minnesota department of health environmental health ... · panel members are invited to ask...

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Minnesota Department of Health Environmental Health Tracking and Biomonitoring Advisory Panel Meeting FEBRUARY 12, 2019

1:00 P.M. – 4:00 P.M.

American Lung Association in Minnesota

490 Concordia Avenue

St. Paul, Minnesota

M D H E N V I R O N M E N T A L H E A L T H T R A C K I N G A N D B I O M O N I T O R I N G

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Minnesota Department of Health Environmental Health Tracking and Biomonitoring PO Box 64882 St. Paul, MN 55164-0882 651-201-5900 [email protected] www.health.state.mn.us

Upon request, this material will be made available in an alternative format such as large print, Braille or audio recording. Printed on recycled paper.

mailto:[email protected]

http://www.health.state.mn.us/

http://www.health.state.mn.us/


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Contents Agenda ........................................................................................................................................ 4

Section Overview: MN FEET Plus preliminary results ................................................................. 8

Section Overview: Healthy Rural and Urban Kids project update ............................................ 20

Section Overview: Toxic Free Kids Act ...................................................................................... 24

Section Overview: MN Tracking Updates ................................................................................. 28

Section Overview: Advisory Panel Subcommittee meeting report .......................................... 34

Section Overview: Other Information ...................................................................................... 40


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Agenda: Environmental Health Tracking and Biomonitoring Advisory Panel Date: 02/12/2019

Welcome & Introductions: Lisa Yost

1:00pm

Panel members and audience are invited to introduce themselves.

Agenda overview: Jessie Shmool

1:05pm

A brief overview of topics and discussion items.

Legislative Updates

1:10pm

Mary Manning will provide an update on the new legislative session and administration.

MN FEET Plus preliminary results

1:20pm

Jessica Nelson will present the results from analysis on the MN FEET Plus newborn bloodspots. Panel members are invited to ask questions and comment.

Discussion 1:40pm

Questions for the panel:

▪ Does the Panel recommend further analyses of these data?

▪ Does the Panel have thoughts on additional hypotheses that could explain results?


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Toxic Free Kids Act

2:00pm

Michelle Gin, Toxic Free Kids Communications Planner with MDH, will present an overview of the Toxic Free Kids Act. Panel members are invited to ask questions and comment.

Refreshments

2:30pm

Please join us in thanking Alan Bender on his many years of service to the EHTB Advisory Panel.

MN Tracking updates

2:50pm

Jessie Shmool will update the panel on MN Tracking priorities and CDC continuing application (year 3 of a 5 year Cooperative Agreement). Panel members are invited to ask questions and comment.

Advisory Panel Subcommittee meeting report and recommendations

3:00pm

An update on the Advisory Panel subcommittee will be provided in written form. Panel members are asked to consider recommending, by consensus or vote, the following recommendations.

Discussion 3:05pm

Recommendations for the panel:

We recommend that MN Biomonitoring, in collaboration with other partners, conduct a project in State Fiscal Year 2019-2020 to continue urine mercury testing in adult East African women of childbearing age. This targeted biomonitoring project would follow up on questions from MN FEET about mercury exposures and use of skin lightening products in this community. This project would use the many lessons learned in MN FEET about recruiting women from this community, and would work with health care providers in a community clinical setting where exposure reduction can be most effective.

We recommend that MN Biomonitoring continue planning for and initiate a new project in adult women of childbearing age in SFY 2019-2020. Based on information from past biomonitoring studies and state and local initiatives to reduce exposure to metals and other chemicals of concern, this project would measure exposures to chemicals used in personal care


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and household products that may affect child development. The project would consider differences by sociodemographic variables related to health equity in order to assess whether targeted public health actions are needed to better protect women’s and children’s health. Planning work would include determining target populations, analytes and recruitment methods, and engaging stakeholders, other partners and communities.

Public comments & audience questions

3:45pm

New Business

3:55pm

Motion to adjourn

4:00pm


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Section Overview: MN FEET Plus preliminary results This section summarizes the preliminary results from the MN FEET Plus newborn bloodspot study. Jessica Nelson will present these results at the meeting.

Questions for the Advisory Panel:

Does the Panel recommend further analyses of these data?

Does the Panel have thoughts on additional hypotheses that could explain results?


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MN FEET Plus preliminary results

Background and goals

Newborn blood spots – small amounts of blood collected from an infant’s heel on a filter card soon after birth – are routinely collected for state newborn screening programs to identify treatable health conditions not evident at birth. The MDH Public Health Laboratory (PHL) developed a novel method of measuring fetal mercury exposure using these same blood spots. Compared to the standard prenatal mercury exposure measures using cord blood or maternal blood, blood spots offer advantages of ease of collection, storage and lower cost.

MDH is one of only a few state health agencies that have reported measuring mercury in newborn blood spots. The first MDH study using this method was conducted by the Fish Consumption Advisory Program, and was one of the original biomonitoring pilot projects from the 2007 Environmental Health Tracking and Biomonitoring (EHTB) law. This study measured mercury in newborn blood spots among infants born to mothers living around the Lake Superior Basin (1). The study found a number of Minnesota infants with mercury concentrations above the level corresponding to the U.S. Environmental Protection Agency’s

(EPA) reference dose (RfD) of 5.8 g/L, and raised questions about the extent of mercury exposure in other parts of the state. The study also raised questions about the reliability of the blood spot methodology, prompting the EHTB Advisory Panel to recommend that MDH continue to evaluate newborn blood spots as a biomonitoring method.

In 2012, MN Biomonitoring collaborated with Dr. Ruby Nguyen (University of Minnesota) and her team’s The Infant Development and Environment Study (TIDES) to conduct a sub-study to start to evaluate the newborn blood spot method. This sub-study – the Pregnancy and Newborns Exposure Study – measured mercury in paired newborn blood spot and cord blood samples from the same babies. Findings published by Nelson et al. (2016) indicated that mercury levels in newborn blood spots were strongly correlated with levels in paired cord blood, but that blood spot measurements may underestimate mercury exposure compared to cord blood (2). Interpretation of the results was limited, however, by small sample size (n=48 overall, n=16 with mercury detected in both cord blood and blood spot samples). The paper recommended further study of the relationship between cord blood and newborn blood spots in larger populations and those with higher mercury exposures.

Thus, in planning the MN FEET study, design decisions were made to enable a cord blood-newborn blood spot comparison in a larger population. MN FEET Plus, the sub-study of MN FEET addressing these questions, re-contacted MN FEET participants and measured mercury in their babies’ newborn blood spot, comparing results with paired cord blood samples.

MN FEET Plus had the following goals: 1. Continue to investigate the relationship between mercury levels in newborn blood spot

v. cord blood, toward evaluating the utility of the blood spot biomonitoring method forpublic health surveillance.

2. Conduct this investigation in a much larger and more diverse population, potentiallywith a greater range of mercury exposures.

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Methods

Recruitment

All MN FEET participants who gave a cord blood sample were eligible to participate in MN FEET Plus. After receiving their MN FEET results, they were mailed a separate recruitment letter for MN FEET Plus. If they chose to participate, they mailed back a written informed consent form. Women who chose to participate received an additional $25 gift card to thank them for their time. We mailed recruitment letters to 393 eligible MN FEET participants and 229 agreed, for a 58% response rate.

Sample collection

Blood spots: MN FEET Plus analyzed the residual portion of blood spots remaining after collection and analysis for the MDH Newborn Screening Program (NSP). As part of the NSP, a health professional takes a few drops of blood from the newborn’s heel within 24-48 hours of birth. The drops of blood fill five spots on a filter paper card. After the drops of blood have dried, they are sent to the NSP to be screened for more than 50 inherited and congenital disorders. For blood spots collected on or after August 1, 2014, the residual blood spots are stored indefinitely and used for program operations as defined in Minnesota State law. A parent can also direct MDH to destroy the residual blood spots.

MN FEET Plus participants gave written informed consent for the residual portion of the NSP blood spot to be used for mercury testing. MN FEET Plus participants’ names, baby’s date of birth, and hospital of birth were matched to their baby’s NSP blood spots (n=229). For each baby, NSP staff pulled the blood spot cards and took two punches from the residual portion of the baby’s blood spots. For quality assurance, staff also took two punches from the blank area of each card as a control for each sample, along with periodic duplicate punches. The punches were transferred to the MDH PHL Environmental Lab without participant identifiers for mercury analysis. All samples were stored and analyzed in a PHL clean room.

Cord blood: The two hospitals that collected cord blood samples for MN FEET, Regions and Abbott hospitals, routinely collect cord blood samples. For babies flagged as MN FEET participants, the attending midwife/OB or nurse drew a second tube of cord blood using their standard protocol. Cord blood was collected in a purple top EDTA tube supplied by the PHL. All specimen collection vessels were pre-screened for metal content.

Within 2 hours of collection, samples were sent to the hospital laboratory for storage. On a weekly basis, samples were picked up by MDH staff, maintaining storage temperature during transport.

Laboratory analysis

Blood spots: For each sample analyzed, NSP staff placed the two punches (3-mm filter paper disks) containing the dried blood into a 96-well filter plate. The PHL chemist transferred the punches into a different plate and added reagent solution to extract the mercury overnight. After extraction, contents were filtered into a 96-well plate and analyzed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) against a five-point aqueous standard calibration curve. To calculate mercury concentration in the blood spot, a total blood volume of 6.2 µL

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blood per specimen (3.1 µL blood per punch) was assumed (3), as is a standard practice in newborn screening programs. Limit of Detection (LOD) 0.587 ug/L; Method Report Limit (MRL) 2.42 ug/L.

Quality control acceptance criteria are summarized in Table 1 and were consistent with other metals analyses (both CDC and EPA methods) performed by MDH PHL.

▪ Every analyzed sample (two punches from a blood spot) was paired with analysis of twopunches from the blank area of the card as a control for each sample, checking both formercury contamination on the blood spot collection card and environmental exposureduring collection, storage and transport.

▪ National Institute of Standards and Technology (NIST) Standard Reference Material (SRM)was spiked onto the filter paper as a blood spot and analyzed using the same extractionprocedure used for samples; the NIST sample was also analyzed in liquid form.

▪ Report level was verified by spotting blood spiked at the report level with mercury andanalyzing using the same extraction procedure used for samples.

▪ Calibration curves were verified by analyzing a second source verification standardprepared from different mercury standard lots than that of the calibrator standards.

▪ Reproducibility was verified by analyzing a set of duplicate punches every 20 samples.▪ Some blood spot samples were analyzed more than once, because of QC issues. While only

the value accompanied by acceptable QC was reported, internal assessment of resultsshows that the duplicate measurements were very similar (Appendix 1).

Table 1. Quality control criteria and schedule

Sample Preparation Acceptable Recovery Frequency

NIST Blood spot + blank 53-94% Before and after every 10 samples

NIST Liquid 79-121% Before and after every 10 samples

Quality Control (Low, Medium & High)

Liquid 85-115% Before and after every 10 samples

Report Level verification

Blood spot 60-140% Every 20 samples

Calibration verification

Liquid 80-120% Every 20 samples

Sample duplicate Blood spot + blank Agree ±20% Every 20 samples

Cord blood: Cord blood samples were analyzed for total mercury concentrations using ICP-MS. LOD 0.090 ug/L; MRL 0.5 ug/L.

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Clotting is a known issue that can affect the analysis because methyl mercury binds to red blood cells. We are not able to fully examine the role of clotting for two reasons: 1) some cord blood samples had obvious clots in the blood tube (n=13), but this clotting was only noted in the record starting part-way through the study; and 2) if clotting occurred prior to collection in the blood tube, this would not have been known or obvious as clotting in the sample tube.

Preliminary results

Descriptive statistics

Mercury was detected in 92% of cord blood samples and 100% of blood spot samples (Table 2). The median, mean and 95th percentile values were notably higher for blood spots compared to cord blood. For cord blood, three samples (1.3%) were above the EPA RfD of 5.8 ug/L, compared to 42% (n=96) for blood spots.

Table 2. Distribution of mercury in cord blood and newborn blood spots (n=229)

Sample Type % detect

Geometric mean

Median 95th

percentile Min Max

N (%) > 5.8 ug/L

Cord blood 92 0.7 0.7 3.1 <LOD 20.2 3 (1.3%)

Newborn blood spot 100 4.9 5.1 14.1 1 25.8 96 (42%)

Correlation between cord blood and blood spot

For 211 of 229 participants, both cord blood and blood spot concentrations were above the LOD. In this sub-set, cord blood and blood spot concentrations were moderately correlated (Pearson correlation coefficient on log-transformed values of 0.36, p<0.0001), and the average blood spot: cord blood ratio was 9.8 + 10.4 (range: 1.0-70). Figure 1 shows a scatterplot and Figure 2 (next page) shows results for each cord blood-blood spot pair (in order of ascending blood spot concentration).

Figure 1. Scatterplot of mercury in cord blood v. newborn blood spots (n=211)

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Figure 2. Mercury concentrations for each sample pair (n=211)

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Newborn blood spot Cord blood

Modification by cord blood concentrations

Comparing correlations between cord blood and blood spot mercury across different cord blood concentrations is helpful for understanding the relationship. Table 3 shows spot: cord ratios and correlations for sub-sets of the population, in increasing order of cord blood mercury concentrations. The relationship between cord blood and blood spot mercury was increasingly discordant as cord blood concentrations got lower.

Table 3. Spot: cord relationship in different sub-sets

Sub-set of samples N (%) Average spot: cord ratio (SD)

Pearson correlation

Cord blood mercury <LOD 18 (8%) 33.2 (28.6) N/A*

Cord blood mercury >LOC and <MRL 66 (29%) 18.0 (14.2) 0.08 (p=0.5)

Cord blood mercury >MRL 145 (63%) 6.1 (4.8) 0.4 (p<0.0001)

Top 8% of cord blood mercury 18 (8%) 2.2 (1.1) 0.7

* All cord blood concentrations are <LOD so correlation analysis not valid.

For the 18 samples with cord blood concentrations below the LOD, the average spot: cord ratio was very high (33.2), with high variability. For the next set of samples, those above the LOD but below the MRL (n=66), the spot: cord ratio was still quite high (18.0) and the two sample types

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were not correlated. For samples above the cord blood mercury MRL, the spot: cord ratio (6.1) and correlation were similar to the overall population (9.8). Finally, in samples in the top 8th percentile (chosen to represent the opposite end of the spectrum from the 8% of samples <LOD) of cord blood concentrations, the spot: cord ratio was much closer to one (2.2), and the samples were more highly correlated.

Evaluation for surveillance applications

For environmental health surveillance, the utility of the blood spot test would be based on its ability to accurately detect elevated newborn exposure, i.e. exposures above the EPA RfD of 5.8 ug/L. Our study assumption was that cord blood measures were the gold standard “true” measure, based on literature and past studies. While this assumption may be problematic, as we explore in the following Discussion section, here we use this point of comparison between cord blood and blood spots to evaluate potential implications for surveillance. Table 4 shows the distribution used to calculate sensitivity, specificity and predictive value positive. These measures were limited by only having three elevated cord blood cases in MN FEET Plus.

Table 4. Elevated cord blood v. blood spot samples

Variable Yes/No Cord blood > 5.8 = Yes Cord blood > 5.8 = No Total

Blood spot > 5.8 = Yes 3 93 96

Blood spot > 5.8 = No 0 133 133

Total 3 226 229

The sensitivity of the blood spot test was 100% (3/3): If a baby had an elevated blood spot result, this was the probability that they were a “true” positive (i.e. also had an elevated cord blood result).

The specificity was 59% (133/226): The probability that the blood spot test correctly classified a baby with a “true” negative result (i.e. baby with non-elevated cord blood).

The predictive value positive was 3% (3/96): If a baby had an elevated blood spot result, this was the probability that they were a “true” positive (i.e. also had an elevated cord blood result).

Discussion

These preliminary results show a consistent pattern of higher mercury concentrations in newborn blood spots compared to paired cord blood samples from the same baby. This was particularly true for sample pairs with low cord blood concentrations. It is difficult to explain these results. We would expect the blood mercury concentrations to be relatively similar to one another, as both cord blood and the newborn blood spot are samples of the newborn’s blood taken within 48 hours of each other.

These results were also unexpected based on findings from the much smaller TIDES sub-study, which observed the opposite association: mercury concentrations tended to be higher in cord blood than newborn blood spots, with an average spot: cord ratio of 0.82 (+ 0.4). The TIDES

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sub-study also found a much stronger correlation between the two samples types (Pearson coefficient = 0.82).

However, there were important differences between MN FEET Plus and the TIDES sub-study. In the TIDES sub-study, newborn blood spots were collected separately for the study after the MDH Newborn Screening blood spots were taken, and two full blood spots (as opposed to the residual portion of blood spots already used for another purpose) were available for analysis. Storage times were shorter between blood spot sample collection and analysis. In addition, cord blood samples were collected in a more controlled manner in TIDES than in MN FEET Plus. In particular, in the TIDES cord blood collection protocol, a needle was used to collect cord blood from the outermost vein of the cord soon after the delivery of the placenta. This minimized the blood’s contact with air and decreased the opportunity for the blood to clot. In MN FEET Plus, on the other hand, cord blood collection for the study relied on existing hospital procedures, which included emptying cord blood into an open metal bowl and drawing a sample, which would likely make clotting more prevalent.

Possible explanations for discordant sample concentrations

We have explored various hypotheses that could explain the discrepancies seen between cord blood and newborn blood spot mercury concentrations in MN FEET Plus. As a biological difference does not seem plausible, these hypotheses relate to sample collection, storage and/or analysis. ▪ Laboratory error can be ruled out as a possibility to explain the differences. As described

above, extensive QA/QC measures were employed to ensure that results were analytically

valid. Of the 229 blood spot samples analyzed, 51 had to be re-injected because they

originally failed QC. The re-analysis results showed that concentrations were very similar

for both runs. All duplicate samples were within the acceptable 20% margin of error.

▪ Contamination in the lab seems very unlikely given that mercury was only detected in the

blank punches from 5 of 229 samples, and at relatively low concentrations (all below the

MRL). When these five samples were excluded, the relationship between the sample types

was similar.

▪ Contamination in the hospital also seems unlikely given the results from the blank punches.

Contamination would have had to occur on the infant’s heel before the blood was spotted

on to the filter paper. Most samples (224/229) were collected at Regions Hospital, with

only five collected at Abbott Northwestern Hospital. Though the number of samples at

Abbott was small, the relationship between samples types was similar for both locations.

Sample collection also extended over a long period (over 2 years), so contamination would

have had to be ongoing to explain the findings.

Two other hypotheses seem to have more potential to explain the differences, perhaps in combination with one another. They both relate to assumptions about homogeneity within the blood spot and cord blood samples. ▪ Quality of blood spots. As the MN FEET Plus blood spot samples were residual punches

taken after all the Newborn Screening Punches were removed, unlike in the TIDES sub-

study, they may have been of lower quality because the spots had already been well used.

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The equation to determine blood spot concentration makes an assumption about the

volume of blood in each spot and that it is identical for all spots. This may be problematic,

and lead to inaccurate mercury concentrations, especially when “true” concentrations (as

measured by cord blood) are very low. This issue of heterogeneity of blood spots is a

recognized issue when using this sample type. Although some checking for uniform

mercury distribution in the blood was done as part of the verification process, there may

be uncharacterized variability.

▪ Issues with clotting in cord blood. Because mercury binds to red blood cells, mercury may

concentrate in blood clots. While cord blood samples were vortexed before analysis, this

only helps with micro-clots. If larger clots were in the blood tube, or if clots existed in the

cord blood before the sample was taken and did not get transferred to the blood tube, the

concentration of mercury may be underestimated. Exclusion of all 13 cord blood samples

noted in the record as having clots did not alter results, but the practice of recording

clotting started part-way through the study, so complete information is not available. This

issue may also in part explain differences between findings in MN FEET Plus and the TIDES

sub-study, as discussed above. Keeping tight control over cord blood collection is

challenging, as the time around a baby’s birth can be chaotic. Anecdotally, other

researchers have raised concerns about practical issues with collecting cord blood samples

for biomonitoring; CDC rejects cord blood samples that have a clot. We did not do this for

MN FEET Plus because we did not have multiple chances to collect a sample and wanted to

collect whatever data we could for participants.

Implications for surveillance

The larger question of the usefulness of newborn blood testing for surveillance of fetal mercury exposures should also be considered. Staff approached the development of the blood spot lab method with the idea that the method may be mainly valid as a screening test for elevated exposures. If we consider the cord blood results as the “truth” (which is a potentially inaccurate assumption, as discussed above), the blood spot test was effective at capturing the elevated cord blood cases and had high sensitivity. However, it had low specificity and predictive value positive, with an extremely high rate of false positives. In this study, blood spot testing did not appear to be effective at characterizing lower-level mercury exposures.

These preliminary results raise various questions about using biomonitoring to measure fetal exposures to mercury. They seem to indicate that testing of newborn blood spots, although it is more efficient and cost effective, is not a reliable measure when compared to cord blood analysis. However, the results also raise questions about using cord blood analysis as the “gold standard” for measuring fetal exposure, especially when standard hospital procedures used for cord blood collection may introduce clotting that may cause underestimated mercury exposure.

Questions for Advisory Panel ▪ Does the Panel recommend further analyses of these data?

▪ Does the Panel have thoughts on additional hypotheses that could explain results?

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References

1. Minnesota Department of Health Division of Environmental Health. Mercury Levels in Blood from Newborns in the Lake Superior Basin. St. Paul, MN: Minnesota Department of Health; 2011. Available from: http://www.health.state.mn.us/divs/eh/hazardous/topics/studies/glnpo.pdf.

2. Nelson JW, Edhlund BL, Johnson J, Rosebush CE, Holmquist ZS, Swan SH, Nguyen RH. Assessing a New Method for Measuring Fetal Exposure to Mercury: Newborn Bloodspots. Int J Environ Res Public Health. 2016 Jul 9;13(7).

3. Li, W.; Lee, M. Dried Blood Spots: Applications and Techniques; John Wiley & Sons, Inc.: Hoboken, NJ, USA, 2014.

Appendix 1

This is a list of the 51 newborn blood spot samples that were analyzed twice because the initial analysis had a failing quality control value. The initial result should not be relied on, because at least one of the quality controls was not within acceptable limits, however it is interesting to examine how close the values are between the initial result (failing QC) and reported result (passing QC) as an indicator of the reliability of the reported result.

Sample

Initial

result

ug/L

Reported

Result

ug/L

17G0369-01 3.45 3.26

17G0370-01 1.93 1.23

17G0371-01 3.51 2.21

17G0372-01 8.00 7.07

17G0373-01 3.42 3.88

17G0374-01 3.66 2.75

17G0375-01 5.21 4.94

17G0376-01 3.26 3.04

17G0377-01 5.20 4.43

17G0378-01 2.12 1.84

17G0379-01 2.20 2.26

17G0380-01 6.10 7.70

17G0381-01 4.26 3.99

17G0382-01 3.96 3.70

17G0383-01 3.32 3.59

17G0384-01 6.76 3.42

17G0385-01 3.64 2.95

17G0386-01 1.95 2.33

17G0387-01 1.75 2.09

17G0388-01 3.93 4.06

17G0389-01 5.19 5.39

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http://www.health.state.mn.us/divs/eh/hazardous/topics/studies/glnpo.pdf.

http://www.health.state.mn.us/divs/eh/hazardous/topics/studies/glnpo.pdf.


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Sample

Initial

result

ug/L

Reported

Result

ug/L

17G0390-01 3.76 3.29

17G0394-01 5.36 3.80

17G0395-01 5.92 5.97

17G0396-01 4.48 4.40

17G0398-01 2.52 1.60

17G0400-01 7.05 6.94

17G0401-01 1.86 3.87

17G0404-01 4.21 3.19

17G0984-01 2.23 2.80

17G1475-01 2.81 3.02

17H0078-01 4.88 4.15

17H0081-01 2.57 4.69

17H0084-01 1.37 1.59

17H0085-01 14.4 14.1

17H0200-01 4.64 3.57

17H0210-01 1.69 1.67

17H0211-01 4.55 4.16

17H0212-01 2.82 2.45

17H0741-01 4.60 4.11

17I1277-01 6.07 6.86

17I1278-01 6.68 3.57

17I1281-01 6.93 6.83

17I1282-01 4.06 4.12

17I1283-01 3.64 3.98

17I1284-01 8.31 8.81

17I1287-01 6.09 6.01

17I1289-01 7.11 7.13

17I1290-01 3.59 3.58

17I1300-01 8.80 8.81

17L0947-01 6.84 7.85

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Section Overview: Healthy Rural and Urban Kids project update This section contains updates on the Healthy Rural and Urban Kids project.

Information Item:

Panel members are invited to comment and ask questions.


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Healthy Rural and Urban Kids project update As discussed at the October 2018 Advisory Panel meeting, recruitment and sample collection for Healthy Kids are complete. Staff from Early Childhood Screening programs at Minneapolis Public Schools and Becker, Todd and Wadena counties conducted these activities. Urine samples were collected from 104 urban and 128 rural children during summer/fall 2018.

Sample analysis

The MDH Public Health Lab (PHL) is completing analysis of the 232 urine samples collected. Metals analysis is complete and air pollution and pesticide analyses are ongoing. MDH is collaborating with the New Hampshire Department of Health and Human Services Public Health

Laboratories to speciate all samples with total arsenic > 20 g/L to determine if the exposure was organic or inorganic. This analysis is underway.

Follow-up cases

“Follow-up levels” were set for two metals tested in the study – arsenic and manganese. These levels indicate the child’s exposure may be elevated and staff will follow-up with the family to see if a source of exposure can be identified and reduced. These levels do not mean that any health effect is expected to occur. Follow-up levels were determined based on 95th percentile exposure levels from previous biomonitoring population surveys in children and conversations with other state biomonitoring programs and colleagues.

MDH PHL has provided early lab results for children with arsenic or manganese above the follow-up levels and families are being contacted by Dr. Mary Winnett, the study physician. Dr. Winnett calls the families, shares their child’s results, answers questions, asks the parent follow-up questions about possible sources of exposure, and discusses ways to prevent exposure.

For manganese, 29 children had levels above the follow-up level of 0.5 g/L. For arsenic, 15

children had levels above the follow-up level of 20 g/L, all of which will be speciated before contacting families. One participant had both manganese and arsenic above follow-up levels. Follow-up cases are in both rural and urban children, and in private well and public water supply users.

Results return materials

Staff is finalizing communications materials that all families will receive when their child’s full results are available this spring. Families will receive a letter, tables with results for all analytes, and information sheets for each of the three types of chemicals measured (metals, air pollution chemicals and pesticides). The information sheets share background information and practical tips for ways families can reduce their child’s exposure.

To ensure that materials are understandable and helpful to families in the study, staff is collaborating with Ticiea Fletcher, resident and community organizer in North Minneapolis, to conduct focus groups. Focus groups will be held with community members from the two North Minneapolis zip codes in the study at the end of January to get feedback on draft materials. IRB submission will follow shortly thereafter.


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Section Overview: Toxic Free Kids Act Michelle Gin, Toxic Free Kids Communications Planner at MDH, will give a presentation to the panel on the Toxic Free Kids Act.

Michelle Gin earned her MPH in Maternal and Child Health from University of Minnesota School of Public Health. She currently serves as the Toxic Free Kids Communications Planner at the Minnesota Department of Health. She serves on multiple interagency and community workgroups to raise awareness about mercury in skin lightening products and communicate with the public and business sector about toxic chemicals in consumer products. Michelle is in the process of submitting a co-authored manuscript for publication discussing the various unintended, yet positive, outcomes of an undergraduate university and state agency collaboration designed to integrate experiential learning into the classroom.

Information Item:



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Toxic Free Kids Act Since 2009, the Toxic Free Kids Act (Minn. Stat. 2010 116.9401 – 116.9407 https://www.revisor.mn.gov/statutes/cite/116.9401#stat.116.9401) has required the Minnesota Department of Health (MDH) to create two lists of chemicals: one list called “Chemicals of High Concern” and one called “Priority Chemicals.” MDH’s Toxic Free Kids program works on updating and reviewing the Chemicals of High Concern and Priority Chemical lists, nominating chemicals for development of health based guidance values within other MDH programs such as Contaminants of Emerging Concern (CEC) program, and is involved in risk communication efforts. The TFK program is housed in the Environmental Surveillance and Assessment Section within the Environmental Health Division and supports the MDH mission to protect, maintain, and improve the health of all Minnesotans.

Information on the second update of the Chemicals of High Concern list (September 7, 2016) is available here: http://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/highconcern.html

A report describing this process as well as some future work plan goals can be found on Toxic Free Kids program Reports page: http://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/reports.html

https://www.revisor.mn.gov/statutes/cite/116.9401#stat.116.9401

http://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/highconcern.html

http://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/reports.html


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Section Overview: MN Tracking Updates This section contains updates from the MM Tracking Program, including:

▪ CDC continuing application (Year 3 of 5-year cooperative funding agreement) ▪ Focus on sub-county data and maps on the MN Public Health Data Access portal

▪ City data pilot project ▪ Radon testing by census tract

Information Item:



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CDC continuing application As part of our cooperative agreement with CDC’s Environmental Public Health Tracking Network, MN tracking is required to submit annual progress reports and continuing applications over the 5-year Cooperative Agreement period. Our grant years run on Federal fiscal calendars and we are currently in year 2, preparing our progress report and application for year 3 (August 2019 – July 2020). MN Tracking enjoys excellent standing with CDC and has consistently met deliverables. We will propose to maintain current funding levels for the coming fiscal year.

Beyond ongoing surveillance activities and maintaining the MN Public Health Data Access portal, our team focus during year 2 has been on building sub-county data resources, developing communications assets to improve stakeholder outreach and engagement, implementing and evaluating process improvement strategies with IT, and conducting in-depth environmental health analyses with partners. Some of these analyses include quantifying morbidity and mortality impacts attributable to air pollution (Life & Breath), examining heat stress vulnerability in Minnesota and Wisconsin, and spatial analysis of socio-economic risk factors associated with radon testing and mitigation disparities.

For year 3, we are proposing to activate these resources and disseminate year 2 project outcomes. Specifically, we plan to:

- Deploy multi-facetted communications campaigns to disseminate findings of environmental health analyses, drawing attention to public health actions to advance health equity and reduce risks for all Minnesotans.

- Build capacity and partnerships for new health education and data utilization tools, including e-Learning resources, webinars, and a tool-kit for integrating environmental health data into Community Health Needs Assessments.

- Chart a technology roadmap for the MN Public Health Data Access portal to guide investment and internal capacity development.

- Maintain rigorous environmental health surveillance activities and data available on the MN Public Health Data Access portal.

Focus on sub-county data and maps Fine-scale geographic data is important for understanding spatial patterns and disparities in environmental hazards, exposures, and health outcomes. Surveillance data, however, is not always suitable for analysis or display at these finer levels, like census tracts or zip codes. A strategic focus area for MN Tracking is identifying and developing sub-county data sources for surveillance. These new sub-county data resources enable stakeholders to more effectively target public health resources and address inequities. Here, we describe two recent sub-county data projects.

Health data for Minnesota cities – pilot project Hospitalization and Emergency Department (ED) visit data are available by zip code, but we are

generally unable to release these data outside of the Twin Cities region due to privacy

protections for sparse data. Feedback from our Local Public Health partners indicates that finer


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geographic resolution is critical, especially in areas with mid-sized cities where we know that

population health profiles are likely to differ greatly between urban versus rural areas of the

county. Over the past year, we worked with three local public health departments to identify

zip codes that comprise the urban areas of Rochester, St. Cloud, and Duluth. To get this project

underway, we started by looking at rates of hospital visits for asthma and COPD, comparing

age-adjusted rates in the urban areas against the surrounding county (or multiple counties).

Moving forward, we will continue to work with local public health partners to explore zip code

aggregations for other mid-sized cities and additional health outcomes.

Explore our City Data Pilot on the MN Public Health Data Access portal: https://data.health.state.mn.us/web/mndata/city-data

Pilot data findings

▪ Age-adjusted asthma hospitalization and ED visit rates were higher in the pilot urban areas, compared to the surrounding county areas. (Charts 1 and 2)

▪ Two cities, Rochester and St. Cloud, had significantly lower rates than the statewide rate for ED visits, but were still higher than their surrounding county area(s). (Chart 1)

▪ St. Could and Duluth had significantly higher asthma hospitalization rates compared to the state. (Chart 2)

▪ For COPD, however, rates were more similar between urban and rural areas. (Chart 3)

Chart 1:

https://data.health.state.mn.us/web/mndata/city-data


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Chart 2:

Chart 3:

Census tract radon test data

MN Tracking has a long-standing collaboration with MDH Indoor Air Unit to develop radon test data for public health surveillance. Our most recent effort was to develop and map census tract-level indicators. Radon is a serious public health issue in Minnesota, where two in five homes tested have radon levels that are a health risk, and our new map can help MDH and our partners improve outreach to increase testing.

Explore our interactive statewide map and data: https://mndatamaps.web.health.state.mn.us/interactive/radontract.html

https://mndatamaps.web.health.state.mn.us/interactive/radontract.html


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The map shows wide variation in testing rates across the state – with large differences, even between some neighboring areas. For example, the census tract with the lowest testing rate had less than 1 property tested annually per 10,000 housing units, while the highest census tract had 321 properties tested annually per 10,000 housing units.

- Across the state, we found higher testing rates in south and southeastern Minnesota, compared to northern Minnesota.

- In the 7-county Metro area, testing rates are lowest in the urban core tracts of Minneapolis and St. Paul and highest in the western suburbs of Hennepin and Carver counties.

Radon testing is a health equity issue. Across Minnesota, testing rates are generally lowest in areas with more households living poverty.

Moving forward, we are developing tract-level indicators of radon mitigation and working with partners to identify area-level risk factors that can further help improve outreach and reduce disparities.


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Section Overview: Advisory Panel Subcommittee meeting report This section contains recommendations, and the rationale behind the recommendations, developed through a series of meetings of the Advisory Panel subcommittee. Advisory Panel members are asked to consider moving these recommendations forward, by consensus or through a vote.

Recommendations for the Advisory Panel:

We recommend that MN Biomonitoring, in collaboration with other partners, conduct a project in State Fiscal Year 2019-2020 to continue urine mercury testing in adult East African women of childbearing age. This targeted biomonitoring project would follow up on questions from MN FEET about mercury exposures and use of skin lightening products in this community. The project would use the many lessons learned in MN FEET about recruiting women from this community, and would work with health care providers in a community clinical setting where exposure reduction can be most effective.

We recommend that MN Biomonitoring continue planning for and initiate a new project in adult women of childbearing age in SFY 2019-2020. Based on information from past biomonitoring studies and state and local initiatives to reduce exposure to metals and other chemicals of concern, this project would measure exposures to chemicals used in personal care and household products that may affect child development. The project would consider differences by sociodemographic variables related to health equity in order to assess whether targeted public health actions are needed to better protect women’s and children’s health. Planning work would include determining target populations, analytes and recruitment methods, and engaging stakeholders, other partners and communities.


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Recommendations of the subcommittee to the Advisory Panel The Advisory Panel subcommittee tasked with advising MDH on future biomonitoring efforts, including following up on MN FEET results in East African women, met for the second time on December 8, 2018, and again by phone on January 11, 2019. Subcommittee members are Ruby Nguyen, Farhiya Farah, Lisa Yost and Eileen Weber.

The subcommittee proposes the following recommendations for consideration by the Advisory Panel:

1. We recommend that MN Biomonitoring, in collaboration with other partners, conduct a project in State Fiscal Year 2019-2020 to continue urine mercury testing in adult East African women of childbearing age. This targeted biomonitoring project would follow up on questions from MN FEET about mercury exposures and use of skin lightening products in this community. The project would use the many lessons learned in MN FEET about recruiting women from this community, and would work with health care providers in a community clinical setting where exposure reduction can be most effective.

2. We recommend that MN Biomonitoring continue planning for and initiate a new project in adult women of childbearing age in SFY 2019-2020. Based on information from past biomonitoring studies and state and local initiatives to reduce exposure to metals and other chemicals of concern, this project would measure exposures to chemicals used in personal care and household products that may affect child development. The project would consider differences by sociodemographic variables related to health equity in order to assess whether targeted public health actions are needed to better protect women’s and children’s health. Planning work would include determining target populations, analytes and recruitment methods, and engaging stakeholders, other partners and communities.

Background

The initial discussions of the subcommittee focused on shaping a future project that would incorporate two objectives in one study: following up on MN FEET results in East African women and more broadly assessing exposures to chemicals that may affect child development in women of childbearing age. However, subsequent meetings made it clear that the two projects are different and that trying to combine them might lessen the ability to do either assessment successfully. For the follow-up to MN FEET (recommendation #1), the question is very specifically about East African women. For the wider study in women of childbearing age (recommendation #2), subcommittee consensus emerged for a broader health equity-sensitive focus on women who may be exposed to metals or chemicals of concern in personal care products.

Rationale for recommendation 1

How can biomonitoring help?

▪ Past feedback from Advisory Panel meetings indicated general agreement that unanswered questions about inorganic mercury exposure in East African women remain from MN FEET and that follow-up biomonitoring would serve a useful purpose.


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▪ Achieving a larger sample size of East African women would allow us to generate more robust data to measure the extent to which exposure is a concern in this community. This information would help inform exposure reduction programs and policies, and tailor efforts to vulnerable communities.

▪ The project would also provide exposure reduction assistance to any women found to have elevated exposures, working with them to lower their and their families’ exposures.

How would this be carried out?

▪ The project would use a clinic-based design. We would work with a University of MN Doctor of Nursing Practice student interested in this topic to identify and partner with a community-based clinic that serves East African women, has trust in the community and has providers interested in collaborating on this project.

▪ Adult women of childbearing age who visit the clinic and are East African would be offered the chance to have their urine tested for mercury. Recruitment would happen in-person by their provider, medical staff or someone closely aligned with the clinic.

▪ The project would involve provider education on the issue of skin lightening products and the utility and use of urine mercury as a biomarker.

▪ The project would be done in conjunction with another Doctor of Nursing Practice student project in the planning stages to do additional urine mercury testing in women at Minnesota Community Care clinics (formerly known as West Side Community Health Services), the largest federally qualified health center (FQHC) in Minnesota.

▪ By being based in clinics, these projects have greater potential to educate providers and integrate the issue into clinical practice, where exposure reduction will be most effective.

How would recruitment differ from the approach used in MN FEET?

▪ The study would include all adult women of childbearing age, not just pregnant women. ▪ Recruitment would be done in-person and not over the phone. Participants would sign

consent forms at the time, and not be asked to return forms in the mail. ▪ The project would only collect urine samples, not cord blood samples. ▪ We would continue our community outreach efforts, using the excellent foundation laid by

work on MN FEET.

Rationale for recommendation 2

What are the goals/objectives of this broader study?

▪ Measure extent to which women of childbearing age from some Minnesota communities are exposed to certain environmental contaminants, including chemicals in personal care and household products.

▪ Assess whether some women are more highly exposed than others by investigating differences by sociodemographic variables and other factors related to health equity.

▪ Compare results to national and state biomonitoring data and to Healthy People 2020 goals (when available).

▪ Investigate sources of exposure using survey data.


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▪ Engage communities included in the study throughout the project as a chance to raise awareness about the chemicals and environmental health more generally, and learn from the communities about their concerns.

▪ Assess whether targeted public health actions are needed to reduce exposures and protect women’s and child’s health in these communities.

▪ Educate providers and initiate discussions about integrating the issues addressed in the study into clinical practice.

Which communities would be included?

▪ MN FEET’s focus on select ethnic groups made sense given the narrower questions about exposure the study was addressing. For this broader study, there are other sampling frames more relevant to public health messaging and action.

▪ The subcommittee discussed considering the structural causes of disparities in chemical exposure and choosing target populations and a sampling frame with this in mind. This has the advantage of broadening the generalizability of the study and potentially making the results more actionable and recruitment easier.

▪ The subcommittee discussed different frameworks, including socioeconomic status (relevant to use of personal care products and products such as pesticides used around the home and related to housing conditions). Depending on the analyte, frameworks could also include immigrant status or other social determinants.

▪ More information and planning for community selection will be discussed with the Advisory Panel at future meetings.

Which analytes would be measured?

▪ The subcommittee discussed aligning study analytes with existing state or other programs, such as the Toxic Free Kids Act, that incorporate data on chemical use and likelihood of human exposure.

▪ The subcommittee also discussed considering whether results have the potential to influence actionable policies as a criteria for chemical selection.

▪ The subcommittee started to consider a list of possible analytes, with a focus on compounds that may impact child development. The list includes ▪ metals (sources: skin lightening products, e-cigarettes, diet, herbal remedies); ▪ home-use pesticides; ▪ bisphenol A/bisphenol S (sources: plastics, canned food, receipt paper); ▪ parabens (sources: cosmetics, personal care products); ▪ TCDPP (sources: flame retardant used in consumer products); ▪ nonylphenol and its ethoxylates (sources: surfactants used in many home products

including cleaners, degreasers, etc.); ▪ phthalates (sources: plastic products, personal care products).

▪ More information and planning for analyte selection will be discussed with the Advisory Panel at future meetings.


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Section Overview: Other Information This section contains documents that may be of interest to panel members.

▪ 2019 upcoming Advisory Panel meeting dates ▪ Environmental Health Tracking and Biomonitoring Advisory Panel Statute ▪ Advisory Panel roster ▪ Biographical sketches of Advisory Panel members ▪ Biographical sketches of staff


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2019 Upcoming Advisory Panel Meeting Dates

The meetings in 2019:

June 11, 2019

October 8, 2019

These meetings will take place from 1-4 pm at

The American Lung Association of Minnesota

490 Concordia Avenue

St Paul, Minnesota


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144.998 ENVIRONMENTAL HEALTH TRACKING AND BIOMONITORING ADVISORY PANEL STATUTE

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 specific qualifications in paragraph (a) shall be appointed, one by the speaker of the house and one by the senate majority leader.

(c) In addition, one representative each shall be appointed by the commissioners of the Pollution Control Agency and the Department of Agriculture, and by the commissioner of health to represent the department’s Health Promotion and Chronic Disease Division.

Subd. 3. Duties. The advisory panel shall make recommendations to the commissioner and the legislature on:

(1) Priorities for health tracking;

(2) Priorities for biomonitoring that are based on sound science and practice, and that will advance the state of public health in Minnesota;

(3) Specific chronic diseases to study under the environmental health tracking system;

(4) Specific environmental hazard exposures to study under the environmental health tracking system, with the agreement of at least nine of the advisory panel members;

(5) Specific communities and geographic areas on which to focus environmental health tracking and biomonitoring efforts;

(6) Specific chemicals to study under the biomonitoring program, with the agreement of at least nine of the advisory panel members; in making these recommendations, the panel may consider the following criteria:


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(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 section 144.995 to 144.998.


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Environmental Health Tracking & Biomonitoring Advisory Panel Roster as of April 2018

Bruce Alexander, PhD Univ. of MN, School of Public Health Environmental Sciences Division MMC 807 Mayo 420 Delaware Street SE Minneapolis, MN 55455 612-625-7934 [email protected] At-large representative

Alan Bender, DVM, PhD Minnesota Department of Health Health Promotion & Chronic Disease 85 East 7th Place/PO Box 64882 St Paul, MN 55164-0882 651-201-5882 [email protected] MDH appointee

Kristie Ellickson, PhD Minnesota Pollution Control Agency Environmental Analysis & Outcomes Division 520 Layfette Road St Paul, MN 55155-4194 651-757-2336 [email protected] MPCA appointee

Farhiya Farah, MPH, CHE St. Mary’s University of Minnesota 2740 Stevens Ave S #2 Minneapolis, MN 55408 [email protected] 612-702-5051 At-large representative

Thomas Hawkinson, MS, CIH, CSP Wenck Associates 7500 Olson Memorial Highway Suite 300 Golden Valley, MN 55427 [email protected] 763-252-6987 Statewide business organization representative

Jill Heins Nesvold, MS American Lung Association of Minnesota 490 Concordia Ave St Paul, MN 55103 651-223-9578 [email protected] Nongovernmental organization representative

Ruby Nguyen, PhD Univ. of MN, School of Public Health Div of Epidemiology & Community Health 7525A 1300 S 2nd St, Suite 300 WBOB Minneapolis, MN 55454 612-626-7559 [email protected] University of Minnesota representative

Geary Olsen, DVM, PhD 3M Medical Department Corporate Occupational Medicine MS 220-6W-08 St Paul, MN 55144-1000 651-737-8569 [email protected] Statewide business organization representative










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Cathy Villas-Horns, MS, PG Minnesota Dept. of Agriculture Pesticide & Fertilizer Management Division 625 Robert St N St Paul, MN 55155-2538 651-201-6697 [email protected] MDA appointee

Eileen Weber, DNP, JD, PHN, BSN, RN Univ of MN, School of Nursing 10623 Nyberg Ave S Hastings, MN 55033 651-276-1730 [email protected] Nongovernmental organization representative

Lisa Yost, MPH, DABT RAMBOLL ENVIRON 333 West Wacker Drive, Suite 2700 Chicago, IL 60606 Local office 479 Iglehart St Paul, MN 55103 651-225-1592 [email protected] At-large representative

VACANT SEAT Minnesota House of Representatives appointee

VACANT SEAT Minnesota Senate appointee




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Biographical Sketches of Advisory Panel Members Bruce Alexander is a Professor in the Division of Environmental Health Sciences at the University of Minnesota’s School of Public Health. He is an environmental and occupational epidemiologist with expertise in cancer, reproductive health, respiratory disease, injury, exposure assessment, and use of biological markers in public health applications.

Alan Bender is the Section Chief of Chronic Disease and Environmental Epidemiology at the Minnesota Department of Health. He holds a Doctor of Veterinary Medicine degree from the University of Minnesota and a PhD in Epidemiology from Ohio State University. His work has focused on developing statewide surveillance systems, including cancer and occupational health, and exploring the links between occupational and environmental exposures and chronic disease and mortality.

Kristie Ellickson joined the Minnesota Pollution Control Agency in 2007 after completing her PhD at Rutgers University and postdoctoral work at both Rutgers and the University of Wisconsin-Madison. Prior to her academic pursuits, she was a U.S. Peace Corps volunteer in the country of Panama. As a graduate student and postdoc she conducted research on trace metal speciation and bioavailability in a variety of environmental matrices. Her work at the MPCA includes the incorporation of cumulative risk and impact assessment principles into regulatory risk, the review of human health risk assessments for large permitted facilities, and she has been the lead investigator on an EPA community-scale air toxics grant targeting passive and active air sampling for Polycyclic Aromatic Hydrocarbons in an urban and rural environment.

Farhiya Farah has lived in Minneapolis for 18 years. She received her Bachelor of Science degree from Marymount University, and Masters of Public Health from University of Minnesota where she is also currently completing her PhD. Prior to launching her company, she was employed as a Senior Public Health Practitioner with Minneapolis Health Department where she spearheaded Healthy Homes Strategic Planning for the City of Minneapolis. She is the founder and Principle Consultant of GlobeGlow Consulting and Research that focuses on applied environmental health research (food safety and home environmental assessments), and community based participatory research specializing with Limited English Population. She has provided technical support to a diverse group of partners including state health department, academic institutions, local health departments and community-based organizations. She is an active member of her community, and has volunteered with the City of Minneapolis Department of Health, ECHO Minnesota, and the DHS Barriers to Utilizing Public Health Insurance Study Project Management Team. She is currently a board member of AverageMohamed (counter extremism messaging), and is a core member of the University of Minnesota School of Public Health Somali Initiative.

Tom Hawkinson is the Senor Industrial Hygienist for Wenck Associates in Golden Valley, Minnesota. He completed his MS in Public Health at the University of Minnesota, with a specialization in industrial hygiene. He is certified in the comprehensive practice of industrial hygiene and a certified safety professional. He has worked in EHS management at a number of Twin Cities based companies, conducting industrial hygiene investigations of workplace contaminants and done environmental investigations of subsurface contamination, both in the United States and Europe. He has taught statistics and mathematics at both graduate and


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undergraduate levels as an adjunct and is on faculty at the Midwest Center for Occupational Health and Safety, which is a NIOSH-sponsored education and resource center at the University of Minnesota’s School of Public Health.

Jill Heins Nesvold serves as the Director of Respiratory Health Division for the American Lung Association in Iowa, Minnesota, North Dakota and South Dakota. Her responsibilities include program oversight and evaluation related to asthma, chronic obstructive lung disease (COPD), lung cancer, and influenza. She holds a master’s degree in health management and a short-course master’s degree in business administration. She has published extensively in a variety of public health areas.

Ruby Nguyen is an assistant professor at the University of Minnesota School of Public Health Division of Epidemiology & Community Health. She received her PhD in Epidemiology from Johns Hopkins University. Ruby’s research focuses on maternal, child and family health; the etiology of reduced fertility; pregnancy-related morbidity, and infertility and later disease. Currently, Ruby is conducting a longitudinal study examining the role of endocrine disrupting chemicals in child development. From 2016-2017, Ruby was Co-Principal Investigator of a statewide prevalence study investigating violence against Asian women and children.

Geary Olsen is a corporate scientist in the Medical Department of the 3M Company. He obtained a Doctor of Veterinary Medicine degree from the University of Illinois and a Master of Public Health in veterinary public health and PhD in epidemiology from the University of Minnesota. For 27 years, he has been engaged in a variety of occupational and environmental epidemiology research studies while employed at Dow Chemical and, since 1995, at 3M. His primary research activities at 3M have involved the epidemiology, biomonitoring (occupational and general population), and pharmacokinetics of perfluorochemicals.

Cathy Villas Horns is the Hydrologist Supervisor of the Incident Response Unit (IRU) within the Pesticide and Fertilizer Management Unit of the Minnesota Department of Agriculture. She holds a Master of Science in Geology from the University of Delaware and a Bachelor of Science in Geology from Carleton College and is a licensed Professional Geologist in MN. The IRU oversees or conducts the investigation and cleanup of point source releases of agricultural chemicals (fertilizers and pesticides including herbicides, insecticides, fungicides, etc. as well as wood treatment chemicals) through several different programs. She has worked on complex sites with Minnesota Department of Health and MPCA staff, and continues to work with interagency committees on contaminant issues. She previously worked as a senior hydrogeologist within the IRU, and as a hydrogeologist at the Minnesota Pollution Control Agency and an environmental consulting firm.

Eileen Weber is a nurse attorney and clinical assistant professor at the University of Minnesota School of Nursing. She founded and leads the Upper Midwest Healthcare Legal Partnership Learning Collaborative. She earned her Doctor of Nursing Practice degree in Health Innovation and Leadership in 2014 from the University of Minnesota. She earned her RN diploma from Thomas Jefferson University Hospital in Philadelphia, PA, her BSN summa cum laude from the University of Minnesota, and her JD in the founding class of the University of St. Thomas School of Law in Minneapolis. Her clinical experience and past certifications have largely been in urban critical care and emergency nursing. She has served as vice-president of the Minnesota Nurses Association, earning awards for political action and outstanding service. She represented nursing on the Minnesota Health Care Commission, was a regular editorial writer for the St.


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Paul Pioneer Press and an occasional op-ed contributor for the Star Tribune. She founded Friends of Grey Cloud and worked with environmental leaders at the local, regional, state and national levels to protect Lower Grey Cloud Island from harmful development and to conserve the Grey Cloud Sand Dune Prairie. She has extensive experience in legislative lobbying, community activism, and political campaign management. Her scholarly work is focused on the intersection of law, public policy, and interprofessional healthcare practice and education.

Lisa Yost is a Principal Consultant at RAMBOLL ENVIRON, an international consulting firm. She is in their Health Sciences Group, and is based in St. Paul, Minnesota. She completed her training at the University of Michigan’s School of Public Health and is a board-certified toxicologist with expertise in evaluating human health risks associated with substances in soil, water, and the food chain. She has conducted or supervised risk assessments under CERCLA, RCRA, or state-led regulatory contexts involving a wide range of chemicals and exposure situations. Her areas of specialization include exposure and risk assessment, risk communication, and the toxicology of such chemicals as PCDDs and PCDFs, PCBs, pentachlorphenol (PCP), trichloroethylene (TCE), mercury, and arsenic. Lisa is a recognized expert in risk assessment and has collaborated in original research on exposure issues, including background dietary intake of inorganic arsenic. She is currently assisting in a number of projects including a complex multi-pathway risk assessment for PDDD/Fs that will integrate extensive biomonitoring data collected by the University of Michigan. She is also an Adjunct Instructor at the University of Minnesota’s School of Public Health.


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Biographical Sketches of Staff Carin Huset, PhD, has been a research scientist in the Environmental Laboratory section of the MDH Public Health Laboratory since 2007. Carin received her PhD in Chemistry from Oregon State University in 2006 where she studied the fate and transport of perfluerochemicals in aqueous waste systems. In the MDH PHL, Carin provides and coordinates laboratory expertise and information to program partners within MDH and other government entities where studies require measuring biomonitoring specimens or environmental contaminants of emerging concern. In conjunction with these studies, Carin provides biomonitoring and environmental analytical method development in support of multiple analyses.

Tess Konen, MPH, graduated from the University of Michigan’s School of Public Health with a master’s degree in Occupational Environmental Epidemiology. She completed her thesis on the effects of heat on hospitalizations in Michigan. She worked with MN Tracking for 2 years as a CSTE Epidemiology Fellow where she was project coordinator for a follow-up study of the Northeast Minneapolis Community Vermiculite Investigation cohort. She currently is an epidemiologist working on birth defects, pesticides, and climate change, and is developing new Disaster Epidemiology tools for MDH-HPCD.

Charlotte Napurski, MPH, is the project coordinator for MN Biomonitoring. She received her Master of Public Health degree from Capella University in 2012. She has over 10 years of experience coordinating research projects in pediatric nephrology and cardiology, cancer survivorship and biomonitoring. She also coordinates the Environmental Health Tracking and Biomonitoring Advisory Panel activities.

Jessica Nelson, MPH, PhD, is an epidemiologist with MN Tracking, working primarily on design, coordination, and analysis of biomonitoring projects. Jessica received her PhD and MPH in Environmental Health from Boston University School of Public Health where her research involved the epidemiologic analysis of biomonitoring data on perfluorochemicals. Jessica was the coordinator of the Boston Consensus Conference on Biomonitoring, a project that gathered input and recommendations on the practice and uses of biomonitoring from a group of Boston-area lay people.

Kathy Raleigh, MPH, PhD, is an epidemiologist for MN Tracking. She completed her PhD in Environmental Health at the University of Minnesota’s School of Public Health and her MPH in Environmental and Occupational Health at the University of Arizona. She has worked on a variety of environmental health projects including: pesticide exposure in children, occupational asthma, mercury exposure in women and children, and occupational exposure to PFOA. Prior to coming to MN Tracking, Kathy was working on maternal and child health projects both internationally with USAID and, more recently, at MDH. She will also be working on the coordination and collection of hospital discharge data, including heart disease and asthma surveillance projects for MN Tracking with a focus on health disparities.

Blair Sevcik, MPH, is an epidemiologist with MN Tracking at the Minnesota Department of Health, where she works on the collection and statistical analysis of public health surveillance data for MN Tracking. Prior to joining MN Tracking in January 2009, she was a student worker with the MDH Asthma Program. She received her Master of Public Health degree in epidemiology from the University of Minnesota School of Public Health in December 2010.


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Jessie Shmool, MPH, DrPh, supervises the Environmental Epidemiology Unit at MDH and is the Principal Investigator for the Environmental Public Health Tracking program. Jessie received her MPH from the Mailman School of Public Health at Columbia University and DrPH from the University of Pittsburgh, where her training and research focused on exposure assessment, GIS and spatial statistics, community-engaged research methods, and environmental health disparities. Prior epidemiology studies have examined social susceptibility to air pollution exposure in chronic disease etiology and adverse birth outcomes.

Lynn Treadwell, Minnesota Public Health Data Portal Coordinator, is an experienced digital communications leader with a solid understanding of websites and application development, social media and digital marketing communications in the health and government sectors. Lynn brings over 10 years of experience in developing optimized online user experiences and digital communications to the position. She will provide stewardship to Minnesota’s public health data portal focusing on audience understanding and interactive development best practices. Lynn has an AAS in graphic design, attended the School of Journalism at University of Minnesota and has a mini-Master’s in Marketing from St. Thomas University.

minnesota department of health environmental health ... · panel members are invited to ask...

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