Partnership for Environmental Research and Community Health Symposium on Project Outcomes University of West Florida Conference Center October 26, 2009 Presented by: John J. Lanza, MD, PhD, MPH, FAAP Florida Department of Health Escambia County Health Department Objectives To evaluate possible adverse health effects on residents living in an exposed community near Superfund sites To perform biomonitoring of residents who lived near Superfund sites To determine knowledge of health advisories by a specific population To measure heavy metal levels in a specific population All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy. -- Paracelsus (1493-1541) Percent Contribution to Cancer (Doll and Pelo, 1981) Pre-PERCH To evaluate possible adverse health effects on residents living in an exposed community near Superfund sites Environmental Justice issues - 1998 CATE project Mount Dioxin Superfund Site Chemicals With Maximal Soil Concentrations Off-site Escambia Treating Agrico Arsenic Benzene Benzo (a) - pyrene Benzo (b) - fluoranthene Benzo (k) - fluoranthene Benzo (a) – anthracene Chrysene Dibenz (a,h) – anthracene Dioxin – TEQ Indeno (1,2,3-c,d) pyrene Naphthalene Pentachlorophenol Arsenic Benzo (a) – pyrene Benzo (b) – fluoranthene Benzo (k) – fluoranthene Benzo (a) – anthracene Chromium (VI) Chrysene Dibenzo (a,h) – anthracene Fluoride Indeno (1,2,3-c,d) pyrene Lead Manganese Sulfate Vanadium Escambia Treating Company The following chemicals were detected at this site. There are insufficient toxicological data available upon which to base an assessment of their public health significance. 1, 2,4 –Trimethylbenzene 1,3,5-Trimethylbenzene 2,6- Dimethylnaphthalene 4 – biphenylamine Acenophthalene Acridine Benco (e) pryene Benzo (g,h,I) perylene Benzo (j) fluoranthene Benzothiphene Bromomethyl (methylpropyl) – pyrmidione C2 Alkylphenanthrene C2 Alkylnaphthothiophene C2 Alkylbiphenyl C2 Alkylpyridine C2 Alkylnaphthalene C2 Alkylquinoline C3 Alkylnaphthalene C3 Alkylbenzene C3 Alkylbiphenyl C3 Alkylquinoline C3 Alkylpyridine C4 Alkylbenzene C4 Alkylnaphthalene C4 Alkylpyridine C5 Alkylbenzene Carbazole Carboxylic acid Carene Chlorethane Chloro (trichloro (chlorophenyl) – ethyl)benzene Copper Cyclopena (d,e,f) phenanthrene Decylhydroxylamine Dibenzofuran Dibenzothiphene Dihdrophenanthrene Dimethylbutanol Dimethyleneicycloheptane Dimethylhexene Dimethylmethylenebicyclohephtane Dimethyloctanol Dimethylpentanol Dioctylphthalate Ethylhexanoic acid Ethylhexanol Formic acid, butyl ester Formic acid, methylpropyl ester Hexadecanoic acid Isopropanol Methoxybutene Methoxypropenylbenzene Methylbiphenyl Methylcarbazole Methyldibenzofuran Methyldibenzothiophene Ethylethylpentanol Methylfluorene Methylhexanol Methylnaphthalene Methyloctanol Methylphenanthrene Methylpropanol Methylquinoline n-Dodecane n-Undecane Nitrocarbazole Octanydrodimethylphenanthrene Oxybismethylpropane Pentane Pentylcyclohexane Quinoline Sulfate Sulfide Tetrachlorodibenzofuran Tetramethylphenanthrene Titanium Trimethylbicycloheptane Titanium Trimethylbicycloheptane Trimethyclyclohexene methanol Vinyl acetate Yttrium CATE Project Began July 1, 2000 – continuing 3 components-running concurrently -1. ID those who live or lived in PRA -2. Pt exposure evaluation history, exam, labs, etc. -3. Education of providers, referrals, epidemiology, toxicology ▪ Referred into PERCH biomonitoring CATE Health Screenings Elevated prevalence of diabetes, hypertension, hepatitis (A,B,C), and obesity relative to national averages Increased obesity may be related to etiology of hypertension and diabetes Uterine/cervical and prostate cancers were observed in greater than expected numbers PERCH Biomonitoring Escambia Treating Superfund site as base Subset of CATE participants 47 residents or former residents Generally, eldest who lived the closest or who worked at the site Completed physical exams, labs, etc. -Standard lab tests -Biomonitoring testing – dioxin/furan, PCP, PAH’s, etc. Cohort Demographics PCDD/PCDF study: 47 participants Ages: 13 to 85 yr (mean: 55.8 yr ) 27 female; 20 male 46 black; 1 white 9 were previous employees of ETC 38 current or previous residents Exposure ranged from 2 to 63 yrs PCDD/F Study TEQ’s ranged from 8.4 to 711.1 ppt Used National controls for comparison Median TEQ of 21.5 ppt exceeded CDC national ave. of 13.6 ppt Removing outlier decreased mean TEQ to 20.9 ppt Increasing age correlated to increased TEQ Length of exposure not correlated to TEQ PCDD/F Study (cont.) Elevated TEQ’s seen in all age groups indicating that PCDD/F exposures were not restricted to the period of plant operation No significant differences in TEQ’s between male/female or black/white Removing outlier, no difference in TEQ’s between workers and non-workers Blood profiles for ETC differed from the soil profiles -- ? bioavailability PCDD/F Levels and Disease No correlation to diabetes TEQ’s were significantly correlated to hypertension – unclear etiology No correlation to cancers reported by the cohort No correlation to liver function indicators No correlation to hematologic indicators Clarinda Triangle Biomonitoring 31 persons across Palafox from ETC Soils with elevated dioxin and arsenic Dioxin TEQ’s similar to that of ETC cohort Elevated hepatitis A levels Study Why the study? -Mercury Deposition Network of National Atmospheric Deposition Program -FL Panhandle and peninsula increased levels of wet deposition of total Hg in U.S. -Coastal populations consume locally harvested fish and shellfish -FL fish consumption advisories locally and statewide for fresh and saltwater species -Studies showed Pensacola, FL fish species exceed EPA screening values for recreational fishers (0.4 mg/kg) The Mercury Cycle Mercury is emitted from hazardous waste combustion and from the stacks of coal-fired power plants because mercury occurs naturally in coal. Mercury can remain in the atmosphere for up to one year, mercury is deposited on land and water bodies within 50 miles of the source, then finds its way into aquatic ecosystems. Bacteria in the sediments of aquatic ecosystems can convert inorganic mercury to methylmercury. Methylmercury is a form of mercury that is especially toxic to humans and wildlife. GI Absorption 95% methyl mercury (MeHg) absorbed in GI tract 25-40% inorganic mercury absorbed in GI tract (rat and mice studies) Metallic mercury not absorbed (< than 1%) Hg Health Issues Fish are good source high quality protein, vitamins, are low in saturated fat, and have high levels of omega-3’s MeHg T ½ = 60 days, pregnancy issue Neurodevelopmental problems in children – cognition issues NHANES > female fish consumers with 3X, and 2X for children higher MeHg Hair deposition of MeHg useful indicator ESC/SR Mercury Study Child-bearing age women 18-49 y.o. in Escambia and Santa Rosa counties, FL Two components: -Questionnaire *Fish consumption practices *Awareness of fish consumption advisories for Hg *Demographics including pregnancy status -Hair sampling –non-invasive Biomonitoring of Mercury Levels in Hair Samples from Women of Child-Bearing Age in Escambia and Santa Rosa Counties, FL R. Rao, N. Renier, J. Lanza, P. Wilson, D. Hodges, S. Rivers Escambia County Health Dept. and University of West Florida Pensacola, Florida ABSTRACT RESULTS Background - According to the U.S. EPA, nearly 75% of fish consumption advisories in the United States have been issued due to mercury contamination (U.S. EPA, 2003). Despite a significant reduction in the use and release of mercury from industrial processes since the 1970s, mercury contamination associated with increased fossil fuel combustion poses a growing contamination problem in many areas (U.S. EPA, 2000). The Southeast, and in particular the Gulf Coast, experiences the highest levels of mercury deposition in the U.S. (NADP, 2004), and the State of Florida issues fish consumption advisories due to mercury levels on varying fish species. Thus, the human population in the Florida Panhandle, near Pensacola, is potentially exposed to highly elevated levels of mercury, primarily through the consumption of regionally caught fish species. Many of the fish consumption surveys that have been issued in the U.S specifically target women of child bearing age because of the concerns that maternal intake of contaminants poses a major health risk to a developing fetus. The human nervous system is highly vulnerable to methyl mercury (MeHg), and exposure to high levels of MeHg during the last two trimesters of pregnancy produces documented neurodevelopment problems in children (McDowell et al., 2004). Biomonitoring of human hair for mercury is a useful indicator of exposure over extended periods of time and hair-mercury concentrations reflect longer-term averages than levels in the blood (Budtz-Jorgensen et al., 2004). Interim results for 70% of the study population have been received and analyzed. The mean Hg (μg/g) in the hair was 0.581 (0.117, 0.282 and 0.610 at 25th, 50th and 75th percentiles, respectively) and 16% fell above the recommended EPA known safe level of 1.0 μg/g Hg in hair (NRC, 2000). There was a significant correlation between increased MeHg levels and increased self-reported consumption of fish over the previous 30 days (Pearson Correlation R=0.210; p<0.01) and 60 days (Pearson Correlation R=0.207; p<0.01). Only 15.7% of the study population reported catching their own fish, while the majority purchased fish at a store (60.8%) and/or consumed fish at a restaurant (64.4%). No correlation was found between MeHg levels and knowledge about the fish advisory although people who caught fish were 2.7 times more likely to know about the fish advisory than people who did not consume fish (p<0.05), and 1.7 times more likely to know about the advisory than people who bought their fish at a store or restaurant (p<0.05). Distribution of Hg in Study Population 1.50% 14% <1 μg/g 1-3 μg/g > 3 μg/g 84.50% n=343 The information gained through this biomonitoring program has established a baseline mercury data set that can be used in future studies to determine whether levels in the human population change in response to new environmental regulations. Local fishing populations appear to be better informed of state fish consumption advisories, although it did not decrease the amount of MeHg that was found in their hair. The data suggest that public health interventions such as education and fish advisories should be geared more towards pregnant women, who are at most risk. Public health education may need to be focused on fish markets and restaurants because the majority of the study population consumed their fish through those avenues and they were less likely to know about the fish advisory. Future studies should focus on species of fish consumed and a more detailed inventory of fish consumed to better understand the risk factors involved with elevated MeHg in this high risk subset of our population. REFERENCES Interim results for 70% of the study population have been received and analyzed. 16% fell above the recommended EPA safe level of 1.0 μg/g. Budtz-Jorgensen, E., Grandjean, P., Jorgensen, P.J., Weihe, P.l., Keiding, N., 2004. Association between mercury concentrations in blood and hair in methylmercury-exposed subjects at different ages. Environmental Research 95, 385-393. NADP, 2004. National Atmospheric Deposition Program 2003 Annual Summary. National Atmospheric Deposition Program (NADP), Illinois State Water Survey. NADP Data Report 200401. National Research Council. Committee on the Toxicological Effects of Methylmercury. 2000.Wahshington, DC: National Academies Press MATERIALS and METHODS The study collected hair from approximately 600 participants (women 18-49 years old regardless of pregnancy status) from Santa Rosa and Escambia Counties, Florida. Only persons that had resided in the study area for at least one year and could give informed consent were included. Hair samples (approximately 100 strands of hair ~ 50 mg) were collected by trained staff, and sent to a certified analytical chemistry laboratory for analysis of mercury levels. In addition, each volunteer was interviewed regarding demographic information and recent fish consumption practices. Demographic data collected included residency zip code, race, gender, years of residency, age, and pregnancy status. A follow-up survey was given to the participants to allow for feedback and a satisfaction rating of the project. Descriptive statistics and correlation analysis were run using SPSS version 12.0 (SPSS, Inc., Chicago, IL). CONCLUSIONS Aware of Fish Advisory Supplies used for hair sampling. A copy of the Florida Fish Advisory was provided to each participant. McDowell, M.A., Dillon, C.F., Osterloh, J., Bolger, P.M., Pellizzari, E., Fernando, R., Oca, R.M.d., Susan E. Schober, T.S., Jones, R.L., Mahaffey, K.R., 2004. Hair mercury levels in U.S. children and women of childbearing age: reference range data from NHANES 1999-2000. Environmental Health Perspectives 112, 1165–1171. 31.40% SPSS, 12.0 version 2002. Chicago, IL 68.60% Yes No n=602 U.S. EPA, 2000. Guidance for assessing chemical contaminant data for use in fish advisories: fish sampling and analysis. US EPA. U.S. EPA, 2003. Update: National Listing of Fish and Wildlife Advisories. United States Environmental Protection Agency, Office of Water. Approximately 100 strands of hair were collected from an inconspicuous location close to the scalp. The majority of participants were unaware of the Florida Fish Advisory prior to the study. No correlation was found between levels of mercury and knowledge of the advisory. Acknowledgements: This study was supported by Grant # 1 R01 EH000096-01 from the U.S. Centers for Disease Control and Prevention (CDC) to the University of West Florida (Principal Investigator, K. Ranga Rao). The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Results of Hg Study Aware of Fish Advisory 31.40% 68.60% Yes No Results of Hg Study Distribution of Hg in Study Population 1.50% 14% 84.50% <1 μg/g 1-3 μg/g > 3 μg/g Esc/SR Hg Follow-up Study Escambia/Santa Rosa - Marketing campaign -Outreach – radio, billboards, wallet card -Questionnaire – Did you learn? • Results (preliminary): -29 % aware of any fish advisory (not asked previously) -65 % aware to limit Hg eaten (pre-survey – 31%) -56 % heard radio or saw billboards -88 % felt wallet card useful Duval – Questionnaire and hair sampling -15.7 % aware of fish advisory -63.4 % aware of Hg fish exposure -7.3 % hair Hg above 1 ppm Hg Wallet Card PERCH Lead Study 50 to 75 k homes in Escambia build prior to 1979 Lead is neurotoxicant to young children 33 homes tested for lead 51.5 % had detectable lead levels 21.2 % had lead levels above HUD guidelines Education and recommendations on remediation What are the numbers? Has anything changed in the past 9 years? Is it too early to tell? Some data to ponder Age-adjusted death rates (per/100,000) from selected chronic diseases for 1998-2000/2006-2008 3-year Rolling Average all races in Florida (FDOH, CHARTS, 2009) Disease Florida Escambia Santa Rosa 804.0/679.8 965.3/817.2 931.0/773.0 Chronic Liver Disease & Cirrhosis 11.0/10.1 12.6/10.2 12.0/11.5 C.L.R.D. Including Asthma 41.0/36.2 52.2/48.5 68.6/54.7 Cardiovascular Diseases 314.3/209.9 377.4/252.9 365.7/227.9 Cancer 190.2/162.3 222.7/191.4 202.0/177.1 21.3/20.6 28.0/33.5 28.1/25.5 All Deaths Diabetes All Causes Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Population All Causes Rolling 3-Year AgeAdjusted Death Rate Per 100,000 White Population All Causes Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Black Population Chronic Liver Disease & Cirrhosis Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Population Chronic Liver Disease & Cirrhosis Rolling 3-Year AgeAdjusted Death Rate Per 100,000 White Population Chronic Liver Disease & Cirrhosis Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Black Population Major Cardiovascular Diseases Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Population Major Cardiovascular Diseases Rolling 3-Year AgeAdjusted Death Rate Per 100,000 White Population Major Cardiovascular Diseases Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Black Population Cancer Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Population Cancer Rolling 3-Year AgeAdjusted Death Rate Per 100,000 White Population Cancer Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Black Population Age-adjusted incidences (/100,000) for all and selected cancers all races in Florida, 1998-2000/2004-2006 Rolling Average (FDOH CHARTS, 2009) Cancer Location Florida Escambia Santa Rosa All Cancer 495.1/452.5 509.1/461.1 469.1/485.2 Breast 128.0/108.3 123.7/114.3 131.3/108.1 20.3/19.1 15.3/15.6 20.9/14.6 11.3/9.1 10.2/8.7 NA Colorectal 57.9/45.0 54.5/42.0 49.9/53.5 Lung 78.0/70.2 94.7/80.1 81.9/88.8 Bladder 24.6/20.6 21.2/17.0 24.7/21.3 Leukemia 13.0/10.8 13.8/11.7 14.8/11.9 9.9/9.7 10.8/11.9 13.0/11.2 159.3/124.2 188.7/140.7 137.9/133.1 Uterine (SR data 03-05) Cervical Pancreas (deaths)(2000/2008) Prostate Age-adjusted death rates (per/100,000) from diabetes by race for 1998-2000/2006-2008 Rolling Average in Florida (FDOH CHARTS, 2009) Race Florida Escambia Santa Rosa All 21.3/20.6 28.0/33.5 28.1/25.5 White 18.8/18.2 22.9/28.9 26.8/24.1 Black 52.6/43.6 59.9/61.6 46.7/71.8 Diabetes All Races Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Population Diabetes Rolling 3-Year AgeAdjusted Death Rate Per 100,000 White Population Diabetes Rolling 3-Year AgeAdjusted Death Rate Per 100,000 Black Population Hospitalization rates (per 100,000) from selected respiratory diseases, rolling threeyear age-adjusted rates 1998-2000/2006-2008 for Florida (FDOH CHARTS, 2009) Disease Florida Escambia Asthma (1º/2º) 462.4/708.3 473.2/829.8 CLRD (1º) Includes asthma 371.9/321.4 339.9/276.4 Santa Rosa 391.7/854.5 387.9/423.0 Adjusted Hospitalization Rate From Asthma Rolling 3-Year Age-Adjusted Hospitalization Rate Adjusted Hospitalization Rate From C.L.R.D. Rolling 3-Year Age-Adjusted Hospitalization Rate Contact Information John J. Lanza, MD, PhD, MPH, FAAP Florida Department of Health Escambia County Health Department 850.595.6557 john_lanza@doh.state.fl.us www.EscambiaHealth.com