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