CDC s National Environmental Public Health Tracking Network
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2 Session: Public Health Applications of Human Biomonitoring September 24-25, 2007 Research Triangle Park, North Carolina CDC s National Environmental Public Health Tracking Network Beverly Stern Kingsley, Ph.D., M.P.H Environmental Health Tracking Branch Division of Environmental Hazards and Health Effects National Center for Environmental Health Centers for Disease Control and Prevention (CDC)
3 Call to Action IOM, 1988 Pew Environmental Health Commission, 2000 Congressional appropriations, 2002 CDC s National Environmental Public Health Tracking Program, 2002
4 CDC s Tracking Program Mission To provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities
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6 Tracking Network At-a-Glance Web-based information system that exists at the local, state, and national level Provides access to nationally consistent data and indicators of environmental health status Serves the public, environmental public health agencies, health care providers and researchers Protects privacy of individuals
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8 CDC s National Biomonitoring Program
9 CDC s National Biomonitoring Program CDC s Environmental Health Laboratory conducts the National Biomonitoring Program Major Activities Produce CDC s National Report on Human Exposure to Environmental Chemicals Respond to public health and terrorism-related emergencies Provide support for States Collaborate on studies of exposure and health effects Develop new and better biomonitoring measurements
10 CDC s National Biomonitoring Program Third National Report on Human Exposure to Environmental Chemicals Selected participants in NHANES Produced for 2-year survey periods First Report (2001) NHANES 99-00, 27 chemicals Second Report (2003) - NHANES 99-00, 116 chemicals Third Report (2005) - NHANES 01-02, 148 chemicals Fourth Report (2008*) NHANES 03-04, 275 chemicals Blood and urine levels of chemicals and metabolites Metals, tobacco smoke, phthalates phytoestrogens, polycyclic aromatic hydrocarbons (PAHs), pesticides, herbicides, insecticides, dioxins, furans, and polychlorinated biphenyls (PCBs) New for Fourth Report: perfluorinated compounds (PFCs), polybrominated diphenyl ethers (PBDEs), environmental phenols (including bisphenol A), and speciated forms of arsenic * Tentative date
11 CDC s National Biomonitoring Program Transferring Biomonitoring to States State Grant Activities 2001: Phase I Planning Grants CDC s Environmental Health Laboratory launched a planning grant program to support biomonitoring capacity building for public health laboratories. 25 state and regional grants (supporting 33 States) 2003: Phase II Implementation Grants CDC funded three applicants to implement biomonitoring programs. 2 States New Hampshire and New York 1 Consortium Rocky Mountain Biomonitoring Consortium (NM, AZ,CO, MT, UT, and WY)
12 Developing the Tracking Program: Grantees 2002 to 2006
13 Pilot Projects Lead the Way
14 Projects Measured # Grantees # Projects Air Asthma Water Cancer 8 9 Lead 6 7 Birth defects 5 7 Pesticides 4 4 Reproductive health 4 4 CO 3 3 Fish/shellfish 2 2
15 Results from Funded Projects Increased capacity Increased availability and enhancement of existing data Built new data systems Created analytic tools Linked data Took action
16 Complexity Initially we thought we could quickly link environmental and health data to investigate community concerns; however, we found tracking is like peeling an onion each layer reveals more issues that require extensive work to find the answers we seek. LuAnn E. White, Ph.D. Professor and Director Tulane School of Public Health and Tropical Medicine Center for Applied Environmental Public Health
17 Challenges Encountered in Pilot Projects Data Access Quality Not in electronic format Geocoding issues Little standardization No metadata Spatial/temporal misalignment Little exposure data Methods No common toolbox of methods Issues with exposure estimation and misclassification Level of resolution Small numbers Latency/induction Confidentiality Interpretation & Communication Sensitivity /Specificity Confidentiality Audience Plain speaking Actionable?
18 Looking Back Moving Forward Key Lessons Stakeholder engagement - link people, programs, resources Successful data sharing formal agreements, resource-sharing, value-added services Policy/regulatory changes may be required Significant up front work in data enhancement & harmonization Level of complexity - surveillance vs. research Varying levels of state readiness technical infrastructure, data sharing, data discovery Communications getting everyone on the same page
19 CDC s Tracking Program Grantees FY 2006
20 Tracking 2006 Planning to Implementation
21 Setting Priorities for Network Content: Tracking Hazard, Exposure, and Health Effects Federal Priorities State, Local, other
22 Priorities Reported by State/local Grantees Category Measure # Grantees (%) Hazard Air 16 (70%) Water 15 (65%) Heavy metals 4 (17%) Exposure Heavy metals 4 (17%) CO 1 ( 4%) Health effect Asthma 17 (74%) Cancer 15 (65%) Lead 12 (52%) Pesticide Poisoning 11 (48 %) Birth defects 10 ( 44%)
23 EPHT and Biomonitoring
24 Public Health Application of Biomonitoring New York City Tracking Program Landmark community HANES Incorporated NYC HANES environmental biomonitoring ( Pb, Cd, Hg), pesticides (organophosphates, pyrethroids) Developed manual for community HANES
25 NYC HANES (cont d) Activities Determine levels of Hg, Cd, Pb in NYC adults identified illegal Hg containing skin-lightening products Metal Hazard Indicators Hg levels associated with fish consumption MeHg exposure in NYC adults higher than national average Half of Asian New York City residents exceed Hg NY standard reporting level 5ug/L
26 Public Health Action NYC HANES (cont d) Brochure for women of childbearing age how to choose fish/seafood to maximize health benefits, minimize potential risks Culturally relevant guidelines on healthy fish consumption for Asian community Alerted health care providers talk with their patients about reducing mercury intake from fish especially women who are pregnant, planning a pregnancy or breastfeeding
27 Public Health Application of Biomonitoring New Mexico Tracking Program Arsenic in Springer, NM Tracking & biomonitoring staff conducted urine & drinking water sampling/analysis of 100 residents following physician notification of elevated patient As levels Compared community As levels to state and national levels measured different As forms
28 Public Health Application of Biomonitoring New Mexico Tracking Program Arsenic Study in Springer, NM Physician tested patient for urinary arsenic to rule out as possible cause of neurological symptoms Patient s results high, according to clinical lab Physician tested several other patients, also had high results No previous history of elevated As levels in drinking water sampling or other obvious source of environmental contamination
29 Arsenic Study (cont d) New Mexico Tracking Program Response Because of existing biomonitoring capacity, health department able to respond to determine if arsenic elevated in community and if so, what was source Tracking & biomonitoring staff conducted urine & drinking water sampling/analysis of over 100 residents Compared to rest of state based on previous biomonitoring samples Results Community had LOWER As levels than rest of state the clinical significance level according to CDC guidelines Conclusion Elevated As due to seafood, not environmental community exposure via arsenic speciation
30 Public Health Application of Biomonitoring Western Tracking & Biomonitoring Collaboration (WTBC) 2001 CDC s Environmental Health Laboratory launch planning grant to support biomonitoring capacity for public health laboratories. $10M distributed to 25 state health departments, regional programs, supporting a total of 33 states 2003 CDC Biomonitoring Program funds formation of Rocky Mountain Biomonitoring Consortium ( RMBC) AZ, CO, MT, NM, UT, WY CDC Tracking Program funds 7 western states CA, MT, NV, NM, OR, UT, WA 2005 CDC Tracking funds formation of Western Tracking and Biomonitoring Collaborative (WTBC)
31 WTBC (cont d) Membership Rocky Mountain Biomonitoring Consortium Western Tracking States AK, HI, ID (Tracking funds to join WTBC)
32 WTBC (cont d) Goal Use collaboration between western tracking states and Rocky Mountain Biomonitoring Consortium states to build capacity for tracking and biomonitoring Objectives Assess current capacity to perform tracking/biomonitoring functions Assess/collate common exposure/environmental interest among WTBC members Explore existing laboratory capacity to perform regional biomonitoring ( leveraging methods, equipment, other funding sources)
33 Tracking Network Implementation Live in 2008 Functions: Provide Nationally Consistent Data and Measures Describe and Discover Data Exchange Data Provide Data Management and Analysis Tools Inform and Interact with the Public
34 For more information: Contact us:
35 Questions
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