in the risk
evaluation and air modeling unit. Her interests lie in special air monitoring studies and the
intersection of air monitoring data and modeled air data as well as the intersection between air
data in general and population demographics. She was a US Peace Corps volunteer in Panama
and after that completed a PhD degree at Rutgers University in a joint program between the
School of Public Health and the Environmental Sciences Department. Prior to joining the MPCA
eight years ago, she held positions in several academic laboratories and taught chemistry and
biology in a weekend college program.
Allison Fast is a student worker in MN Tracking who is currently pursuing her master’s degree
in epidemiology at the University of Minnesota. Allison researches and composes success
stories for MN Tracking. Additionally, she works with MN Biomonitoring in the development
and coordination of MN FEET.
Helen Goeden, PhD, is a toxicologist and tech team lead of the Contaminants of Emerging
Concern Program with the Health Risk Assessment section of the Environmental Health
Division. Helen has expertise in Biology and Public Health and is responsible for toxicological
assessment of a wide range of environmental contaminants; development of state-wide healthbased criteria for drinking water; development, improvement and integration of risk
assessment methods and public health policies that are protective of sensitive or more highly
exposed populations; and projects specific to emerging environmental health threats. Helen
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received her PhD in Environmental Health/Toxicology from the University of Cincinnati College
of Medicine.
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 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 worked with MN Tracking for 2 years as a CSTE
Epidemiology Fellow where she was project coordinator for a follow-up study of the Northeast
Minneapolis Community Vermiculite Investigation cohort. She currently is an epidemiologist
working on birth defects, pesticides, and climate change, and is developing new Disaster
Epidemiology tools for MDH-HPCD.
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 three 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, webbased portal dissemination, and presentations in the Chronic Disease and Environmental
Epidemiology section. Ms. Lindgren has also received training in the area of GIS for chronic
disease mapping and analysis. In addition to her work for MN 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.
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Matthew Montesano, MPH, is 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 webbased 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 Bostonarea 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.
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.
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.
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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.
Addis Teshome has been an epidemiologist with MN Tracking since September 2014. Her work
involves populating a database of the scientific literature on perflurochemicals (PFCs),
performing statistical analysis of public health data, and developing various elements of the MN
Family Environmental Exposure Tracking project. Prior to joining MN Tracking as a student
worker in June 2014, she held similar positions at MDH’s Center for Occupational Health and on
the Safety and the Autism Spectrum Disorders Public Health Surveillance Report. Addis is
analyzing trends in predictors and outcomes of alcohol consumption among racial/ethnic
subgroups in partial fulfilment of her master’s degree in epidemiology at the University of
Minnesota’s School of Public Health.
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 coinvestigator 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 MN.
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