Biomonitoring programs in Michigan, Minnesota and New York to assess human exposure to Great Lakes contaminants.

Over the past century, industrialization and urban practices have resulted in the contamination of the Great Lakes ecosystem-the world's largest surface freshwater system-that provides drinking water and recreation to more than 40 million residents. In 2010, the Great Lakes Restoration Initiative was launched to accelerate efforts to protect and restore the Great Lakes and surrounding areas. Funded by GLRI, the Agency for Toxic Substances and Disease Registry initiated the Biomonitoring of Great Lakes Populations (BGLP) program. The objective of the program is to assess human exposure to legacy and emerging contaminants in the Great Lakes by measuring the body burden of contaminants in potentially susceptible populations. The BGLP program consists of a series of cross-sectional studies carried out collaboratively with states that are funded through ATSDR. The first BGLP Program (BGLP-I) began in 2010 and was completed in September 2015 through cooperative agreements with state health departments in Michigan, Minnesota, and New York. The three state programs targeted susceptible adult populations living in designated areas of contamination. Contaminants measured in all populations include mercury, lead, mirex, hexachlorobenzene, dichlorodiphenyltrichloroethane, and selected polychlorinated biphenyl congeners. In addition, some chemicals of emerging concern, such as per- and polyfluoroalkyl substances, were measured in several populations. The biomonitoring results helped guide public health actions to mitigate chemical exposures in these vulnerable Great Lakes populations. We provide an overview of the BGLP-I program's study populations, designs, and general methods. This overview provides a lead-in for subsequent manuscripts that present human biomonitoring data for legacy and emerging contaminants in culturally diverse susceptible populations-i.e., shoreline anglers, sport anglers, American Indians, and Burmese immigrants-residing in seven areas of concern.

The Flint Water Crisis: A Coordinated Public Health Emergency Response and Recovery Initiative.

CONTEXT: The City of Flint was already distressed because of decades of financial decline when an estimated 140 000 individuals were exposed to lead and other contaminants in drinking water. In April 2014, Flint's drinking water source was changed from Great Lakes' Lake Huron (which was provided by the Detroit Water and Sewerage Department) to the Flint River without necessary corrosion control treatment to prevent lead release from pipes and plumbing. Lead exposure can damage children's brains and nervous systems, lead to slow growth and development, and result in learning, behavior, hearing, and speech problems. After the involvement of concerned residents and independent researchers, Flint was reconnected to the Detroit water system on October 16, 2015. A federal emergency was declared in January 2016. PROGRAM: The Centers for Disease Control and Prevention provided assistance and support for response and recovery efforts including coordinating effective health messaging; assessing lead exposure; providing guidance on blood lead screening protocols; and identifying and linking community members to appropriate follow-up services.In response to the crisis in Flint, Congress funded the Centers for Disease Control and Prevention to establish a federal advisory committee; enhance Childhood Lead Poisoning Prevention Program activities; and support a voluntary Flint lead exposure registry. The registry, funded through a grant to Michigan State University, is designed to identify eligible participants and ensure robust registry data; monitor health, child development, service utilization, and ongoing lead exposure; improve service delivery to lead-exposed individuals; and coordinate with other community and federally funded programs in Flint. The registry is also collaborating to make Flint "lead-free" and to share best practices with other communities. DISCUSSION: The Flint water crisis highlights the need for improved risk communication strategies, and environmental health infrastructure, enhanced surveillance, and primary prevention to identify and respond to environmental threats to the public's health. Collecting data is important to facilitate action and decision making to prevent lead poisoning. Partnerships can help guide innovative strategies for primary lead prevention, raise awareness, extend outreach and communication efforts, and promote a shared sense of ownership.

Lessons from the 2006 Louisiana health and population survey.

The 2005 hurricane season caused extensive damage and induced a mass migration of approximately 1.1 million people from southern Louisiana in the United States. Current and accurate estimates of population size and demographics and an assessment of the critical needs for public services were required to guide recovery efforts. Since forecasts using pre-hurricane data may produce inaccurate estimates of the post-hurricane population, a household survey in 18 hurricane-affected parishes was conducted to provide timely and credible information on the size of these populations, their demographics and their condition. This paper describes the methods used, the challenges encountered, and the key factors for successful implementation. This post-disaster survey was unique because it identified the needs of the people in the affected parishes and quantified the number of people with these needs. Consequently, this survey established new population and health indicator baselines that otherwise would have not been available to guide the relief and recovery efforts in southern Louisiana.

Anxiety affecting parkinsonian outcome and motor efficiency in adults of an Ohio community with environmental airborne manganese exposure.

Manganese (Mn) is a nutrient and neurotoxicant sometimes associated with mood, motor and neurological effects. Reports of health effects from occupational exposure to Mn are well known, but the reported links to environmental airborne Mn (Mn-Air) are less conclusive. Marietta, OH (USA) is a previously identified community with elevated Mn-Air from industrial emissions. Households were randomly selected in Marietta and the comparison town (Mount Vernon, OH). The responders were used to recruit on a voluntary basis 30- to 75-year-old residents, i.e. 100 in Marietta and 90 in Mount Vernon. They were administered the Unified Parkinson's Disease Rating Scale (UPDRS), motor efficiency, and mood tests, along with a comprehensive questionnaire including demographics, health and work history. Blood Mn (MnB), serum ferritin, and hepatic enzymes were measured. Results were compared with those of 90 residents from a demographically similar comparison town, Mount Vernon, OH, where Mn-Air from industrial emissions was not of concern. Mn-Air exposure indices were modeled for Marietta residents. The Mn-exposed participants resided on average 4.75 miles (range 1-11) from the Mn point source. Their modeled residential Mn-Air estimate ranged from 0.04 to 0.96 µg/m(3) and was on average 0.18 µg/m(3). The group means of MnB were similar for the Mn-exposed (9.65 µg/L) and comparison (9.48 µg/L) participants. The Marietta group reported more generalized anxiety on the Symptom Checklist-90-Revised (SCL-90-R) than the comparison group (p=0.035). Generalized anxiety in Marietta was related to a cumulative exposure index (p=0.002), based on modeled Mn-Air concentration and length of residence. Higher generalized anxiety scores were related to poorer performance on UPDRS tests [adjusted relative risk (95%CI): 2.18 (1.46-3.25) for motor-related activities of daily living, 3.44 (1.48-7.98) for bradykinesia, and 1.63 (1.06-2.53) for motor/movement]. Group differences in SCL-90-R generalized anxiety between the two towns and the observed relationship between exposure indices and generalized anxiety suggest an association between environmental Mn exposure and anxiety states. Whether this association is due to direct neurotoxic effects of Mn-Air or concern about the health effects of air pollution remains an open question. The results highlight the importance of measuring anxiety in relation to neuropsychological and neurological endpoints, and should be validated in other studies of Mn-exposed communities.

Incidence and descriptive epidemiology of mesothelioma in the United States, 1999-2002.

To estimate the recent incidence of mesothelioma in the United States and characterize its descriptive epidemiology, incidence data were obtained from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) Program. Age-adjusted incidence rates and 95% confidence intervals were calculated. The U.S. incidence was 1.11 cases per 100,000 persons. Most cases occurred among older, white males. However, 173 cases (< 2%) occurred in persons younger than 40. The proportion of women with peritoneal mesothelioma was triple that of men (14.8% vs 5.4%). Of 40 reporting states, 11 had incidence rates significantly higher than the national rate.

Menstrual function among women exposed to polybrominated biphenyls: a follow-up prevalence study.

BACKGROUND: Alteration in menstrual cycle function is suggested among rhesus monkeys and humans exposed to polybrominated biphenyls (PBBs) and structurally similar polychlorinated biphenyls (PCBs). The feedback system for menstrual cycle function potentially allows multiple pathways for disruption directly through the hypothalamic-pituitary-ovarian axis and indirectly through alternative neuroendocrine axes. METHODS: The Michigan Female Health Study was conducted during 1997-1998 among women in a cohort exposed to PBBs in 1973. This study included 337 women with self-reported menstrual cycles of 20-35 days (age range: 24-56 years). Current PBB levels were estimated by exponential decay modeling of serum PBB levels collected from 1976-1987 during enrollment in the Michigan PBB cohort. Linear regression models for menstrual cycle length and the logarithm of bleed length used estimated current PBB exposure or enrollment PBB exposure categorized in tertiles, and for the upper decile. All models were adjusted for serum PCB levels, age, body mass index, history of at least 10% weight loss in the past year, physical activity, smoking, education, and household income. RESULTS: Higher levels of physical activity were associated with shorter bleed length, and increasing age was associated with shorter cycle length. Although no overall association was found between PBB exposure and menstrual cycle characteristics, a significant interaction between PBB exposures with past year weight loss was found. Longer bleed length and shorter cycle length were associated with higher PBB exposure among women with past year weight loss. CONCLUSION: This study suggests that PBB exposure may impact ovarian function as indicated by menstrual cycle length and bleed length. However, these associations were found among the small number of women with recent weight loss suggesting either a chance finding or that mobilization of PBBs from lipid stores may be important. These results should be replicated with larger numbers of women exposed to similar lipophilic compounds.

ATSDR's trichloroethylene subregistry methods and results: 1989-2000.

The National Exposure Registry of the Agency for Toxic Substances and Disease Registry (ATSDR) uses standard methods to study human exposure in four chemical subregistries: trichloroethylene (TCE), dioxin, benzene, and trichloroethane. The TCE Subregistry includes a baseline cohort of 4006 white registrants with drinking water exposure in Michigan, Indiana, Illinois, Pennsylvania, and Arizona. Between 3 and 6 follow-ups per site were conducted from 1989 to 2000, after baseline. Standardized morbidity ratios, controlling for age and sex, compared prevalences of 16 general health conditions in the subregistry with aggregated national estimates from the 1989-1994 National Health Interview surveys. Excess cases of dermatologic, hematologic, or hepatic disorders and strokes persisted over the lifetime of the registry. Persistent excess urinary tract disorders are likely caused by a systematic bias. This review of first-generation methods may be used to strengthen future exposure registries.