Consideration of cultural and lifestyle factors in defining susceptible populations for environmental disease.

To define mechanisms of susceptibility for populations affected by environmental exposures, both exposure and toxicity assessments must be considered. This review examines cultural and lifestyle factors that help define potentially susceptible populations in two groups, Asian and Pacific Islanders (API) and members of Tribal Nations in the Pacific Northwest region of the US and Western Canada. These groups, which may consume 10 times more fish and seafood than average US consumers, have special dietary practices that can lead to significant exposures to persistent pollutants and biotoxins found in fish and shellfish. The mechanism of toxicity of these contaminants is also important. Using the example of dioxin-like polychlorinated biphenyls (PCBs), different risk assessment approaches are presented and the analytical sensitivity needed to assess risk for different consumption groups is evaluated quantitatively. Our studies have also shown that regulatory agencies evaluation of fish consumption for average US populations do not always adequately consider unique consumption and cooking practices of these groups. Partnering with communities is important for appropriate exposure and risk assessments. This also empowers proactive action by communities to evaluate the risks and many benefits of fish and shellfish consumption and develop risk management strategies tailored for their communities.

Assessment of PCB congener analytical methods: do they meet risk assessment needs?

Congener-specific PCB analysis allows use of toxic equivalency (TEQ) TCDD-based risk assessment approaches when analytical methods are sufficiently sensitive. Many efforts to analyze fish samples for PCB congeners report the majority of samples as non-detects; these data are of little use for human health risk assessment if the limits of analytical detection exceed levels of potential health concern. However, increasing analytical sensitivity is costly and technically difficult. An approach to assess analytical sensitivity needs for risk assessment by defining toxicological endpoints of concern and acceptable risk levels is presented. This framework was applied to assessment of potential PCB TEQ cancer risks to the general United States population and tribal consumers of Columbia River fish, but may be easily adjusted for other situations. A probabilistic model was used to calculate the necessary analytical sensitivity for PCB TEQ cancer risk assessment using the Environmental Protection Agency's new draft cancer risk slope factor for TCDD and fish consumption data. Desired levels of analytical sensitivity were estimated for the congener expected to contribute the most to PCB TEQ, PCB 126, and compared to limits of detection for various analytical methods. The financial and health value of methods with different levels of analytical sensitivity were compared using a value of information approach, which includes analytical cost and cost of potential health outcomes, and a proposed risk assessment utility approach which considers the relative health protectiveness of analytical options non-monetarily. Sensitivity analyses indicate that average consumption rate, cancer risk slope factor choice, and knowledge of existing PCB contamination are important considerations for planning PCB congener analysis.

Imi Ho'ola post-baccalaureate program: recruitment, retention, and graduation of Asian American and Pacific Islander students in medicine.

Imi Ho'ola has been a successful model for training underrepresented minorities and disadvantaged individuals in medicine at the University of Hawai'i. This program has 28 years of experience assisting students to prepare for, qualify for, and complete the M.D. program, thereby producing medical doctors and other health professionals for Hawai'i, Guam, American Samoa, the U.S. Associated Pacific Islands (USAPI), and the continental U.S. Recently, Imi Ho'ola has expanded its outreach efforts to create an educational pathway for local high school and college students encouraging them to pursue higher education and health careers. A description of the Imi Ho'ola is presented with emphasis on its post-baccalaureate curriculum begun in 1995.