minneapolis children’s arsenic study: a biomonitoring ... · arsenic study: a biomonitoring pilot...
TRANSCRIPT
Minneapolis Children’s Arsenic Study: A Biomonitoring Pilot Project
Minnesota Department of Health April 27, 2009
Commissioner’s Office 625 Robert Street N P.O. Box 64975 St. Paul, MN 55164-0882 651-201-5000 www.health.state.mn.us
(blank page)
Minneapolis Children’s Arsenic Study: A biomonitoring pilot project
April 27, 2009 For more information, contact: Environmental Health Tracking & Biomonitoring Program Chronic Disease and Environmental Epidemiology Section Health Promotion and Chronic Disease Division Minnesota Department of Health 85 East Seventh Place, Suite 220 P.O. Box 64882 St. Paul, MN 55164-0882 Phone: 651-201-5000 Fax: 651-201-5898 TDD: 651-201-5797 Upon request, this material will be made available in an alternative format such as large print, Braille or cassette tape. Printed on recycled paper. This report is also available online at www.health.state.mn.us/tracking.
(blank page)
ACKNOWLEDGEMENTS
MINNESOTA DEPARTMENT OF HEALTH Sanne Magnan, Commissioner
Jeanne M. Danaher, Deputy Commissioner
Minnesota Environmental Health Tracking and Biomonitoring Steering Committee John Linc Stine, Assistant Commissioner of Health Joanne Bartkus, PhD, Director, Public Health Laboratory Division Linda Bruemmer, Acting Director, Environmental Health Division Mary Manning, RD, MBA, Director, Health Promotion and Chronic Disease Division
Minnesota Environmental Health Tracking and Biomonitoring Advisory Panel John Adgate, PhD Bruce Alexander, PhD Beth Baker, MD, MPH Alan Bender, DVM, PhD Cecilia Martinez, PhD Debra McGovern Geary Olsen, DVM, PhD
Susan Palchick, PhD, MPH Gregory Pratt, PhD Dan Stoddard, MS, PG David Wallinga, MD (former member) Samuel Yamin, MPH Lisa Yost, MPH, DABT
Minnesota Environmental Health Tracking and Biomonitoring Workgroup Jerome Alholm Michonne Bertrand, MPH Carin Huset, PhD Jean Johnson, PhD, MS Frank Kohlasch, JD Louise Liao, PhD
Rita Messing, PhD Pamela Shubat, PhD John Soler, MS Allan Williams, PhD, MPH Erik Zabel, PhD Joe Zachmann, PhD
Report authors: Adrienne Kari, MPH, Jean Johnson, PhD, MS, and Allan Williams, MPH, PhD, Division of Health Promotion and Chronic Disease Betsy Edhlund, PhD, Public Health Laboratory Division
Sincere thanks to our recruitment staff, Elizabeth Johnson project consultant, Margaret Sweeney-Gonzalez who also provided Spanish translation and interpretation for our Hispanic community members, and to Iman Hassan for help with Somali translation and recruitment. We also gratefully acknowledge Medical Consultant, Mary Winnett, MD, MPH, for her work providing education to area clinicians and medical counseling with participants and their physicians. Thanks to many other department staff for their contributions: Michonne Bertrand, Tannie Eshenaur, Mary Jeanne Levitt, Jeannette Sample, Leslie Schreier and Paul Swedenborg. Finally, we thank the many study participants and members of the South Minneapolis community for their time, participation and support. For more information contact: Jean Johnson Minnesota Department of Health Division of Health Promotion and Chronic Disease 651-201-5902 or email: [email protected]
v
(blank page)
vi
TABLE OF CONTENTS ACKNOWLEDGEMENTS...............................................................................................v LIST OF FIGURES ....................................................................................................... viii LIST OF TABLES......................................................................................................... viii EXECUTIVE SUMMARY ..............................................................................................ix INTRODUCTION .............................................................................................................1 METHODS ........................................................................................................................2 Study Population and Recruitment ..............................................................................2 Biomonitoring Specimen Collection............................................................................5 Laboratory Analyses ....................................................................................................5 Data Analyses ..............................................................................................................7 RESULTS ..........................................................................................................................7 Demographic Characteristics of Participants...............................................................7 Urinary Arsenic Levels ................................................................................................7 Urinary Arsenic, Soil Arsenic and Other Factors ........................................................8 Communication of Individual Participant Results.......................................................9 Case Studies of Three Highest Children....................................................................10 Comparison of Findings with Other Studies of Arsenic Exposure in Children.........11 DISCUSSION..................................................................................................................14 RECOMMENDATIONS.................................................................................................15 REFERENCES ..............................................................................................................17 FIGURES .......................................................................................................................19 TABLES ........................................................................................................................28 APPENDICES .................................................................................................................35 APPENDIX A: Legislation .....................................................................................37 APPENDIX B: Arsenic Study Flier .......................................................................43 APPENDIX C: Invitation to Participate Letter and Forms. ...................................49 APPENDIX D: Sample Result Letter (<15 µg/g) ...................................................65 APPENDIX E: Sample Result Letters (>15 µg/g)..................................................73
vii
LIST OF FIGURES Figure 1. Map of South Minneapolis Neighborhood with Arsenic Contamination ....20 Figure 2. Action Plan Based on Total Arsenic Levels .................................................21 Figure 3. Distribution or Total Urinary Arsenic Levels in 65 Children .......................22 Figure 4. Comparison of Organic and Inorganic Urinary Arsenic Levels in 23
Children with Total Arsenic >15 µg/g ..........................................................23 Figure 5. Range of Soil Arsenic Levels for Yards of 65 Children Representing 44 Properties (High, Average, Low Values) ......................................................24 Figure 6. Total Urinary Arsenic Levels vs. Average Soil Arsenic Levels for 65
Children (linear scale) ...................................................................................25 Figure 7. Total Urinary Arsenic Levels vs. Average Soil Arsenic Levels for 65
Children (log scale) .......................................................................................26 Figure 8. Inorganic Arsenic Levels vs. Average Soil Arsenic Levels for 23 Children with Total Arsenic >15 µg/g ..........................................................27
LIST OF TABLES
Table 1. Study Population Eligibility & Participation – Original Protocol ................29 Table 2. Study Population Eligibility & Participation – Expanded Protocol..............29 Table 3. Demographic and Housing Characteristics of Study Participants ................30 Table 4. Urinary Total Arsenic Concentrations ..........................................................31 Table 5. Speciated Urinary Arsenic for Children with Total Arsenic >15 µg/g .........32 Table 6 Basic Correlations Between the Normalized Soil Arsenic Concentrations
and the Urinary Arsenic Levels .....................................................................32 Table 7. Potential Arsenic Exposures Based on Questionnaire ..................................33 Table 8. Weather at Time of Urine Collection............................................................33 Table 9. Length of Time Child Played in Yard Based on Questionnaire....................33 Table 10. Urinary Arsenic Levels Found in Children in Various Studies ....................34
viii
EXECUTIVE SUMMARY
In 2007 the Minnesota Legislature enacted legislation directing the Minnesota Department of
Health (MDH) to complete a series of biomonitoring pilot projects. These projects were directed
and implemented to provide MDH with the experience and knowledge to create a state
biomonitoring program by building both laboratory and epidemiological capacities and
capabilities. One of these projects was to investigate the range and distribution of arsenic levels
in a community likely to be exposed.
Arsenic soil contamination had been found prior to 2007 in south Minneapolis. The
Environmental Protection Agency, Minnesota Department of Agriculture, and MDH had
completed sampling in the area to determine the levels of contamination on each property within
a ¾ mile radius of a former pesticide production plant. With this information MDH selected this
community to conduct the Minneapolis Children’s Arsenic Study. Study protocols were
reviewed by the Science Advisory Panel and approved by the MDH Institutional Review Board.
Following many hundreds of mailed invitations in multiple languages and door-to-door
solicitations, 65 children between the ages of 3 and 10 were eventually enrolled from the
community and participated in the study with parental consent. Each child completed two
consecutive first morning void urine collections to be measured for arsenic levels. Each child’s
urine collection was measured for total arsenic and results were provided to the participants.
Urine with a total arsenic level greater than 15 µg/g (creatinine-corrected) was further analyzed
for arsenic species (types of arsenic). The geometric mean of total urinary arsenic for the 65
children was 13.5 µg/g with a range of 5.6 to 191.3 µg/g. The highest arsenic levels in children
were primarily associated with forms of arsenic (organic) that are generally considered less toxic
and dietary in origin.
ix
x
The arsenic levels found in the 65 children from south Minneapolis are broadly consistent with
results reported in other studies. However, comparisons with other studies are difficult to
interpret since each study examined different populations and utilized different study protocols
(sampling methods, age groups, season, types of analysis, etc.).
While not a primary aim of this study, this study examined urinary arsenic levels in relation to
previously-collected data on soil arsenic levels that were available from the investigatory
activities by various federal and state agencies. Correlations were examined between total
urinary arsenic and various measures of soil arsenic level found on the property where each child
resided. None of the correlations between soil arsenic levels and urinary arsenic levels were
significant. However, there are many potential reasons why this study did not find a correlation
between arsenic levels in children and the available soil arsenic levels and this finding should not
be interpreted to mean that arsenic-contaminated soil poses no risk to children. The further
determination of routes and sources of exposure would require a more extensive investigation
and was beyond the scope of this pilot project. MDH staff will present these finding to the
community and solicit recommendations from the community for further public health action in
response to the study results.
The purpose and intent of this pilot project was to inform a future biomonitoring program for the
state of Minnesota. The project succeeded in this respect and the information and experience it
provided are necessary and valuable to the success of the Environmental Health Tracking and
Biomonitoring program at MDH.
INTRODUCTION
In 2007 the Minnesota State Legislature passed Minnesota Statute 144.995 – 144.998, which
established the Environmental Health Tracking and Biomonitoring (EHTB) program and
directed the Minnesota Department of Health (MDH) to design and implement four pilot
biomonitoring projects. The primary purpose of each of the pilot projects is to measure the
range and distribution of exposure to a selected chemical or chemicals in a community identified
as likely to be exposed. Exposure is measured through the collection of a biological sample,
such as blood or urine, from voluntary participants from the community. Another purpose of the
pilot projects is to build biomonitoring capacity in the state and to develop recommendations for
the Legislature for the creation of an ongoing biomonitoring program in Minnesota.
This biomonitoring pilot project, known as the Minneapolis Children’s Arsenic Study, was
designed to measure the range and distribution of urinary arsenic levels in 100 children living in
the South Minneapolis area, specifically within the Seward, Longfellow, Little Earth,
Powderhorn, Phillips, East Phillips, and Corchoran neighborhoods. Children in this community
were identified as “likely to be exposed” due to elevated soil arsenic levels as identified through
various federal and state agency investigations. In 1994, elevated levels of arsenic in the soil
were found along Hiawatha Avenue when a reconstruction project was begun. Further testing of
the surrounding area occurred and the former CMC Heartland Partners Lite Yard Site, a former
pesticide manufacturer, was identified as a contributing source to the soil arsenic concentrations
along Hiawatha Avenue 1. In 2001 MDH and the Minnesota Department of Agriculture (MDA)
began an investigation of the residential area surrounding the site to evaluate possible
contamination of the neighborhood with arsenic. Over 3,500 properties were tested by MDH,
MDA, or the Environmental Protection Agency (EPA) between 2001 and 2006. Properties
tested were within a ¾ mile radius from the CMC Heartland site, located at the corner of 28th
Avenue and Hiawatha Avenue in Minneapolis. MDH and the Agency for Toxic Substances and
Disease Registry (ATSDR) developed a soil action level of 95 ppm (parts per million of arsenic
in soil). Properties that were found to have an arsenic soil concentration greater than 95 ppm
were to have the soil removed by the EPA. A total of 197 properties were identified and actions
were initiated to remove the soil from the properties. In 2007 the site was listed on the National
1
Priorities List (Superfund) to facilitate the remediation of soil from properties that had an arsenic
concentration of less than 95 ppm but greater than 25 ppm2.
EHTB program staff, with input from the EHTB Advisory Panel and an interagency workgroup,
developed a project protocol document for the Minneapolis Children’s Arsenic Study. Children
were selected for this project because children are likely to have the greatest exposure to
contaminants in residential soils from their outdoor play activities and greater potential for
ingestion from frequent hand to mouth behaviors. The target sample size of 100 was specified in
the legislation. The project was presented to the community in community group meetings and
with local public health officials for community acceptance. The project was also reviewed and
approved by the MDH Institutional Review Board (IRB) for the protection of human subjects in
research.
METHODS
Study Population and Recruitment
The original study protocol identified eligible children for the project as all children ages 3 to 10
years currently living on properties with a soil arsenic value greater than 20 ppm and not yet
remediated. A level of 20 ppm was used to identify these properties since the background
concentrations for arsenic in Minnesota urban soil is estimated to be about 16 ppm. EHTB
requested and the EPA provided a list of all of the properties tested within the designated area of
soil sampling. A total of 511 properties meeting the study criteria for identifying eligible
participants were selected from the EPA list.
Table 1 summarizes the recruitment and participation of study subjects. Mailing addresses were
gathered and, through property visits, a total of 883 household units were identified on the 511
properties. The number of households is higher than the number of properties due to the
presence of many multiple-family housing units and apartment complexes. A letter detailing the
project was sent to each household along with a brief survey inviting any eligible household with
children to respond. The survey requested very limited information: the resident’s name,
address, the presence of eligible children between the ages of 3 years and 10 years, if the parent
2
or legal guardian was available for consent, and the name and age of each eligible child. The
letter explained that from a list of all eligible children identified from the returned surveys, 100
children were to be randomly selected for participation, and selection would be limited to one
child per household.
The initial mailing was sent in May 2008 in anticipation of the concluding school year and the
increased likelihood of children’s exposure to residential soil during outdoor play at home over
the summer. All materials were mailed in both English and Spanish as well as providing a phone
number for individuals to call to request materials in another language. This phone number and
accompanying information was provided in Somali, Vietnamese, Hmong, and Spanish. Some
letters were returned by the post office due to vacancy at the property, the building/home no
longer existing, or an incorrect address. If the address was incorrect, a search was completed to
correct the address and resend if possible. Of the 883 households, 107 (12%) were vacant and
776 (88%) occupied. Identification of vacant households was either through the U.S. postal
service or by study staff.
To assure that all households eligible for participation were aware of the study and had the
opportunity to participate, study staff visited all households that had not returned the survey.
Only 122 households returned the initial survey, requiring at least one visit to 654 households by
study staff. Materials were left at the home during each visit, even if the resident was not
present at the time. Materials left at the home included a flier describing the study, the study
survey, and a postcard detailing the time and date of the visit. All materials were left in both
English and Spanish due to the large Hispanic population in south Minneapolis. A Somali
translator and translated materials were also available for households that preferred materials in
Somali. Of the 654 homes visited by study staff, 354 required more than 3 visits. Despite this
effort, study staff was not able to contact a total of 229 households. At the end of the
recruitment period, study staff had made contact with or received a survey from 532 households
(60%).
From the households that either returned the survey or were spoken to by staff, 105 (12%) had
children between the ages of 3 and 10 years who were eligible to participate. Providing
3
information about the household and any children present to project staff was voluntary and a
portion of these 105 homes chose not to participate. Of the 105 households, 13 households
(12%) refused to participate. Of the remaining households with children, 45 provided
information on the study survey but failed to complete study consent documents or return staff
contacts. A total of 47 households completed recruitment materials, and of those, 40 children
meeting the original eligibility criteria participated and completed the specimen collection. In
an effort to include more children, sibling sets (multiple children living in the same household)
were not excluded.
By early August 2008 it had become apparent that the recruitment goal of 100 children (as
specified in the legislation) would not be met with the original study population limited to homes
with a soil arsenic concentration of greater than 20 ppm. Therefore, it was decided to expand the
recruitment eligibility to include any child between 3 and 10 years of age living in households
identified through soil testing (a ¾ mile radius around 28th Street and Hiawatha Avenue)
including those on properties with less than 20ppm of soil arsenic. This expanded eligibility
included 2,652 households in the south Minneapolis area. The change in the study recruitment
protocol and a newly developed flier (produced in English, Spanish, and Somali) were submitted
to the MDH Institutional Review Board (IRB) and approved. Once approval had been obtained
the fliers were mailed out in the first week of September, 2008. Of the 2,652 fliers mailed out,
161 were returned by the post office or a neighbor due to vacancy. Door-to-door recruitment
was not completed in the expanded study area since the resources and time necessary were not
available. With the expansion of the study area, an additional 27 eligible children were
identified, with 25 completing the specimen collection.
At completion of the recruitment and enrollment phase of the study, a total of 119 children were
identified as eligible and all were invited to participate, with 75 children having the consent
materials completed. Of the 75 consenting children, 9 passively refused by never returning study
staff phone calls or responding to visits by study staff to the home. One family moved out of the
study area before the completion of the study requirements. A total of 65 children from 44
households completed all of the study requirements, including specimen collection by the end
date of the study.
4
Biomonitoring Specimen Collection
Once the signed consent materials had been received by study personnel, a urine collection kit
was dropped off at the participant’s home. The collection of two first morning voids as the
biological sample to measure was recommended by the EHTB Science Advisory Panel1.
Advisory panel members recommended that by choosing two urine specimens collected on
successive mornings, rather than a single urine void sample, the investigators would be more
likely to capture a child’s exposure to soil arsenic, especially if patterns in play in the yard are
dependent on weather. Furthermore, parents would have double the chance of collecting a
child’s first urine void. The panel had considered including hair sampling as well but noted that
external contamination of hair and the inherent variability of arsenic deposition due to hair-type
(ethnicity) may confound an interpretation of the results. Urinary arsenic is considered the most
reliable measure for current/recent arsenic exposure with the majority of the dose excreted in the
urine3.
The collection kit contained the following: instructions on how to complete the collection, two
30 mL urine collection cups with attached funnel, a brief written questionnaire, and bags to place
the collection cups into once completed. Parents of the children were asked to collect the first
morning urine void on two consecutive days and to complete a short questionnaire. The
questionnaire asked about their child’s ethnicity and possible sources of arsenic exposure at the
time of the collection including: time spent playing in the yard at home, the presence of
uncovered soil in the yard, the presence of CCA- or green-treated lumber on decks or play
equipment at the home, weather conditions (rainy or dry), any consumption of fish or shellfish,
use of home remedies or natural medicines, whether the child is on a special diet or takes dietary
supplements, and whether anyone in the home smokes. After each collection parents were asked
to contact study staff who then visited the home and picked up the urine collection that was then
delivered to the MDH Public Health Laboratory (PHL).
Laboratory Analysis
Upon arrival at the Public Health Laboratory, urine samples were frozen until testing. Prior to
analysis, the two samples for each participant were thawed to room temperature and combined
5
into a new collection container. If the sample was going to be analyzed within 24 hours, the
combined sample was stored in a refrigerator; if not, it was refrozen.
The total arsenic concentration of each sample was measured using an inductively coupled
plasma – dynamic reaction cell – mass spectrometer (ICP-DRC-MS). Samples were diluted with
a 2% nitric acid/internal standard solution and compared to a calibration curve. Two types of
quality control samples, one type made within the laboratory and the other purchased from an
external source, were also analyzed with each set of samples.
At the time of total arsenic analysis, the concentration of creatinine in each sample was also
measured. Creatinine concentration is measured by monitoring the intensity of the red-orange
color that forms as a result of the interaction between alkaline picrate and creatinine. A creatinine
corrected total arsenic concentration was then calculated by dividing the measured total arsenic
concentration by the creatinine concentration for each sample. Such “creatinine-corrected”
urinary arsenic concentrations (given in micrograms of arsenic per gram of creatinine, µg/g) are
frequently reported in biomonitoring studies along with arsenic levels per liter of urine (given as
micrograms of arsenic per liter of urine, µg/L).
If a sample had a creatinine-corrected total arsenic concentration higher than 15 μg/g, the
concentrations of six individual arsenic species was determined. The concentrations of
arsenocholine, arsenobetaine, arsenous (III) acid, arsenic (V) acid, monomethylarsonic acid, and
dimethylarsinic acid were measured by analyzing the urine samples, which had been diluted with
an EDTA solution, using liquid chromatography – inductively coupled – dynamic reaction cell –
mass spectrometry (LC-ICP-DRC-MS). The measured concentration of each arsenic species was
divided by the creatinine concentration previously determined to yield a creatinine-corrected
arsenic species concentration. The concentrations of arsenic (V) acid, arsenous (III) acid,
monomethylarsonic acid and dimethylarsinic acid are counted with measures of inorganic
arsenic, and the concentrations of arsenocholine and arsenobentaine are counted as organic
arsenic.
6
Data Analyses
All questionnaire data were double entered and edit checked for errors. Statistical analysis of the
urinary arsenic levels was completed using SAS 9.1. Geometric means and log transformations
were determined for all of the urinary arsenic variables as they all had log normal distributions.
Soil arsenic data were also highly skewed requiring a log transformation to more closely
normalize the distributions. The skew in the soil and urine distributions are most likely due to a
few strong outliers in the study group.
RESULTS
Demographic Characteristics of Participants
Table 3 describes the demographic and housing characteristics of the study participants. There
were almost equal numbers of boys (49%) and girls (51%) and a diverse representation of
participants by race/ethnicity, with 46% self-identifying as non-Hispanic White, 15% non-
Hispanic black, 6% Asian-American, 23% Hispanic, 1% Native American, and 7% other or not
indicated. Most of the participants lived in a single family house or duplex (79%).
Urinary Arsenic Levels
Tables 4 and 5 and Figures 3 and 4 show the distribution of total and speciated urinary arsenic
levels. A total of 65 children provided two morning voids for analysis. Total creatinine-corrected
arsenic levels ranged from 5.63 to 191.3 µg/ g with a geometric mean of 13.5 µg/ g (95% CI
11.4-15.9 µg/ g). The geometric mean without creatinine-correction was 14.2 µg/ L (95% CI
11.5-17.5 µg/ L). Of the 65 urine samples, 23 (35.38%) had total arsenic levels greater than 15
µg/ g creatinine and speciation was completed for this group. No significant differences were
found in arsenic concentrations or demographic factors between those recruited in the initial
protocol (soil arsenic >20 ppm, N=40) and those recruited in the expanded protocol (soil arsenic
< 20 ppm, N=25). Therefore, these two groups were combined in subsequent analyses.
Figure 4 shows the concentrations of organic and inorganic arsenic for each of the 23 samples
that exceeded a total arsenic concentration of 15µg/g creatinine. Organic arsenic was the major
7
component of arsenic exposure found among the three children with the highest arsenic levels.
Organic arsenic is less toxic than inorganic arsenic, and exposure comes primarily through food,
particularly seafood.
Urinary Arsenic, Soil Arsenic and Other Factors
Since soil arsenic levels were available for each property from previous investigatory activities
by state and federal agencies, an analysis was conducted to examine correlations between
children’s urine arsenic levels with several measures of property soil arsenic concentration.
Figure 5 shows the distribution of soil arsenic concentrations for the 44 properties where the 65
children lived. Each property had between 2 and 4 soil samples analyzed to determine the level
of arsenic in the soil. Two different measures were used to characterize the soil arsenic level for
each property: one measure represents the highest recorded soil arsenic value found on the
property, while the other measure used is the calculated average of the soil arsenic values. The
geometric mean soil arsenic level for the 65 children was 27.2 parts per million (ppm) using the
highest measured value, with the 10th percentile at 4.3ppm and the 95th percentile of 370 ppm.
Using the average soil concentration, the geometric mean was 19.5 ppm, with the 10th percentile
at 3.8 ppm and the 95th percentile at 204.5 ppm.
Both the high and average soil arsenic concentrations for each child’s property were used in the
analysis to measure the relationship between soil and urine arsenic concentration. Table 6
shows the correlations between various urinary arsenic measures and the highest soil arsenic
levels. Figures 6 and 7 show graphically the relationship between total urinary arsenic and
average soil arsenic levels (scatterplots) using two different scales (linear and log). No
significant association was found between children’s total urinary arsenic levels and the soil
arsenic levels measured on the properties using either the highest or the average soil level.
Similarly, no relationship between urinary levels of inorganic arsenic and soil arsenic
concentrations was found for the 23 children with speciated arsenic levels measured, as shown in
Figure 8.
Tables 7 through 9 summarize responses from a short questionnaire given to parents at the time
of urine collection. The purpose of this short survey was to provide study staff with possible
8
exposure information should a child have a total urinary arsenic level greater than 50 µg/g
creatinine. Due to the limited scope of the pilot study, the questionnaire was not developed or
intended as a valid measure of covariates for use in the statistical analysis.
To determine whether the inclusion of sibling sets (non-independent observations) in the analysis
alters the relationship between soil arsenic levels and urinary arsenic levels, basic analyses were
completed comparing those in the study group that were siblings to those in the study group that
were not. A difference was found between the sibling group and the non-sibling group in
regards to the gender percentages; with a greater number of males falling into the sibling
category than females. To further investigate the possible effect of sibling status, one sibling was
randomly selected from each sibling grouping and the analysis was re-run. A comparison
between the two analyses revealed no significant differences when siblings were excluded nor
when one child was randomly included in the analysis. All of the geometric mean distributions
for each of the arsenic variables overlapped for the two groups. The correlations between soil
arsenic levels and urinary arsenic values remained non-significant in the adjusted analysis as
they had been in the total group analysis. As differences have been reported between males and
females in mean urinary arsenic level, an analysis was completed comparing the mean urinary
arsenic levels between males and females. No significant differences were found between males
and females for any of the speciated arsenic variables.
Communication of Individual Participant Results
Each participant (parent) was asked during the informed consent process to decide if they would
like to receive the results of the test, and all participants requested that the results for their child
(children) be provided to them. Figure 2 details the protocol for returning participants total
arsenic results. Once the analysis for the urinary total arsenic concentration was completed, a
letter was sent to each participant with the total arsenic results. Depending on the arsenic
concentration for the child, one of three different results letters (see Appendix) was sent as
follows: 1) children with a urinary total arsenic level below 15 µg/g creatinine, 2) children with a
level between 15 µg/g creatinine and 50 µg/ g creatinine, and 3) children with a level between 50
9
µg/g creatinine and 200 µg/g creatinine. A fourth letter was available, for children with a level
greater than 200 µg/g creatinine, but was not needed as none of the results exceeded this level.
At a level greater than 15 µg/g creatinine the participant’s urine was further tested, or speciated,
to determine the portion of the total arsenic concentration that was inorganic or organic. All
speciated arsenic results were mailed in second results letter to the 23 participants with total
urinary arsenic levels at or greater than 15 µg/g creatinine.
A total arsenic concentration above 50 µg/ g creatinine was considered to be indicative of
exposure to arsenic above the reference level established in the study protocol and further
follow-up was recommended based on ATSDR and CDC’s use of 50 µg/g creatinine as an action
level4. According to protocol, the parents of any child with a total arsenic level greater than 50
µg/g creatinine were contacted by staff with the results, with a written letter and a phone call.
There were three individual results that exceeded the 50 µg/g creatinine total arsenic and one that
measured approximately 49 µg/g creatinine. Parents of these four children all received a packet
with information about how to reduce exposure and recommendations to have their child seen by
their primary care provider to complete a repeat urine test to determine if the arsenic exposure
for the child continued and to complete an exposure history form. Parents received the names
of clinics in the community where study staff had presented information on the study and where
testing for arsenic was available. A consulting physician was available for individual counseling
and one family received help from staff to access health care as they were currently without
health care. In addition, questionnaire data for these cases and the speciation results were
examined to identify possible sources for arsenic exposure and to guide further investigation.
Case Studies of Three Highest Children
The three individual cases with total arsenic greater than 50 µg/g creatinine are described below.
• Case #1 had a total arsenic level of 58.9 µg/g creatinine, 84.9% of the total arsenic was
organic arsenic. The child was a young non-white boy at eight years of age. The child on
average played outside less than one hour a day every day of the urine collection week,
including the days of urine collection. The weather was a mix of rainy and dry during the
urine collection period. The child did consume fish or shellfish during the two days prior
10
to urine collection. The home had uncovered soil on the property, but no green-
treated/CCA wood on the property. The child did not take any home remedies, natural
medicines, homeopathic medicines, dietary supplements, and was not on a special diet.
The child resided in a non-smoking home.
• Case # 2 had a total arsenic level of 155.9 µg/g creatinine, 77.6% of the total arsenic was
organic arsenic. The child was a young non-white girl at six and a half years of age. The
child on average played outside one to two hours a day every day the week of the urine
collection, and 3 to 4 on the days of urine collection. The weather was a mix of rainy and
dry during the urine collection period. The child did not consume fish or shellfish during
the two days prior to urine collection. The home had uncovered soil on the property, but
no green-treated/CCA wood on the property. The child did not take any home remedies,
natural medicines, homeopathic medicines, dietary supplements, and was not on a special
diet. The child resided in a non-smoking home.
• Case #3 had a total arsenic level of 191.27 µg/g creatinine, 93.7% of the total arsenic was
organic arsenic. The child was a young non-white girl at nine and a half years of age.
The child on average played outside less than one hour a day every day the week of the
urine collection, including the days of urine collection. The weather was a mix of rainy
and dry during the urine collection period. The child did not consume fish or shellfish
during the two days prior to urine collection. The home did not have uncovered soil on
the property, and no green-treated/CCA wood on the property. The child did not take any
home remedies, natural medicines, homeopathic medicines, dietary supplements, and was
not on a special diet. The child resided in a non-smoking home.
Comparison of Findings with Other Studies of Arsenic Exposure in Children
There have been relatively few published studies of urinary arsenic exposures among children in
the U.S. Furthermore, these studies differ in purpose, targeted population, location,
environmental exposures and assessments, analytic procedures, time of year, and other study
factors. Therefore, comparison of the findings must be undertaken very cautiously. However,
11
these studies can provide some perspective on urinary arsenic levels found in this pilot study.
These studies are described below and summarized in Table 10.
Smiley’s Clinic, a family medicine clinic in south Minneapolis affiliated with University of
Minnesota Physicians, recently completed a study investigating levels of urinary arsenic in clinic
patients5. Smiley’s is located on the former CMC Heartland Site and this project was
undertaken to meet the needs of community members concerned about ongoing arsenic soil
contamination. All patients between the ages of 3 and 15 years of age were invited to complete a
spot urine collection at the time of their child’s wellness office visit. The spot urines were then
sent to their clinic lab for arsenic analysis. If a total arsenic level greater than 35 µg/L was found,
the sample was also speciated. The Smiley’s project was not meant to investigate the
relationship between urinary arsenic levels and soil arsenic levels. Preliminary data analyses for
75 children aged 3-15 years who participated in this study indicated a geometric mean total
urinary arsenic level of 20.4 µg/L (95% CI 17.5-23.9) compared to the geometric mean of 14.2
µg/L (95% CI 11.5-17.5) for the present MDH study. There were no specimens with elevated
inorganic arsenic levels. Since the Smiley’s Clinic study used a different and higher total urinary
arsenic threshold (>35 µg/L) than the MDH study (>15 µg/g creatinine-corrected) for speciating
the arsenic, it is not possible to compare inorganic arsenic levels for the two studies.
A study similar to the MDH Children’s Arsenic Study was conducted by Tsuji and colleagues in
Middleport, New York, examining the relationship between urinary arsenic levels in children and
adults and the soil arsenic concentrations in the summer and fall of 20036. As in the
Minneapolis Study, soil arsenic exposure was presumably due to soil contamination from a
former pesticide plant. The similar study designs between the Middleport, NY study and the
MDH Children’s Arsenic study make comparison of the two study samples feasible. The two
studies utilized similar urine collection methods and soil arsenic data was available under similar
circumstances. The total urinary arsenic levels in both study samples had comparable geometric
means (Middleport GM = 15.7 µg/L and S. Minneapolis GM = 14.2 µg/L), with neither study
finding a significant relationship between the soil arsenic levels and urinary arsenic levels.
12
Child and adult urinary arsenic levels were examined as part of the National Health and Nutrition
Examination Survey (NHANES)7. NHANES uses a complex sampling protocol to allow for a
representative national sample with reliable estimates for various demographic groups 8. While
the NHANES data showed a lower urinary arsenic level (GM = 7.1 µg/L, 95% CI 5.7-8.8 µg/L)
than the MDH Children’s Arsenic Study GM = 14.2 µg/L), this difference should be interpreted
very cautiously due to some key differences in study design. NHANES collects spot urines at
the time of the participant’s visit, while the MDH protocol called for the collection of two first
morning voids to best approximate a 24-hour urine collection. The MDH protocol may reflect a
better method for capturing arsenic exposure, as discussed by our Science Advisory Panel1. In
addition, the published NHANES data for arsenic included children aged 6-11 years versus the
3-10 years age range for the MDH study with an average age of 6 years. NHANES samples over
an entire calendar year while the MDH sample collection was limited to the late summer months
when there is more likely to be outdoor exposures. NHANES also collects a nationally
representative sample, including both rural and urban areas, whereas the MDH study population
is urban.
A 1997 study by Hwang and colleagues investigated the possible environmental exposure to
children from arsenic deposited in soil by a former copper smelter in Anaconda, Montana9. The
study recruited 414 children under 72 months of age to complete an exposure assessment as well
as the collection of a urine sample to measure arsenic body levels. The study was conducted
during the summers of 1992 and 1993. The geometric mean for the total urinary arsenic level for
289 children of the total study group was 19.1 µg/L. They collected information on the child’s
demographics, behavior/play habits, residence location, house history, and general
environmental conditions. They also collected soil, dust, water, and urine samples. The urine
samples were collected on two consecutive mornings to best capture possible arsenic exposure.
Soil arsenic measures were collected and characterized into 5 groups; 1) perimeter soil, 2) bare-
area composite soil, 3) garden-area composite soil, 4) sand box or dirt play area sample, and 5)
gravel or hardpack drive/parking areas. Not all children provided two consecutive morning
voids and a portion of the samples provided had unusually low creatinine measures and were
excluded from the analysis; a total of 271 children’s measures were analyzed. The study found
a significant correlation between bare soil arsenic values and speciated arsenic values; however,
13
no significant correlation was found between total urinary arsenic and bare soil arsenic values.
This study makes a concentrated effort to accurately describe and measure the total arsenic
exposure to children living in the community. The authors collected a number of soil arsenic
measures, detailed questionnaire data on the child’s play activities as well as diet, air exposure
level estimates, water exposure level estimates, and distance from the child’s residence to the
former copper smelting site. This degree of exposure measurement is necessary to determine or
evaluate routes of exposure of arsenic.
A pilot study by Shalat and colleagues in 2006 was conducted in Miami-Dade County, FL, to
investigate the arsenic exposure to young children who play on CCA- treated wood structures10.
Eleven children between the ages of 12 and 72 months were recruited for the project. A mean
urinary arsenic level of 13.6 µg/L was found for the 11 children. Each child provided two hand
rinses, pre and post play exposure, and a single first morning void following play exposure.
Environmental samples were also collected from each of the play areas including, wipe samples,
sawdust samples, and mulch samples. No association was found between the total urinary
arsenic levels and CCA treated wood. The pilot project did not attempt speciation for the project
and so they are unable to distinguish the type or source of arsenic in the urine.
DISCUSSION
The results from this biomonitoring pilot study provide information on the range and distribution
of urinary arsenic levels of 65 children living in South Minneapolis who completed the study.
Due to difficulties with the identification and recruitment of participants, the goal of obtaining a
random sample of 100 children exposed to elevated levels in the soil was not achieved. Due to
the non-random enrollment of participants, this study group is not considered to be representative
of the current population of children living in these South Minneapolis neighborhoods.
After reviewing several similar studies of children’s urinary arsenic levels, our results are
generally consistent with results found in other communities, including a concurrent
investigation of children attending a south Minneapolis community clinic. Results were also
consistent with results measured in another urban community in New York with soil arsenic
14
exposure from pesticide contamination. Similar to the New York study, no relationship was
found between the soil arsenic values and the urinary arsenic levels.
The absence of an association between arsenic levels in children and in the soil should not be
interpreted to mean that arsenic-contaminated soil poses no risk to children. There are several
important limitations that should be noted in interpreting these results that could explain the
absence of an association with levels in the soil. Soil measurements were not taken at the same
time that urinary arsenic measurements were taken nor were the locations specifically targeted
toward children’s play areas in the yard. There were large variations in soil concentrations from
samples taken in different locations around the yard. Thus, the soil concentration measurements
that were used may not adequately characterize each child’s actual soil exposure at the time of
the study. Reports of children’s time spent playing in the yard indicate that most of the children
spent two hours or less outdoors in the yard on days when the specimen was collected, thus
exposure levels may have been different on other days. Indoor exposure to arsenic in house
dust, which was not measured in this pilot, may be an important contributor to exposure in young
children. Drinking water is not a likely source of exposure for children in this study because all
homes are served by the municipal water supply.
RECOMMENDATIONS
The Minnesota Legislature directed MDH to conduct the pilot biomonitoring projects in a
manner that is community-based, thus involving community members to the extent possible in
providing input in to the study, including the development of recommendations. As these study
findings are presented to the community, recommendations will be solicited from the community
for follow-up or any further investigation of arsenic exposure.
As stated previously, one purpose of this project was to inform recommendations for a future
biomonitoring program for the state of Minnesota. The project succeeded in this respect and the
information and experience it provided are necessary and valuable to the success of future
projects.
15
For future biomonitoring projects directed at the communities residing in south Minneapolis and
similar urban communities, several recommendations can be made:
• Provide a significant lead time into the project to engage community partners and
members; approximately one year is needed prior to study recruitment to identify the
most effective means of ensuring wide study participation by community members.
• At least four to six field staff members are needed to work with the
community/participants during the recruitment and specimen collection phase of the
study protocol
• At least one Spanish speaking staff member and one Somali speaking staff member are
needed and community interpreters for other languages should be identified and
available.
• Conduct a feasibility study to determine the number of likely eligible participants in order
to better anticipate the number of household contacts and resources needed to achieve the
desired study sample size.
Although this study examined correlations between soil arsenic levels and urinary total arsenic
levels, the identification of routes of arsenic exposure was not the primary aim of the study. To
resolve questions about the sources of exposure, a more complete exposure assessment would be
needed. The absence of a correlation between urine levels and soil levels in this study group
does not suggest an absence of risk from soil contamination. Prudent public health policies that
minimize the risk to children in this community through continued soil remediation, prevention
of soil ingestion and community-wide health education are recommended.
16
REFERENCES
1. Minnesota Department of Health Environmental Health Tracking and Biomonitoring
Advisory Panel Meeting. March 11, 2008. Meeting Minutes for December 17, 2007
Advisory Panel Meeting p. 113 – 121.
2. Minnesota Department of Health, Health Consultation; Off Site Soils: CMC Heartland
Partners Lite Yard Site Minneapolis, Hennepin County, Minnesota. August 9, 2006.
ATSDR.
3. Baker B, Topliff A, Messing R, Durkin D, and Small Johnson J. 2005. Persistent
Neuropathy and Hyperkeratosis from Distant Arsenic Exposure. Journal of
Agromedicine vol 10(4):43 – 54.
4. Carrizales L, Razo I, Tellez-Hernandez J, Torres-Nerio R, Torres A, Batres L, Cubillas
A, Diaz-Barriga F. 2006. Exposure to arsenic and lead of children living near a copper
smelter in San Luis Potosi, Mexico: Importance of soil contamination for exposure of
children. Environmental Research 101: 1-10.
5. Personal communications with Dr. Peter Harper, Dr. Nancy Baker, and Emily Moody;
Smiley’s Clinic in South Minneapolis. March 2009
6. Tsuji JS, Van Kerkhove MD, Kaetzel RS, Scrafford CG, Mink PJ, Barraj LM, Crecelius
EA, Goodman M. 2005. Evaluation of Exposure to Arsenic in Residential Soil.
Environmental Health Perspectives vol 113(12): 1735 – 1740.
7. Caldwell K, Jones R, Verdon C, Jarrett J, Caudill S, and Osterloh J. 2008. Levels of
urinary total and speciated arsenic in the US population: National Health and Nutrition
Examination Survey 2003 – 2004. Journal of Exposure Science and Environmental
Epidemiology 19(1):1- 10.
8. NHANES website, details on recruitment, study design, data and sample collection.
http://www.cdc.gov/nchs/nhanes.htm
17
9. Hwang YH, Bornschein RL, Grote J, Menrath W, Roda S. 1997. Environmental arsenic
exposure of children around a former copper smelter site. Environmental Research
72(1): 72-81.
10. Shalat SL, Solo-Gabriele HM, Fleming LE, Buckley BT, Black K, Jimenez M, Shibata T,
Durbin M, Graygo J, Stephan W, Van De Bogart G. 2006. A pilot study of children's
exposure to CCA-treated wood from playground equipment. The Science of the Total
Environment 367(1): 80-88.
11. ATSDR Public Health Assessment for South Minneapolis Soil Contamination Site
MNN000509136 July 29, 2008
18
19
FIGURES
Figure 1. Map of South Minneapolis Neighborhood With Arsenic Contamination
ATSDR Public Health Assessment for South Minneapolis Soil Contamination Site MNN000509136 July 29, 20089
20
Figure 2. Action Plan Based on Total Arsenic Level
Plan of action based on Total Urinary Arsenic
Result
<15 µg/g creatinine ≥ 15 – 50 ≥ 50 – 200 µg/g creatinine
≥ 200 µg/g creatinine µg/g creatinine
“Above Normal” ● Will speciate ● Attempt to ID sources
● Recommend retesting with personal physician
● Follow up phone call from MDH physician
“Above Normal” ● Will speciate
● Attempt to ID sources ● If Concerned will recommend taking results to personal
physician
“Normal” ● Will speciate
● Attempt to ID sources ● If Concerned will recommend taking results to personal
physician
“Normal” ● May speciate
the urine ● No Further
Action Required
21
Figure 3. Distribution of Total Urinary Arsenic Levels in 65 Children
0 <= <
10
10 <= <
20
20 <=
< 30
30 <= <
40
40 <= <
50
50 <=
< 60
60 <= <
70
70 <= <
80
80 <= <
90
90 <=
< 100
100 <= <
110
110 <=
< 120
120 <=
< 130
130 <=
< 140
140 <=
< 150
150 <= <
160
160 <=
< 170
170 <= <
180
180 <=
< 190
190 <=
< 200
200 <=
< 210
0
5
10
15
20
25
30
Num
ber o
f Chi
ldre
n
Total Urinary Arsenic Levels µg/g (Creatinine-corrected)
ATSDR/CDC Level of Action (>50 µg/g)
1
22
Figure 4. Comparison of Organic and Inorganic Urinary Arsenic Levels in 23 Children with Total Arsenic >15 µg/g*
0
20
40
60
80
100
120
140
Urin
ary
Ars
enic
µg/
g (C
reat
inin
e-co
rrec
ted) Total Organic Arsenic µg/g
Total Inorganic Arsenic µg/g
*Each double bar represents a single child’s speciation results, ordered from lowest to highest total arsenic result.
23
Figure 5. Range of Soil Arsenic Levels for Yards of 65 Children Representing 44 Properties* (High, Average, Low Values)
♦
♦
♦
♦
♦
♦♦♦♦♦♦♦
♦♦♦
♦♦
♦♦
♦♦
♦♦
♦
♦♦
♦
♦♦♦♦♦♦♦
♦♦
♦♦
♦♦
♦
♦
♦
♦♦
♦
♦♦♦♦♦♦♦
♦♦
♦
♦
♦
♦
♦♦♦♦
♦
♦
1
10
100
1000
Ran
ge o
f Soi
l Ars
enic
Lev
els -
ppm
High Mean Low
*Siblings in the same household were all assigned same soil arsenic value
24
Figure 6. Total Urinary Arsenic Levels vs. Average Soil Arsenic Levels for 65 Children
(linear scale)
••
••
••••••••
•• •••
•••• •••
•
•••••••••
•
•••••
••• •••
••
•
••••••••
• ••••
•
•
•0
20
40
60
80
100
120
140
160
180
200
0 100 200 300 400 500 600
Tota
l Urin
ary
Ars
enic
µg/
g (C
reat
inin
e-co
rrec
ted)
Average Soil Arsenic Concentration - ppm
25
Figure 7. Total Urinary Arsenic Levels vs. Average Soil Arsenic Levels for 65 Children (log scale)
•
•
•
•••• ••••
•
•• •••
•••• •
•
•
•
•••••
•
•••
•
•
••
••
•
•
• ••
•
••
•
••••••
•
•
••
••
•
•
•
•
1
10
100
1000
1 10 100 1000
Tota
l Urin
ary
Ars
enic
µg/
g (C
reat
inin
e-co
rrec
ted)
Average Soil Arsenic Concentration - ppm
26
Figure 8. Inorganic Arsenic Levels vs. Average Soil Arsenic Levels for 23 Children with Total Arsenic > 15 µg/g (linear scale)
•
•
•
••
•
•
•
•
•
•
•
••
•
•
•
•
•
•
••
•
0
5
10
15
20
25
30
0 100 200 300 400 500 600Inor
gani
c U
rinar
y A
rsen
ic µ
g/g
(Cre
atin
ine-
corr
ecte
d)
Average Soil Arsenic Concentration - ppm
27
TABLES
28
Table 1. Study Population Eligibility and Participation—Original Protocol Total Number of Eligible Properties 511 Total Number of Eligible Households 883 Population Category N Vacant Households (identified by post office or study staff) 107 Occupied Households 776 Surveys Returned/Contact Made 532 Surveys Not Returned/Contact Never Made 229 Households Not Requiring a Visit 122 Households Requiring at Least One Visit 654 Households Requiring at Least Three Visits 354 Households With a Child Between 3 and 10 Years of Age 105 Households (with children) Returned Survey, Began Study 47 Households (with children) Refused 13 Households (with children) Passively Refused 45 Children that Participated From the Original Households 40
Table 2. Study Population Eligibility and Participation—Expanded Protocol Total Number of Additional Eligible Properties 2652 Population Category N Properties With No Response 2464 Vacant Properties (identified by post office or neighbor) 161 Properties Who Called to Participate 27 Children Invited From Expanded Population 27 Children that Participated From the Expanded Population 25
29
Table 3. Demographic and Housing Characteristics of Study Participants Characteristic Count Gender of the child Male 32 Female 33 Race/Ethnicity of the child African – American; Non-Hispanic Black 10 Asian – American 4 Chicano/Latino 15 Native American 1 Non-Hispanic White 30 Other 3 I prefer not to say 2 Type of Residence the Child lives in Townhome/apartment 2 3- or 4-plex 8 Duplex 12 House 39
30
Table 4. Urinary Arsenic Concentrations Population Arsenic by urine
creatinine level (µg/ g)
Arsenic by urine volume (µg/ L)
All Children (N = 65)
Geometric Mean (95% CI) 13.5 (11.4-15.9) 14.2 (11.5-17.5)
Median 11.3 12.1
Range 5.6 - 191.3 3.4 – 383.6
Girls (N = 33)
Geometric Mean (95% CI) 15.6 (11.9, 20.3) 17.3 (12.4, 24.3)
Median 12.7 13.8
Range 6.4 – 191.3 5.6 – 383.6
Boys (N = 32)
Geometric Mean (95% CI) 11.6 (9.4, 14.2) 11.6 (9.1, 14.6)
Median 9.6 9.7
Range 5.6 – 58.9 3.4 – 64.7
Original Study Sample (N = 40)
Geometric Mean (95% CI) 14.4 (12.0, 17.4) 12.0 (8.6, 16.9)
Median 13.1 13.8
Range 5.7 – 155.9 5.5 – 254.5
Expanded Study Sample (N = 25)
Geometric Mean (95% CI) 15.5 (12.1, 19.7) 12.4 (8.4, 18.1)
Median 9.1 9.6
Range 5.6 – 191.3 3.4 – 383.6
31
Table 5. Speciated Urinary Arsenic for Children With Total Arsenic > 15 µg/g (N=23) Category Range
(creatinine correction) µg/g
Range µg/L
Total Inorganic Arsenic 5.6 – 29.0 5.2 – 66.4 Total Organic Arsenic < LOD – 122.1 <LOD – 244.9
Arsenic Species Arsenobetaine (19 detects) - < LOD** – 243.8 As III (13 detects) - < LOD – 4.0 As V (6 detects) - < LOD – 7.5 Dimethylarsinic Acid (23 detects) - 2.5 – 55.7 MMA (20 detects) - < LOD – 6.9 Arsenocholine (1 detect) - <LOD – 1.1 *Arsenic levels were speciated only for children with total arsenic levels ≥ 15 µg/g (creatinine-corrected) ** LOD is the Limit of Detection, 1 µg/L for each species of arsenic Table 6. Basic Correlations Between The Normalized Soil Arsenic Concentrations and the Urinary Arsenic Levels.* Correlations Correlation
Coefficient (R)
R2 P value
High Soil value with Total Arsenic (creatinine corrected) 0.084 0.007 0.521 High Soil value with Total Arsenic (µg/L) 0.155 0.024 0.223 High Soil value with Total Inorganic Arsenic (creatinine corrected) 0.100 0.010 0.645 High Soil value with Total Inorganic Arsenic (µg/L) 0.170 0.029 0.433 High Soil value with Total Organic Arsenic (creatinine corrected) 0.045 0.002 0.862 High Soil value with Total Organic Arsenic (µg/L) 0.010 0.0001 0.962 *Log transformations were completed for the continuous variables as they were log-normally distributed
32
33
Table 7. Potential Arsenic Exposures Based on Questionnaire Arsenic Exposure Variable Yes No Unsure/Missing Presence of Green Treated Wood 11 47 7 Was the Child on a Special Diet 4 60 1 Did the Child consume Fish 5 60 Was the Child taking any Medicines 3 62 Did anyone smoke in the home 6 58 1 Presence of uncovered Soil on the Property 45 20 Was the Child taking supplements 23 42 Table 8. Weather at the Time of Urine Collection Weather Condition N Mix of rainy and dry 30 Mostly dry 31 Mostly wet 3 Missing 1 Table 9. Length of Time Child Played in Yard Based on Questionnaire Time Playing in the yard Less
than 1 hour
1 – 2 hours
3 – 4 hours
5--6 hours
More than 7 hours
Number of hours the child spent in the yard on average during the past week
(number of children) 23 22 12 4 4
Number of hours the child spent in the yard on average during the past 2 days
(number of children) 15 36 10 4 0
Table 10. Urinary Arsenic Levels Found in Children in Various Studies* Study and Population (Sample size) Urine
Sample Time period Geometric Mean Total
Arsenic by urine creatinine level (µg/g)
Geometric Mean Total Arsenic by
urine volume (µg/ L)
Median Range
MDH Children’s Arsenic Study (N=65) Children, age 3-10 years, residing in S. Minneapolis neighborhood with known soil arsenic contamination from former pesticide plant
Two morning
voids
July-Sept 2008
13.5 (11.4-15.9) 14.2 (11.5-17.5) 11.3 µg/g 12.1 µg/L
5.6--191.3 µg/g 3.4--383.6 µg/L
Smiley’s Clinic in Minneapolis5 (N=75) Children, age 3-15 years, residing in Metro area attending clinic for well-child exam
Spot sample
Nov. 2007-Nov. 2008
NA 20.4 (17.5-23.9) 22.5 µg/L 0.8--140.1 µg/L
Middleport, New York, Study6 (N=142) Children, Age 2-13 years, residing in Middleport community, where an arsenic pesticide manufacturing facility had been located
Two morning
voids
August-Sept 2003
NA 15.7 (GSD=1.7) NA 2.1--59.9 µg/L
US NHANES Study7 (N=290) Children, 6-11 years of age, stratified national sample in US
Spot sample
2003-2004 8.3 (6.6-10.3) 7.1 (5.7-8.8) 7.1 µg/g 6.7 µg/L
0.9--195.7 µg/g 0.4--333.5 µg/L
Anaconda, Montana9 (N=312) Children, age <6 years, residing in a community where former long-term copper smelter operations had caused soil arsenic contamination
Two morning
voids
1992-1993 NA 19.1 (GSD=1.9) NA NA
Miami-Dade County, FL Study10 (N=11) Children, age 1-6 years, with (7) and without (4) CCA-treated wood playground sets
Morning void or diaper
? NA 13.6 13.0 µg/L 7.2--23.1 µg/L
*Arsenic values in parentheses represent 95% Confidence Intervals or Geometric Standard Deviations (GSD); values shown as µg/g are creatinine-corrected levels.
34
APPENDICES
35
36
(blank page)
Appendix A Legislation
37
(blank)
38
Minnesota Environmental Health Tracking And Biomonitoring 2007
$1,000,000 each year is for environmental health tracking and biomonitoring. Of this amount, $900,000 each year is for transfer to the Department of Health. The base appropriation for this program for fiscal year 2010 and later is $500,000.
144.995 DEFINITIONS; ENVIRONMENTAL
HEALTH TRACKING AND
BIOMONITORING. (a) For purposes of sections 144.995 to 144.998, the terms in this section have the meanings given. (b) "Advisory panel" means the Environmental Health Tracking and Biomonitoring Advisory Panel established under section 144.998. (c) "Biomonitoring" means the process by which chemicals and their metabolites are identified and measured within a biospecimen. (d) "Biospecimen" means a sample of human fluid, serum, or tissue that is reasonably available as a medium to measure the presence and concentration of chemicals or their metabolites in a human body. (e) "Commissioner" means the commissioner of the Department of Health. (f) "Community" means geographically or nongeographically based populations that may participate in the biomonitoring program. A "nongeographical community" includes, but is not limited to, populations that may share a common chemical exposure through similar occupations, populations experiencing a common health outcome that may be linked to chemical exposures, populations that may experience similar chemical exposures because of comparable consumption, lifestyle, product use, and subpopulations that share ethnicity, age, or gender. (g) "Department" means the Department of Health. (h) "Designated chemicals" means those chemicals that are known to, or strongly suspected of, adversely impacting human health or development, based upon scientific, peer-reviewed animal, human, or in vitro studies, and baseline human exposure data, and consists of chemical families or metabolites that are included in the federal Centers for Disease Control and Prevention studies that are known collectively as the National Reports on Human Exposure to Environmental Chemicals Program and any substances specified by the commissioner after receiving recommendations under section 144.998, subdivision 3, clause (6). (i) "Environmental hazard" means a chemical or other substance for which scientific, peer-reviewed studies of humans, animals, or cells have demonstrated that the chemical is known or reasonably anticipated to adversely impact human health.
(j) "Environmental health tracking" means collection, integration, analysis, and dissemination of data on human exposures to chemicals in the environment and on diseases potentially caused or aggravated by those chemicals. 144.996 ENVIRONMENTAL HEALTH
TRACKING; BIOMONITORING. Subdivision 1. Environmental health tracking. In cooperation with the commissioner of the Pollution Control Agency, the commissioner shall establish an environmental health tracking program to: (1) coordinate data collection with the Pollution Control Agency, Department of Agriculture, University of Minnesota, and any other relevant state agency and work to promote the sharing of and access to health and environmental databases to develop an environmental health tracking system for Minnesota, consistent with applicable data practices laws; (2) facilitate the dissemination of aggregate public health tracking data to the public and researchers in accessible format; (3) develop a strategic plan that includes a mission statement, the identification of core priorities for research and epidemiologic surveillance, and the identification of internal and external stakeholders, and a work plan describing future program development and addressing issues having to do with compatibility with the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program; (4) develop written data sharing agreements as needed with the Pollution Control Agency, Department of Agriculture, and other relevant state agencies and organizations, and develop additional procedures as needed to protect individual privacy; (5) organize, analyze, and interpret available data, in order to: (i) characterize statewide and localized trends and geographic patterns of population-based measures of chronic diseases including, but not limited to, cancer, respiratory diseases, reproductive problems, birth defects, neurologic diseases, and developmental disorders; (ii) characterize statewide and localized trends and geographic patterns in the occurrence of environmental hazards and exposures; (iii) assess the feasibility of integrating disease rate
39
data with indicators of exposure to the selected environmental hazards such as biomonitoring data, and other health and environmental data; (iv) incorporate newly collected and existing health tracking and biomonitoring data into efforts to identify communities with elevated rates of chronic disease, higher likelihood of exposure to environmental hazards, or both; (v) analyze occurrence of environmental hazards, exposures, and diseases with relation to socioeconomic status, race, and ethnicity; (vi) develop and implement targeted plans to conduct more intensive health tracking and biomonitoring among communities; and (vii) work with the Pollution Control Agency, the Department of Agriculture, and other relevant state agency personnel and organizations to develop, implement, and evaluate preventive measures to reduce elevated rates of diseases and exposures identified through activities performed under sections 144.995 to 144.998; and (6) submit a biennial report to the chairs and ranking members of the committees with jurisdiction over environment and health by January 15, beginning January 15, 2009, on the status of environmental health tracking activities and related research programs, with recommendations for a comprehensive environmental public health tracking program. Subd. 2. Biomonitoring. The commissioner shall: (1) conduct biomonitoring of communities on a voluntary basis by collecting and analyzing biospecimens, as appropriate, to assess environmental exposures to designated chemicals; (2) conduct biomonitoring of pregnant women and minors on a voluntary basis, when scientifically appropriate; (3) communicate findings to the public, and plan ensuing stages of biomonitoring and disease tracking work to further develop and refine the integrated analysis; (4) share analytical results with the advisory panel and work with the panel to interpret results, communicate findings to the public, and plan ensuing stages of biomonitoring work; and (5) submit a biennial report to the chairs and ranking members of the committees with jurisdiction over environment and health by January 15, beginning January 15, 2009, on the status of the biomonitoring program and any recommendations for improvement. Subd. 3. Health data. Data collected under the biomonitoring program are health data under section 13.3805.
144.997 BIOMONITORING PILOT
PROGRAM. Subdivision 1. Pilot program. With advice from the advisory panel, and after the program guidelines in subdivision 4 are developed, the commissioner shall implement a biomonitoring pilot program. The program shall collect one biospecimen from each of the voluntary participants. The biospecimen selected must be the biospecimen that most accurately represents body concentration of the chemical of interest. Each biospecimen from the voluntary participants must be analyzed for one type or class of related chemicals. The commissioner shall determine the chemical or class of chemicals to which community members were most likely exposed. The program shall collect and assess biospecimens in accordance with the following: (1) 30 voluntary participants from each of three communities that the commissioner identifies as likely to have been exposed to a designated chemical; (2) 100 voluntary participants from each of two communities: (i) that the commissioner identifies as likely to have been exposed to arsenic; and (ii) that the commissioner identifies as likely to have been exposed to mercury; and (3) 100 voluntary participants from each of two communities that the commissioner identifies as likely to have been exposed to perfluorinated chemicals, including perfluorobutanoic acid. Subd. 2. Base program. (a) By January 15, 2008, the commissioner shall submit a report on the results of the biomonitoring pilot program to the chairs and ranking members of the committees with jurisdiction over health and environment. (b) Following the conclusion of the pilot program, the commissioner shall: (1) work with the advisory panel to assess the usefulness of continuing biomonitoring among members of communities assessed during the pilot program and to identify other communities and other designated chemicals to be assessed via biomonitoring; (2) work with the advisory panel to assess the pilot program, including but not limited to the validity and accuracy of the analytical measurements and adequacy of the guidelines and protocols; (3) communicate the results of the pilot program to the public; and (4) after consideration of the findings and recommendations in clauses (1) and (2), and within the appropriations available, develop and implement a base program. Subd. 3. Participation. (a) Participation in the biomonitoring program by providing biospecimens is voluntary and requires written, informed consent.
40
Minors may participate in the program if a written consent is signed by the minor's parent or legal guardian. The written consent must include the information required to be provided under this subdivision to all voluntary participants. (b) All participants shall be evaluated for the presence of the designated chemical of interest as a component of the biomonitoring process. Participants shall be provided with information and fact sheets about the program's activities and its findings. Individual participants shall, if requested, receive their complete results. Any results provided to participants shall be subject to the Department of Health Institutional Review Board protocols and guidelines. When either physiological or chemical data obtained from a participant indicate a significant known health risk, program staff experienced in communicating biomonitoring results shall consult with the individual and recommend follow-up steps, as appropriate. Program administrators shall receive training in administering the program in an ethical, culturally sensitive, participatory, and community-based manner. Subd. 4. Program guidelines. (a) The commissioner, in consultation with the advisory panel, shall develop: (1) protocols or program guidelines that address the science and practice of biomonitoring to be utilized and procedures for changing those protocols to incorporate new and more accurate or efficient technologies as they become available. The commissioner and the advisory panel shall be guided by protocols and guidelines developed by the Centers for Disease Control and Prevention and the National Biomonitoring Program; (2) guidelines for ensuring the privacy of information; informed consent; follow-up counseling and support; and communicating findings to participants, communities, and the general public. The informed consent used for the program must meet the informed consent protocols developed by the National Institutes of Health; (3) educational and outreach materials that are culturally appropriate for dissemination to program participants and communities. Priority shall be given to the development of materials specifically designed to ensure that parents are informed about all of the benefits of breastfeeding so that the program does not result in an unjustified fear of toxins in breast milk, which might inadvertently lead parents to avoid breastfeeding. The materials shall communicate relevant scientific findings; data on the accumulation of pollutants to community health; and the required responses by local, state, and other governmental entities in regulating toxicant exposures; (4) a training program that is culturally sensitive
specifically for health care providers, health educators, and other program administrators; (5) a designation process for state and private laboratories that are qualified to analyze biospecimens and report the findings; and (6) a method for informing affected communities and local governments representing those communities concerning biomonitoring activities and for receiving comments from citizens concerning those activities. (b) The commissioner may enter into contractual agreements with health clinics, community-based organizations, or experts in a particular field to perform any of the activities described under this section. 144.998 ENVIRONMENTAL HEALTH
TRACKING AND BIOMONITORING
ADVISORY PANEL. Subdivision 1. Creation. The commissioner shall establish the Environmental Health Tracking and Biomonitoring Advisory Panel. The commissioner shall appoint, from the panel's membership, a chair. The panel shall meet as often as it deems necessary but, at a minimum, on a quarterly basis. Members of the panel shall serve without compensation but shall be reimbursed for travel and other necessary expenses incurred through performance of their duties. Members appointed by the commissioner are appointed for a three-year term and may be reappointed. Legislative appointees serve at the pleasure of the appointing authority. Subd. 2. Members. (a) The commissioner shall appoint eight members, none of whom may be lobbyists registered under chapter 10A, who have backgrounds or training in designing, implementing, and interpreting health tracking and biomonitoring studies or in related fields of science, including epidemiology, biostatistics, environmental health, laboratory sciences, occupational health, industrial hygiene, toxicology, and public health, including: (1) at least two scientists representative of each of the following: (i) nongovernmental organizations with a focus on environmental health, environmental justice, children's health, or on specific chronic diseases; and (ii) statewide business organizations; and (2) at least one scientist who is a representative of the University of Minnesota. (b) Two citizen panel members meeting the scientific qualifications in paragraph (a) shall be appointed, one by the speaker of the house and one by the senate majority leader. (c) In addition, one representative each shall be appointed by the commissioners of the Pollution Control Agency and the Department of Agriculture,
41
and by the commissioner of health to represent the department's Health Promotion and Chronic Disease Division. Subd. 3. Duties. The advisory panel shall make recommendations to the commissioner and the legislature on: (1) priorities for health tracking; (2) priorities for biomonitoring that are based on sound science and practice, and that will advance the state of public health in Minnesota; (3) specific chronic diseases to study under the environmental health tracking system; (4) specific environmental hazard exposures to study under the environmental health tracking system, with the agreement of at least nine of the advisory panel members; (5) specific communities and geographic areas on which to focus environmental health tracking and biomonitoring efforts; (6) specific chemicals to study under the biomonitoring program, with the agreement of at least nine of the advisory panel members; in making these recommendations, the panel may consider the following criteria: (i) the degree of potential exposure to the public or specific subgroups, including, but not limited to, occupational; (ii) the likelihood of a chemical being a carcinogen or toxicant based on peer-reviewed health data, the chemical structure, or the toxicology of chemically related compounds; (iii) the limits of laboratory detection for the chemical, including the ability to detect the chemical at low enough levels that could be expected in the general population; (iv) exposure or potential exposure to the public or specific subgroups; (v) the known or suspected health effects resulting from the same level of exposure based on peer-reviewed scientific studies; (vi) the need to assess the efficacy of public health actions to reduce exposure to a chemical; (vii) the availability of a biomonitoring analytical method with adequate accuracy, precision, sensitivity, specificity, and speed; (viii) the availability of adequate biospecimen samples; or (ix) other criteria that the panel may agree to; and (7) other aspects of the design, implementation, and evaluation of the environmental health tracking and biomonitoring system, including, but not limited to: (i) identifying possible community partners and sources of additional public or private funding; (ii) developing outreach and educational methods and materials; and
(iii) disseminating environmental health tracking and biomonitoring findings to the public. Subd. 4. Liability. No member of the panel shall be held civilly or criminally liable for an act or omission by that person if the act or omission was in good faith and within the scope of the member's responsibilities under sections 144.995 to 144.998. INFORMATION SHARING. On or before August 1, 2007, the commissioner of health, the Pollution Control Agency, and the University of Minnesota are requested to jointly develop and sign a memorandum of understanding declaring their intent to share new and existing environmental hazard, exposure, and health outcome data, within applicable data privacy laws, and to cooperate and communicate effectively to ensure sufficient clarity and understanding of the data by divisions and offices within both departments. The signed memorandum of understanding shall be reported to the chairs and ranking members of the senate and house of representatives committees having jurisdiction over judiciary, environment, and health and human services.
42
Appendix B Arsenic Study Fliers
43
(blank)
44
Minneapolis Children’s Arsenic Study
WHAT: The Minnesota Department of Health (MDH) is conducting an important study to find out how much arsenic children living in south Minneapolis have in their bodies. WHERE: The neighborhoods that are part of the study include Phillips, Powderhorn, Corcoran, Seward and Longfellow. The yards of some of the homes in these neighborhoods have higher than normal levels of arsenic.
WHEN: Starting in May 2008, MDH will begin recruiting children to be in the study. HOW: MDH will send letters to families who might be eligible to be in the study. These are people who live in homes where the EPA found that the yards have more than 20 parts per million of arsenic. The letter will explain the project and ask people to fill out a short form. From the forms that are sent back to MDH 100 children will be invited to be in the study. If you have any questions about the
arsenic study, please contact
Adrienne Kari at MDH at 651-201-3635
May 2008 45
Current residentMailing address
Minneapolis Children’s Arsenic StudyReturn address
Minneapolis Children’s Arsenic StudyIf you have children between the ages of 3 and 10, they may be eligible to be in the Minneapolis Children’s Arsenic Study. Please look inside for more information.
(Spanish)If you have children between the ages of 3 and 10, they may be eligible to be in the Minneapolis Children’s Arsenic Study. Please look inside for more information.
(Somali)If you have children between the ages of 3 and 10, they may be eligible to be in the Minneapolis Children’s Arsenic Study. Please look inside for more information.
preprinted postage
The Minnesota Department of Health (MDH) is doing a study in your neighborhood to look for arsenic in children’s bodies. This study, called the Minneapolis Children’s Arsenic Study, will look for arsenic in 100 children. The study is being done in the same areas where the Environmental Protection Agency did testing of the soil for arsenic.
There are 20 spots still available in the study, so we are now expanding our recruitment efforts to additional homes. If you have children between the ages of 3 and 10 living in your home, they could be eligible to be part of the study.
If your child is in the study, you may need to help him or her collect two urine samples. You will also need to fill out a short survey. MDH will let you know how much arsenic is in your child’s urine, unless you do not want to have this information.
If you would like your child to be in the study, please call Adrienne Kari at 651-201-3635 for more information. The spots in the study will be assigned on a first-come, first-served basis. We will be finishing enrollment in August, so please call soon. Thank you!___________________________________________________________________________
SPANISH The Minnesota Department of Health (MDH) is doing a study in your neighborhood to look for arsenic in children’s bodies. This study, called the Minneapolis Children’s Arsenic Study, will look for arsenic in 100 children. The study is being done in the same areas where the Environmental Protection Agency did testing of the soil for arsenic.
There are 20 spots still available in the study, so we are now expanding our recruitment efforts to additional homes. If you have children between the ages of 3 and 10 living in your home, they could be eligible to be part of the study.
If your child is in the study, you may need to help him or her collect two urine samples. You will also need to fill out a short survey. MDH will let you know how much arsenic is in your child’s urine, unless you do not want to have this information.
If you would like your child to be in the study, please call Margaret Sweeney at 612-274-1173 for more information. The spots in the study will be assigned on a first-come, first-served basis. We will be finishing enrollment in August, so please call soon. Thank you!____________________________________________________________________________
SOMALI The Minnesota Department of Health (MDH) is doing a study in your neighborhood to look for arsenic in children’s bodies. This study, called the Minneapolis Children’s Arsenic Study, will look for arsenic in 100 children. The study is being done in the same areas where the Environmental Protection Agency did testing of the soil for arsenic.
There are 20 spots still available in the study, so we are now expanding our recruitment efforts to additional homes. If you have children between the ages of 3 and 10 living in your home, they could be eligible to be part of the study.
If your child is in the study, you may need to help him or her collect two urine samples. You will also need to fill out a short survey. MDH will let you know how much arsenic is in your child’s urine, unless you do not want to have this information.
If you would like your child to be in the study, please call Iman Hassan at 651-201-4956 for more informa-tion. The spots in the study will be assigned on a first-come, first-served basis. We will be finishing enroll-ment in August, so please call soon. Thank you!
46
What is the Minneapolis Children’s Arsenic Study?The Minneapolis Children’s Arsenic Study will measure how much arsenic is in the bodies of 100 children living in south Minneapolis, where the soil in some yards is contaminated with arsenic. The Minneapolis Children’s Arsenic Study is funded by the Minnesota state legislature as part of the Environmental Health Tracking and Biomonitoring Program at the Minnesota Department of Health.
Why is the Minneapolis Children’s Arsenic Study being done?Tests of the soil show that some of the yards in south Minneapolis have more arsenic than is normal for city yards. The soil tests were done by the United States Environmental Protection Agency (EPA), the Minnesota Department of Agriculture, and the Minnesota Department of Health (MDH) between 2001 and 2006.
This soil testing provides data on how much arsenic is in people’s yards. But we do not know how much arsenic has gotten into people’s bodies. The Minneapolis Children’s Arsenic Study will measure arsenic levels in children who are exposed to arsenic in the soil.
Who is eligible to be in the Minneapolis Children’s Arsenic Study? In order to be eligible to be in the study, children must live in a home where the EPA has conducted testing of the soil. Children must also be between the ages of three and ten to be eligible to be in the study. The study only in-cludes children because they have contact with the soil through outdoor play and are more likely to get soil in their mouths.
Which neighborhoods are included in the Minneapolis Children’s Arsenic Study? The neighborhoods that are part of the study include parts of Phillips, Powderhorn, Seward, Corcoran, and Long-fellow. These are the same neighborhoods where the EPA conducted testing of the soil. To view a map of the EPA testing area and a summary of the soil testing results, go to www.epa.gov/region5/sites/cmcheartland/.
What will children in the Minneapolis Children’s Arsenic Study have to do?The children who are part of the study will need to provide two urine samples. The urine will be collected at the children’s homes using supplies that MDH will provide. The urine will need to be collected two days in a row, the first time the child goes to the bathroom each morning. Young children may need their parents to help them collect the urine. MDH staff will pick up the urine samples from the home.
Parents of the children who are part of the study will be asked to answer a few questions about their child’s play activities and diet.
How will children’s arsenic levels be checked?The MDH lab will measure how much arsenic in each child’s urine. If the lab finds the total amount of arsenic in the urine is more than 15μg/L, the lab will measure how much of the arsenic is organic (a less harmful form of arse-nic) and how much is inorganic (a more harmful form of arsenic).
Minneapolis Children’s Arsenic Study Overview August 2008
When will the study results be available?Individual results from the lab test for arsenic will be given to the children’s parents within one month, if they want to receive them. If the lab runs a second test to measure how much of the arsenic is organic and how much is inor-ganic the results will be provided to parents within two to three months.
The results of the entire project will be available in winter or spring of 2009. These results will provide a general picture of the levels of arsenic in children living in south Minneapolis. The results will include the average, range and distribution of arsenic levels.
What is arsenic?Arsenic is a metal that is found in the earth’s crust. Arsenic can be found naturally in the air, water, soil and rocks. Arsenic is also sometimes used to make pesticides, fertilizers, and chemicals to protect pets from ticks and other pests. Until recently, arsenic was used to treat wood to make it last longer. This type of wood is called copper-chromated arsenic (CCA) treated wood. This kind of wood was often used to build playgrounds, decks, and raised garden beds in people’s yards. Arsenic is also found in some foods (such as seafood), homeopathic, traditional, and herbal medicines, dietary supplements, and cigarette smoke.
Where did the arsenic in people’s yards come from?From 1938 to 1963 pesticides that contained arsenic were stored at the corner of Hiawatha Avenue and 28th Street. Some of the arsenic in people’s yards probably came from dust blowing from this storage site into people’s yards. Some of the arsenic in people’s yards probably came from other sources, such as pesticides or fertilizers used by homeowners and certain kinds of pressure-treated lumber in people’s yards.
How can arsenic harm people’s health?Even though arsenic is a naturally occurring substance, it is also a toxin. This means arsenic can harm people’s health if they are exposed to it under certain conditions. The effects of arsenic depend on how much, how often, and how long people are exposed to it. The effects of arsenic also depend on what type of arsenic people are exposed to. Organic arsenic, which is found in seafood, is not usually harmful to the body. Inorganic arsenic, which is found in things like pesticides and treated wood, can be harmful.
Most people are exposed to very low levels of arsenic in the air, soil, water and food on a daily basis without any health effects. Exposure to higher levels of arsenic over a long period of time can cause changes in the color and thickness of the skin, numbness, loss of blood flow to the hands and feet, and certain kinds of cancer (e.g., skin, bladder, and lung). Exposures to very high levels of arsenic in a short period of time can have serious effects on the immune system and the nervous system, and can even cause death. The amount of arsenic found in most people’s yards will not cause these types of health problems.
Will the Minneapolis Children’s Arsenic Study tell us about the health effects of arsenic? The arsenic study will only tell us the levels of arsenic in children living in south Minneapolis. The testing will not be able to tell us whether arsenic caused anyone to get sick. That type of information can only be learned from health studies that are beyond the scope of this study.
For more information…For more information about the Minneapolis Children’s Arsenic Study, please contact Adrienne Kari at MDH at 651-201-3635 or [email protected].
47
(Blank page)
48
Appendix C Invitation to Participate and Forms
49
(blank)
50
Date <First Name> <Last Name> <Address> <Address2> <City>, <State> < Zip> Dear <First Name> <Last Name>, The Minnesota Department of Health (MDH) is doing a study in your neighborhood to look for arsenic in children’s bodies. This study, called the Minneapolis Children’s Arsenic Study, will look for arsenic in 100 children between the ages of 3 and 10. We are contacting you for this project because the soil in your yard was found to be contaminated with arsenic. The study will only include children because they have the greatest chance of being exposed to the arsenic in the soil. This is because they are more likely to play outside and to get soil in their mouths. Arsenic is a metal that occurs naturally in soil and rocks. It can sometimes be found in well water and in certain foods. It can also be found in some pesticides. MDH is concerned about arsenic in the soil because if you get too much in your body over a long period of time it can harm your health. (Please see the enclosed fact sheet for more information.) We are sending you this letter to find out if there are any children living in your home between the ages of 3 and 10 who are eligible to be part of the study. If you and your child would like to be considered for the study please fill out the enclosed form and return it to MDH in the envelope provided. (If there are no children between 3 and 10 years of age in your home, or you do not want to participate, please let us know by filling out the top of the form and returning it in the envelope provided. Doing this will make sure that we do not contact you again about this study.) From all of the forms MDH receives, 100 children will be picked at random to be in the study. If your child is selected, you will receive a letter inviting him or her into the study. The letter will provide more information and will include the consent forms that have to be filled out to be in the study. If your child is picked to be in the study, you can choose at that time whether or not you want to participate. Even if you return the enclosed form to us you can decide not to be part of the study later on. If your child is chosen to be part of the study, you may need to help him or her collect two urine samples. The urine will be collected two days in a row, first thing in the morning when your child wakes up. You will also need to fill out a very short survey about your child’s outside play habits. The urine will be looked at by the MDH Public Health Lab for arsenic. MDH will let you know how much arsenic is in your child’s urine, unless you do not want to have this information. Thank you for taking the time to read this letter. Please contact Adrienne Kari at (651) 201-3635 if you have any questions about the study. We look forward to hearing from you. Sincerely, Jean Johnson, PhD Biomonitoring Program Director IRB Approval #08-192 Revised: 5/5/2008 Minnesota Department of Health
51
Minneapolis Children’s Arsenic Study: Household Survey Household Information: Please complete the following general information about you and your household. All information will be kept private. Your name (first and last, please print):____________________________________________________ Mailing Address:________________________________ Apt #:_______________ City:_____________________________State:_____________Zip:___________ What type of building is this residence? (check one) House (single family) Duplex (2 units) 3 or 4-plex (3-4 units) Apartment (5 or more units) Are there children living in this household between 3 and 10 years of age? Yes No If no, stop here and please return this survey by mail in the provided envelope. If yes, do you want to have your child (children) considered for selection in to this study?
No, I do not want my child (children) to be considered for this study.
If no, Stop here and please return this survey by mail in the envelope provided.
Yes, I do want my child (children) to be considered for this study.
Are you the child/children’s primary adult caregiver (parent or guardian)? Yes No Please provide the following contact information for the child’s primary adult caregiver: Name (First and Last):__________________________________________________ (please print) Phone number (home):_______________(work):__________________(cell):________________ Best time to contact by phone: 9am to noon noon to 4pm 4pm to 9pm Anytime
Please list below all children between 3 and 10 years of age. This information will be used to add your child (children) to a list of children who may be randomly selected and invited into the study. Completing this survey now does not enroll your child in the study. You are not required to provide this information. However, if you choose not to provide the information then it will not be possible for your child to be in the study. This information will be kept private. Day Month Year 1. Child’s name:__________________________ Date of Birth:_____/____/_____ Girl Boy
2. Child’s name:__________________________ Date of Birth:_____/____/_____ Girl Boy
3. Child’s name:__________________________ Date of Birth:_____/__ __/_____ Girl Boy
4. Child’s name:__________________________ Date of Birth:_____/____/_____ Girl Boy
5. Child’s name:__________________________ Date of Birth:_____/____/_____ Girl Boy
If you have more children between the ages of 3 and 10 please use the other side of this form. Thank you for taking the time to fill out this survey and returning it in the enclosed envelope to the Minnesota Department of Health. We will be in contact with you once we have determined who will be invited to participate. If you have any questions please do not hesitate to call Adrienne Kari, at (651) 201-3635.
IRB Approval #08-192 Revised On: April 1, 2008 52
Minneapolis Children’s Arsenic Study Overview
What is arsenic? Arsenic is a metal that is found in the earth’s crust. Arsenic can be found naturally in the air, water, soil and rocks. Arsenic is also sometimes used to make pesticides and fertilizers. Until recently, arsenic was used to treat wood to make it last longer. This type of wood is called copper-chromated arsenic (CCA) treated wood. This kind of wood was often used to build playgrounds, decks, and raised garden beds in people’s yards. Arsenic is also found in some foods (such as seafood), homeopathic, traditional, and herbal medicines, dietary supplements, and cigarette smoke. Even though arsenic is a naturally occurring substance, it is also a toxin. This means arsenic can harm people’s health if they are exposed to it under certain conditions. There are two kinds of arsenic: organic and inorganic. Organic arsenic is the kind of arsenic in seafood and shellfish. This kind of arsenic is not usually harmful. Inorganic arsenic is the kind of arsenic found in pesticides and treated wood. Inorganic arsenic is more toxic than organic arsenic. Why did I get this letter about the Minneapolis Children’s Arsenic Study? The Minnesota Department of Health (MDH) sent you this letter because the soil in your yard has more arsenic in it than is normal for a city yard. Tests on the soil in your yard showed that your yard has more than 20 parts per million of arsenic in it. These tests were done by the United States Environmental Protection Agency (EPA), the Minnesota Department of Agriculture, and the Minnesota Department of Health between 2001 and 2006. This level of arsenic in the soil is not necessarily dangerous, but it is higher than some other city yards. How did the arsenic get into the soil? From 1938 to 1963 pesticides that contained arsenic were stored at the corner of Hiawatha Avenue and 28th Street. Some of the arsenic in people’s yards probably came from dust blowing from this storage site into people’s yards. Some of the arsenic in people’s yards probably came from other sources, such as pesticides or fertilizers used by homeowners and certain kinds of pressure-treated lumber in people’s yards. How can arsenic harm people’s health? The effects of arsenic depend on how much, how often, and how long people are exposed to it. The effects of arsenic also depend on what type of arsenic people are exposed to. Organic arsenic, which is found in seafood, is not usually harmful to the body. Inorganic arsenic, which is found in things like pesticides and treated wood, can be harmful. Most people are exposed to very low levels of arsenic in the air, soil, water and food on a daily basis without any health effects. Exposure to higher levels of arsenic over a long period of time can cause changes in the color and thickness of the skin, numbness, loss of blood flow to the hands and feet, and certain kinds of cancer (e.g., skin, bladder, and lung). Exposures to very high levels of arsenic in a short
53
period of time can also be harmful. Such exposures can have serious effects on the immune system and the nervous system and can even cause death. These kinds of health effects usually happen only with high levels of exposure. The amount of arsenic found in most people’s yards will not cause these types of health problems.
How will the Minneapolis Children’s Arsenic Study work? One hundred children between the ages of 3 and 10 will be invited to be part of the arsenic study. These children will be picked at random from the survey forms that are returned to MDH. The survey forms will be mailed to each household that was identified by the EPA as having greater than 20 parts per million of arsenic in the soil. The children who are part of the study will need to provide two urine samples. The urine will be collected at the children’s homes using supplies that MDH will provide. The urine will need to be collected two days in a row, the first time the child goes to the bathroom each morning. Young children may need their parents to help them collect the urine. MDH staff will pick up the urine samples from the home and the MDH lab will look to see whether there is any arsenic in it. Results from the lab test for arsenic will be given to the parents of participating children if they want them. If the lab finds the total amount of arsenic in the urine is more than 15μg/L, the lab will look to see how much of the arsenic is organic and how much is inorganic. These results will also be provided to parents who want them, but it may take several months, as this is a more difficult lab test than the first one. The results of the entire project will be available in winter or spring of 2009. These results will provide a picture of what the levels of arsenic look like in children living in south Minneapolis. What will we learn from the Minneapolis Children’s Arsenic Study? The parents of each child who is part of the arsenic study will have the chance to find out how much arsenic is found in their child’s urine. MDH will also combine all of the children’s results to figure out on average how much arsenic is in children in south Minneapolis. Will the Minneapolis Children’s Arsenic Study tell us about the health effects of arsenic? The arsenic study will only tell us the levels of arsenic in children living in south Minneapolis. The testing will not be able to tell us whether arsenic caused anyone to get sick. That type of information can only be learned from large-scale health studies that are beyond the scope of this study. For more information… For more information about this study, please contact Adrienne Kari at the Minnesota Department of Health at 651-201-3635 or [email protected]. Rev. 1/09
54
Date <First Name> <Last Name> <Address> <Address2> <City>, <State> <Zip Code> Dear <First Name> <Last Name>, Thank you for taking the time to complete the survey about the children living in your home for the Minneapolis Children’s Arsenic Study. At this time we would like to invite <child’s name> to join our study. This study is directed by MDH. Your child’s participation will give us valuable information about how much arsenic is in children living in south Minneapolis. This study will also help us learn about the best ways to gather information about the chemicals in people’s bodies. Please read the consent forms included with this letter carefully. If your child, <child’s name>, agrees to be a part of the study, please sign and date the forms and return them to the MDH in the envelope provided. If you have any questions or concerns please contact our study coordinator, Adrienne Kari, at 651-201-3635 or e-mail [email protected].
Once we receive the consent forms from you, we will send you the materials to collect your child’s urine. The materials will include all of the things you will need to collect two urine samples from your child. The materials will include instructions on how to collect the urine. You must collect the urine two days in a row. You must also collect the urine the first time your child goes to the bathroom in the morning. We will also ask you to answer a few questions about your child’s play habits on a form.
When you are ready to collect your child’s urine you will need to call MDH staff at (651)201-3635. Please be sure to call either before or immediately after you collect the first urine. MDH staff will pick the up the urine at your house.
If you agree, we will send you a letter with the results of the arsenic test for your child. You will also be provided with advice on what you can do to reduce your child’s exposure to arsenic. If the test shows that your child’s arsenic level is high, you will be advised to see your physician for a repeat of the test. Thank you for being a part of this important study. Again, please contact Adrienne Kari at 651-201-3635 or email [email protected] if you have any questions. Sincerely, Jean Johnson, PhD
IRB Approval #08-192 Biomonitoring Program Director Minnesota Department of Health
55
(blank)
56
Participant ID
For your records
Minneapolis Children’s Arsenic Study Parent/Guardian Consent Form
Introduction: Your child is invited to be a part of a research project that will measure the amount of arsenic in people’s bodies. Your child has been invited to be in this study because your home has been identified to have arsenic in the soil. Please read this form and call 651-201-3635 to ask any questions you may have before you agree for your child to be in the study. The Minneapolis Children’s Arsenic Study will be carried out by staff at the Minnesota Department of Health (MDH). Purpose: There are two main goals of this study. The first goal is to measure the levels of arsenic in the urine of children who live in south Minneapolis. The second goal is to learn about the best ways to conduct this type of study in other places in the future. We will be able to compare the arsenic levels of the children in south Minneapolis to the levels in other children in the country. Procedures: If you agree to allow your child to be a part of this study, we will ask you a few questions about your child’s outside play habits. We will also ask you to collect urine samples from your child on two days in a row. You will need to collect the urine first thing each morning. Supplies to help you collect your child’s urine and a short survey will be mailed to your home. Once you have called our staff (you may just leave a voicemail message), we will ask you to place the urine sample in a cool or shady place outside of your home for our staff to pick up. You will receive the results for the total amount of arsenic (μg/L) in your child’s urine within one month of the collection. If your child’s urine has a value greater than 15μg/L of arsenic, the lab will run more tests on the urine to find out what type of arsenic it is. Other samples (<15 μg/L) may also be tested further for laboratory purposes; if your child’s sample is included in this process we will provide you with these results at a later date. These extra tests will only be run in batches, so there will be a delay in getting these results. Stored Urine Samples: Most of the urine your child collects for the study will be used up in the arsenic testing process. The urine that is not used up and is left over from the collection will be stored at the MDH laboratory for the duration of the study, or about one year. At the end of the study period the left over sample will be destroyed.
IRB Approval #08-192 Revised on April 1, 2008
57
Participant ID
Risks of Being in the Study: There is no health risk to being in the study. Benefits of Being in the Study: Once we have tested the urine samples, and with your permission, we will send you a letter with your child’s test results. We will provide you with an interpretation of the results. We will let you know if your child’s results show any cause for concern, and we will also send you a summary of the results of the whole project. Follow Up: If your child has a high result we may recommend having your child followed up with your family doctor, which will be at your own cost. You will be able to call the MDH staff during the study if you have any questions. If your doctor has questions about arsenic, he or she may also call the MDH staff. The names and phone numbers of people to contact are listed below. Confidentiality: All the information and laboratory results collected about you and your child for this study are private. You are the only one who will receive your child’s own individual results. At the end of the study, MDH will share the results of the study with you, the public and researchers who want to know about the results of the study. The results will combine all of the children’s data together. We will not identify you or your child by name. We will not include any information that could identify you in any reports that we write. All of the information we collect for this project will be stored safely, as required by the Minnesota Government Data Practices Act. Data will be in a secure area, in a password-protected and locked database or file at all times. Only members of the research project team will ever have access to the data. Voluntary Participation: Your participation is voluntary. It is not required that your child be in this study. You can decide whether or not to allow your child to be a part of the study. Your choice will not affect your current or future relations with MDH or other groups that are part of the study. If you decide to allow your child to be a part of the study, you are free to take your child out of the study at any time. If the study staff decides it is in your child’s best interest, or if your child fails to follow the study requirements, your child’s participation in this study may be ended without your permission. Compensation: Once you have completed all of the study requirements, we will send you a $10.00 Cub foods gift card to cover your time commitment to the study. Contacts and Questions: If you have any questions, you can call or email the Biomonitoring Coordinator, Adrienne Kari, at (651-201-3635) or [email protected], or you can call the director for the project, Dr. Jean Johnson (651-201-5902). The toll-free number for MDH is 1-888-345-0823. If you or your child have any questions or concerns about the study or your rights as a research participant, and you would like to talk to someone other than the researcher(s), you may contact Peter Rode of the MDH Institutional Review Board at (651) 201-5942.
IRB Approval #08-192 Revised on April 1, 2008 58
Participant ID By marking the check boxes below and signing this form you are saying that you have had a chance to read the information provided, ask questions about the study, and that you are willingly giving permission for your child to participate in the study. You are also saying that you will allow the study staff to collect, store, and share the information gathered for the arsenic study as described above. You have been provided a copy of this consent, for your records. I agree that my child may participate in the Minneapolis Children’s Arsenic Study. yes no I agree to receive my child’s arsenic test result. yes no I give you permission to contact me in the future for other research projects. yes no Minor Participant’s Name:________________________________________________ (printed) Parent/Guardian Name:___________________________________________________ (printed) Parent/Guardian Signature:_________________________________________________ Date Signed:____________________________________________________________ Biomonitoring Coordinator Signature:________________________________________ IRB Approval #08-192 Revised on April 1, 2008
59
(blank)
60
Minneaplis Children’s Arsenic Study Urine Collection Instructions
****Before Collecting the urine please be sure your child has not eaten any seafood or fish for at least 3 days before you collect****
MAKE SURE YOU HAVE RECEIVED ALL OF THE SUPPLIES. Please look in the box that was mailed to your home to make sure you have all of these items: • two labeled urine collection cups with funnels attached • a brown paper bag • two plastic bags containing a small strip of papertowel • a survey and envelope
If any of these items are not present please let MDH staff know right away and we will be sure to get you the items you need.
COLLECT THE URINE SAMPLE. You will need to collect your child’s urine for two days in a row. On both days, this should be done first thing in the morning. It may be a good idea to place both of the urine cups in the bathroom or some other place where they will remind you to collect the urine in the morning. The collection cups have funnels attached to the top to make it easier to collect the urine. After the urine has been collected twist the funnel off and throw it away, screw on the metal cap. COMPLETE THE SURVEY. Please fill out the brief survey and place it in the envelope provided. Do not write your or your child’s name on the envelope. The identification label will identify your child on the form and will match the labels on the sample container. ARRANGE TO HAVE THE URINE SAMPLE PICKED UP. Either the evening before or the morning that you collect each urine sample please call our staff at (651) 274-1078 so we can pick it up from your house. Until the urine can be picked up, please store the containers in your refrigerator. MDH staff will attempt to meet you at your home to pick up the samples, however if you are unable to do that please be sure to describe where you will put the urine cup outside your house so that staff can find it. Please put the urine in a cool and shady location so that it does not heat up and so that no one disturbs the container. PUT THE URINE SAMPLE OUTSIDE SO IT CAN BE PICKED UP. On the day you collect the first urine sample, put the survey and the urine sample in the labeled brown paper bag. Put the bag in your refrigerator until MDH staff can get to your residence to pick up the second sample. Again, MDH staff will try to meet you at your residence to collect the sample, but if this is not possible please place the sample outside the home in a shady and cool place where it will be left alone and MDH staff can locate it easily. If you have questions about these instructions, please contact the study coordinator, Adrienne Kari at 651-274-1078.
61
(blank)
62
Attach label here Minneapolis Children’s Arsenic Study Exposure Questionnaire Parent or guardian, Please answer these questions on Day 2 after you have completed both urine collections, by circling and filling in your responses below. Thank you. Thinking about your child’s activities during this past week please answer the following questions: 1. How many days in the past week was your child at home during the day for 7 hours or more? 1 2 3 4 5 6 7 days 2. On average, about how many hours each day did your child play outside in the yard at your home this past week ? Less than 1 1-2 3-4 5-6 7 or more hours Thinking about the past 2 days (when you collected your child’s urine) please answer the following questions: 3. What was the weather like in the past 2 days? Mostly dry Mix of rainy and dry Mostly wet (rainy) 4. How many hours total did your child play outside in your home’s yard in the past 2 days? Less than 1 1-2 3-4 5-6 7 or more hours 5. In the past 2 days, has your child eaten any fish or shellfish, including canned tuna? Yes No 6. Is there anything we should know about your child’s activities over the past 2 days? _________________________________________________________ _________________________________________________________ __________________________________________________________ Please answer the following questions about the yard at your home. 7. Do you have any uncovered soil (areas with no grass) in your yard (not including gardens)? Yes No 8. Do you have any “green-treated” wood in your yard (used typically for building decks and play structures)? Yes No Not Sure
63
Please answer the following questions about your child. 9. Does your child use any home remedies, natural medicines or homeopathic medicines? Yes No 10. Does your child take any dietary supplements (vitamins/minerals)? Yes No 10a. If yes, what type of supplements do they take? _____________________________________________________________ 11. Is your child on a special diet? Yes No 11a. If yes, what type of diet is your child on? ______________________________________________________________ 12. Does anyone in your home smoke? Yes No 13. How would you describe your child’s race/ethnicity? (please circle one) Non-hispanic white Non-hispanic black Native American Chicano/Latino Asian-American African-American Other I prefer not to say Completed by (name:) ______________________________date:___________________ In case we cannot contact you (parent or guardian), please provide the name of a close friend or relative that would be able to assist us in reaching you if we were unable to contact you at your current address and phone. Please let them know that your child is participating in this study in case we need to contact them. Name (First and Last):__________________________________________________ Phone Number :____________________________________________________
IRB Approval #08-192 Revised On: March 19, 2008
64
Appendix D Sample Results Letter (< 15 µg/g creatinine)
65
(blank)
66
October 3, 2008 <First Name> <Last Name> <Address> <Address 2> <City>, <State> <Zip Code> Dear <First Name>, Thank you very much for your and <child’s name>’s, participation in the Minneapolis Children’s Arsenic Study, conducted by the Minnesota Department of Health (MDH). Your child’s sample, <study ID>, was analyzed by the Minnesota Department of Health, Public Health Laboratory (601 Robert Street North, St. Paul, MN 55164). We have reviewed your child’s results and found that the total arsenic level is within the normal range. Your child’s total arsenic level is ____ ug/g creatinine, collected on <date>. The normal level is considered to be less than 50 ug/g creatinine. The total urinary arsenic level shows what a person has most recently been exposed to (within days or weeks). The urinary arsenic level does not tell us how long a person has been in contact with arsenic. The level of arsenic in the urine may go up or down depending on different conditions; a person’s daily activities, diet, when the urine was collected, and if the person has any other health problems. Sometimes people will have the same exposures to arsenic but different urinary arsenic levels. We do no believe there is any reason for you to worry about the arsenic level that was found. We do not believe that you need to seek medical care for your child at this time. However, if you wish, you may bring this letter with you to your child’s next doctor’s visit so you can discuss the results with the doctor. Also, if you would like to decrease your child’s exposure to arsenic, please read the enclosed handout for ideas on how to do that. Even though your child’s results are normal, the MDH laboratory may be looking at your child’s urine sample again to see how much of the arsenic is organic and how much is inorganic. Organic arsenic in our bodies usually comes from foods, such as fish. Inorganic arsenic in our bodies usually comes from soil, water, and some pesticides. Inorganic arsenic is more harmful to the body than the organic arsenic. We will send you another letter letting you know the results of the second test if it is completed. It may take several months before you receive these results if these tests are completed. Once we have analyzed the results from all of the people who were in the study we will mail you a report of the study’s findings. We will also let you know when we will be holding meetings to present the results of the study. Thank you for being a part of this important study. If you have any questions or concerns please feel free to contact me at 651-201-3635 or [email protected]. Sincerely, Adrienne Kari Biomonitoring Coordinator Minnesota Department of Health 67
(blank)
68
Minneapolis Children’s Arsenic Study Reducing exposure to arsenic
There are many ways that people can be exposed to arsenic. Most people are not exposed to enough arsenic to make them sick. However, if you would like to reduce your or your children’s exposure to arsenic, here are some ideas. Arsenic can be present in soil, old pressure-treated wood, pesticides and fertilizers, dietary supplements and folk medicines, tobacco, and food. Soil Urban soils can contain many contaminants, including arsenic, lead, and pet wastes. Here are some steps you can take to reduce contact with all of these contaminants in the soil: • Provide children with a safe place to play. Build a sandbox with a lined bottom and fill it
with clean sand. Cover it when not in use to keep out any contaminated dirt.
• Make sure there are no bare spots in your yard. You can plant grass seed or lay sod. Bushes and other plants can also help keep the soil in place.
• Wash your hands and teach your children to wash their hands after gardening or playing in the dirt.
• Keep dirt from getting inside the house: o Take off your shoes when you enter the house. Store your shoes at the entryway. o Wipe off your pets’ feet before letting them inside. o Keep windows closed on windy days. This will keep dust from blowing inside.
• Remove the dirt that gets inside:
o Vacuum or wet-mop regularly to get rid of any dust inside the house. Use a vacuum with a HEPA filter (a special filter that removes small dust and particles from the air) to prevent dust from being redistributed through the house.
o Clean surfaces with damp rag. o Change your furnace filter every three months. o Wash items that go into children’s mouths, such as pacifiers and toys.
• Be careful when gardening:
o Use gloves when you garden to keep dirt off your hands and fingernails. o Rinse off garden tools. o Dampen the soil before gardening to prevent dust from forming. o Wash and peel vegetables grown in the yard to remove any soil on the outside of the
vegetables. o Consider growing vegetables in raised beds filled with clean soil. o Wash gardening and play clothes separately from other clothes.
69
Pressure-treated wood Some pressure-treated wood contains arsenic. This type of wood is called CCA-treated wood, or green-treated lumber. This wood is no longer being sold to homeowners, but can still be found in many people’s yards – in decks, playground equipment, picnic tables, raised garden beds and other structures. If you have a deck or other outdoor structures made of CCA-treated wood, here are some ways you can reduce your exposure to arsenic: • Never burn CCA-treated wood. If you’re not sure if the wood is CCA-treated, don’t burn it. • Replace CCA-treated wood, if possible. If you cannot remove the CCA-treated wood, seal it
every year with stain or varnish to reduce the amount of arsenic that is released. • Wash children’s hands after they play on CCA playground structures. • Avoid cutting CCA-treated wood. If you must cut CCA-treated wood, wear a face mask so
you don’t inhale the sawdust. Pesticides and fertilizers Check to see whether you have any old pesticides, fertilizers and other soil supplements that contain arsenic. If you do not know whether they contain arsenic do not use them. Call the Minnesota Department of Agriculture at 651-201-6560 to find out how you can safely dispose of them. For more information about metals in fertilizers, go to http://www.health.state.mn.us/divs/eh/risk/studies/metals.html Dietary supplements and folk medicines Some traditional, natural and homeopathic medicines contain arsenic. Some vitamins and dietary supplements also contain arsenic. These medicines and supplements contain arsenic: • Fowler’s solution • Donovan’s solution • Asiatic pill • Kushtay • Yellow root tea • Kelp • Arsenicum album • Dietary supplements containing chitin (Chitosan for example) • Dietary supplements containing seaweed • Calcium supplements containing seashells Tobacco and cigarettes Tobacco and cigarettes contain some arsenic. • Avoid frequent exposure to other people’s smoke, especially when indoors. • If you smoke, try to quit. You can call QUITPLAN at 1-888-354-PLAN (7526) to get help
with quitting. • If you smoke, do not smoke inside the house or near your children. This will prevent long-
term, low-level exposures to arsenic.
70
Food Some foods contain arsenic. However, the kind of arsenic found in most foods is usually not harmful. Arsenic is found in the following types of food: • Seafood and shellfish (e.g., crab, oysters, clams, tuna, fish sticks, and fish from the ocean) • Seaweed/kelp • Rice and rice milk Other sources of arsenic • Jobs: Some jobs expose people to arsenic. For example, people who work with lead or
copper smelting, pesticides and fertilizers, semi-conductors, railroad cars or tracks, poultry feed or manure, and/or animal “dips” may be exposed to arsenic. Showering and changing clothes before entering the house can help to prevent arsenic from getting inside.
• Water: In some parts of Minnesota there is arsenic in the drinking water. This is not the case in Minneapolis.
Rev. 1/09
71
(blank)
72
Appendix E Sample Results Letter (> 15 µg/g creatinine)
73
(blank)
74
<Date> <First Name> <Last Name> <Address> <City>, <State> <Zip Code> Dear <First Name>, Thank you very much for your and <child’s name>’s, participation in the Minneapolis Children’s Arsenic Study, conducted by the Minnesota Department of Health (MDH). Your child’s sample, <study ID>, was analyzed by the Minnesota Department of Health, Public Health Laboratory (601 Robert Street North, St. Paul, MN 55164). We have reviewed your child’s results and found that the total arsenic level is within the normal range. Your child’s total arsenic level is ____ ug/g creatinine, collected on <date>. The normal level is considered to be less than 50 ug/creatinine. The total urinary arsenic level shows what a person has most recently been exposed to (within days or weeks). The urinary arsenic level does not tell us how long a person has been in contact with arsenic. The level of arsenic in the urine may go up or down depending on different conditions; a person’s daily activities, diet, when the urine was collected, and if the person has any other health problems. Sometimes people will have the same exposures to arsenic but different urinary arsenic levels. We do not believe there is any reason for you to worry about the arsenic level that was found. We do not believe that you need to seek medical care for your child at this time. However, if you wish, you may bring this letter with you to your child’s next doctor’s visit so you can discuss the results with the doctor. Also, if you would like to decrease your child’s exposure to arsenic, please read the enclosed handout for ideas on how to do that. Even though your child’s results are normal, the MDH laboratory will be looking at your child’s urine sample again to see how much of the arsenic is organic and how much is inorganic. Organic arsenic in our bodies usually comes from foods, such as fish. Inorganic arsenic in our bodies usually comes from soil, water, and some pesticides. Inorganic arsenic is more harmful to the body than the organic arsenic. We will send you another letter letting you know the results of the second test. It may take several months before you receive these results. Once we have analyzed the results from all of the people who were in the study we will mail you a report of the study’s findings. We will also let you know when we will be holding meetings to present the results of the study. Thank you for being part of this important study. If you have any questions or concerns please feel free to contact Adrienne Kari at 651-201-3635 or [email protected]. Sincerely, Adrienne Kari Biomonitoring Coordinator Minnesota Department of Health
75
(blank)
76
<Date> <First Name> <Last Name> <Address> <City>, <State> <Zip Code> Dear <First Name>, Thank you very much for your and your child’s, <child’s name>, participation in the Minneapolis Children’s Arsenic Study, conducted by the Minnesota Department of Health (MDH). Your child’s sample, <study ID>, was analyzed by the Minnesota Department of Health, Public Health Laboratory (601 Robert Street North, St. Paul, MN 55164). We have reviewed your child’s results and found that the total arsenic level is above the normal range. We recommend that you go to a doctor for repeat testing. Your child’s total arsenic level is ___, collected on <date>. The normal level is considered to be less than 50 ug/L. The total urinary arsenic level shows what a person has most recently been exposed to (within days or weeks). The urinary arsenic level does not tell us how long a person has been in contact with arsenic. The level of arsenic in the urine may go up or down depending on different conditions; a person’s daily activities, diet, when the urine was collected, and if the person has any other health problems. Sometimes people will have the same exposures to arsenic but different urinary arsenic levels. The MDH laboratory will be looking at your child’s urine again to see how much of the arsenic is organic and how much is inorganic. We will send you another letter letting you know the results of this second test. It may take several months before you receive the results. It is unlikely that your child has had or will have any health effects from the arsenic. However, we recommend you take your child to their doctor for further follow up. A doctor will review the results and help you understand what they mean for your child’s health. A doctor may want to:
• Test your child’s urine again to see if the result is still above the normal range. • Do a special test on your child’s urine to see what kind of arsenic is in the urine. Organic
arsenic in the body usually comes from foods, such as fish. Inorganic arsenic usually comes from soil, water, and some pesticides. Inorganic arsenic is more harmful to the body than organic.
• Talk to you about how your child might be getting exposed to arsenic. • Talk to you about ways to reduce your child’s exposure to arsenic in the future.
If you do not have a doctor, there are a number of clinics in your area that can help you.
77
You may also want to take action to reduce your child’s exposure to arsenic. Please review the enclosed information on how to reduce exposure to arsenic. Once we have analyzed the results from all of the people who were in the study we will mail you a report of the study’s findings. We will also let you know when we will be holding meetings to present the results of the study. If you or your child’s doctor have any questions, please call me at 651-201-3635. Thank you for being part of this important study. Sincerely, Adrienne Kari, MPH Biomonitoring Coordinator Minnesota Department of Health
78
Arsenic Exposure Checklist Please carefully read through the following list. Check all boxes that might fit the person being checked for arsenic exposure. Well Water
□ Do you get your drinking water from a well?
□ If you do, has it been tested for arsenic?
Foods and Medicines
□ Do you eat shellfish, tuna, fishsticks, fish from the oceans, or seaweed?
□ Do you eat rice often? □ Do you use any special medicines? □ Do you use any special skin creams? □ Do you take any dietary
supplements?
Home and Garden □ Have you ever had the soil in your
yard test for arsenic? Who tested it? ___________________________ □ Do you have the sample results from
the laboratory? □ If you have vegetable or food
garden, does it have a border or edge made from green treated wood?
□ Have you ever used fertilizers, pesticides or soil supplements (like Ironite) in your garden?
If so, please list the kinds ___________________________ ___________________________ □ Have you ever used fertilizers,
pesticides or soil supplements on your lawn?
If so, please list the kinds __________________________ __________________________
□ Are there fertilizers, pesticides or soil supplements stored anywhere in your home or yard?
□ Are then any areas of bare soil in your yard (not covered by grass or plants)?Any bare soil (not covered by sod or other plants)
□ Do you have a pet that spends time in your yard and indoors?
□ Do you use animal shampoos or dips for your pets?
□ Do you use any pesticides (like ant killer) inside?
□ Do you have a wooden deck? □ Do you have a wooden play set for
children? □ Do you ever burn scrap wood,
outside or inside? □ Do you wash fruit and vegetables
bought at a store before eating them? Recreation
□ Do your children play in playgrounds with wooden structures?
□ Do you have picnics on unpainted wooden picnic tables?
Work Please place a check in the box if you have ever done any of these things as part of your job.
□ smelting copper or lead □ making pressure treated wood □ making semiconductor □ making or applying pesticides □ making or applying fertilizers □ making or applying animal “dip” □ making animal food □ working with animal wastes
79
(blank)
80
Minneapolis Children’s Arsenic Study Reducing exposure to arsenic
There are many ways that people can be exposed to arsenic. Most people are not exposed to enough arsenic to make them sick. However, if you would like to reduce your or your children’s exposure to arsenic, here are some ideas. Arsenic can be present in soil, old pressure-treated wood, pesticides and fertilizers, dietary supplements and folk medicines, tobacco, and food. Soil Urban soils can contain many contaminants, including arsenic, lead, and pet wastes. Here are some steps you can take to reduce contact with all of these contaminants in the soil: • Provide children with a safe place to play. Build a sandbox with a lined bottom and fill it
with clean sand. Cover it when not in use to keep out any contaminated dirt.
• Make sure there are no bare spots in your yard. You can plant grass seed or lay sod. Bushes and other plants can also help keep the soil in place.
• Wash your hands and teach your children to wash their hands after gardening or playing in the dirt.
• Keep dirt from getting inside the house: o Take off your shoes when you enter the house. Store your shoes at the entryway. o Wipe off your pets’ feet before letting them inside. o Keep windows closed on windy days. This will keep dust from blowing inside.
• Remove the dirt that gets inside:
o Vacuum or wet-mop regularly to get rid of any dust inside the house. Use a vacuum with a HEPA filter (a special filter that removes small dust and particles from the air) to prevent dust from being redistributed through the house.
o Clean surfaces with damp rag. o Change your furnace filter every three months. o Wash items that go into children’s mouths, such as pacifiers and toys.
• Be careful when gardening:
o Use gloves when you garden to keep dirt off your hands and fingernails. o Rinse off garden tools. o Dampen the soil before gardening to prevent dust from forming. o Wash and peel vegetables grown in the yard to remove any soil on the outside of the
vegetables. o Consider growing vegetables in raised beds filled with clean soil. o Wash gardening and play clothes separately from other clothes.
81
Pressure-treated wood Some pressure-treated wood contains arsenic. This type of wood is called CCA-treated wood, or green-treated lumber. This wood is no longer being sold to homeowners, but can still be found in many people’s yards – in decks, playground equipment, picnic tables, raised garden beds and other structures. If you have a deck or other outdoor structures made of CCA-treated wood, here are some ways you can reduce your exposure to arsenic: • Never burn CCA-treated wood. If you’re not sure if the wood is CCA-treated, don’t burn it. • Replace CCA-treated wood, if possible. If you cannot remove the CCA-treated wood, seal it
every year with stain or varnish to reduce the amount of arsenic that is released. • Wash children’s hands after they play on CCA playground structures. • Avoid cutting CCA-treated wood. If you must cut CCA-treated wood, wear a face mask so
you don’t inhale the sawdust. Pesticides and fertilizers Check to see whether you have any old pesticides, fertilizers and other soil supplements that contain arsenic. If you do not know whether they contain arsenic do not use them. Call the Minnesota Department of Agriculture at 651-201-6560 to find out how you can safely dispose of them. For more information about metals in fertilizers, go to http://www.health.state.mn.us/divs/eh/risk/studies/metals.html Dietary supplements and folk medicines Some traditional, natural and homeopathic medicines contain arsenic. Some vitamins and dietary supplements also contain arsenic. These medicines and supplements contain arsenic: • Fowler’s solution • Donovan’s solution • Asiatic pill • Kushtay • Yellow root tea • Kelp • Arsenicum album • Dietary supplements containing chitin (Chitosan for example) • Dietary supplements containing seaweed • Calcium supplements containing seashells Tobacco and cigarettes Tobacco and cigarettes contain some arsenic. • Avoid frequent exposure to other people’s smoke, especially when indoors. • If you smoke, try to quit. You can call QUITPLAN at 1-888-354-PLAN (7526) to get help
with quitting. • If you smoke, do not smoke inside the house or near your children. This will prevent long-
term, low-level exposures to arsenic.
82
Food Some foods contain arsenic. However, the kind of arsenic found in most foods is usually not harmful. Arsenic is found in the following types of food: • Seafood and shellfish (e.g., crab, oysters, clams, tuna, fish sticks, and fish from the ocean) • Seaweed/kelp • Rice and rice milk Other sources of arsenic • Jobs: Some jobs expose people to arsenic. For example, people who work with lead or
copper smelting, pesticides and fertilizers, semi-conductors, railroad cars or tracks, poultry feed or manure, and/or animal “dips” may be exposed to arsenic. Showering and changing clothes before entering the house can help to prevent arsenic from getting inside.
• Water: In some parts of Minnesota there is arsenic in the drinking water. This is not the case in Minneapolis.
Rev. 1/09
83