Biological, Environmental, and Physical Effects Panel Part 2 Navajo - PowerPoint PPT Presentation

Biological, Environmental, and Physical Effects Panel –Part 2 Navajo Birth Cohort Study, DiNEH Project, and Native EH Equity Center Debra MacKenzie, Research Assistant Professor, Community Environmental Health Program, Department of Pharmaceutical Sciences, UNM David Begay, Research Assistant Professor, Community Environmental Health Program, UNM Maria Welch-Research Field Staff (NBCS), Southwest Research and Information Center (SRIC) Abigail Sanders - Cohort Clinical Liaison (NBCS), Tuba City Regional Health Center

Overview of projects addressing health effects of uranium exposure DINEH Project — Active and Legacy Exposure — Older population (average age 55) — Exposure data includes surveys and biomonitoring data — Navajo Birth Cohort Study — Legacy Exposure — Younger adult population (average age 27) — Extensive exposure data (surveys, home environmental assessments, biomonitoring, existing agency & research data – e.g., NURE, — NTUA, previous water quality measurement data) Native Environmental Health Equity Center (EH Equity) — Mixed metal exposure in three Tribal communities (Cheyenne River Sioux, Crow Nation and Navajo Nation) — Immunologic and Mechanistic studies with community members and model systems — ECHO-Environmental influences on Child Health Outcomes — Follow NBCS cohort up to 5 years of age — Immunologic and developmental outcomes, continued biomonitoring and mechanistic studies —

DINEH PROJECT RESULTS (AVERAGE AGE 55): ACTIVE-MINING ERA EXPOSURES (WORKERS AND FAMILY) INCREASED RISK OF KIDNEY DISEASE Active-mining related exposures were estimated from self-reported survey data A: Washed the clothes of a uranium worker (22%) B: Worked in a uranium mine (10%)* C: Lived in a mining camp (4%) D: Worked in a uranium mill (2%)* E: Worked on a uranium mine or mill reclamation or hauled uranium ore or tailings in a pickup truck (2%) *Many workers have already died from lung cancer, cohort had more family members than workers Hund et al., 2015, Journal of Royal Statistical Society, Series A, Statistics in Society

DINEH RESULTS (AVERAGE AGE 55): ON GOIN G EN V IRONMENTA L LEGA CY EXPOSU RES à IN CREA SED RISK FOR HYPERTEN SION, A U TOIMMU NE DISEA SE & DEV ELOPMENT OF ON E OR MORE CHRON IC DISEA SES IN CLU DING KIDN EY DISEA SE, DIA BETES, HYPERTEN SION Exposures to legacy uranium mine and mill waste estimated from: 1) Integrated proximity of each resident’s home* to all of the 100 abandoned uranium mine and mill waste features 2) Reported activities resulting in contact with uranium mine and mill wastes A: Used materials from abandoned uranium mine or mill (17%) B: Herded livestock next to uranium mine, mill or waste dump (13%) C: Drunk or contacted uranium mine waste water (13%) D: Played on a uranium tailings pile or waste dump (13%) E: Played outdoors near a uranium mine, mill, or waste dump (12%) F: Sheltered livestock in an abandoned uranium mine (2%) *Note: Median length of residence in current homes was 33 years Hund et al., 2015, Journal of Royal Statistical Society, Series A, Statistics and Society (F) (A) (B) (D) and (E) (C)

Drinking water, hauling, and co-exposure concerns Arsenic in Navajo Nation Water Sources • ~30% of Navajo population lack access to regulated drinking water ( 14% of tribal population nationally; 0.6 of US population ) • Water quality in ~500 unregulated sources shows 18-20% exceed arsenic MCL; 15% exceed uranium MCL, often colocated (Hoover et al., submitted) • In contrast to previous studies, only 5.5% of NBCS participants report drinking from Uranium in Navajo unregulated sources Nation Water Sources • 10.3% drinking from PWSs out of compliance with As &/or U 5

Uranium in Waste Also Mobile in Supported by funding from NSF EPSCOR Water Elevated U and co-occurring metals in abandoned mine wastes (Blake et al., ES&T, 2015) Uranium in water sources used for drinking by humans and livestock exceed drinking water standards by 5 - >20 fold Wetland and reservoir downstream of Jackpile Mine 6

Navajo Birth Cohort Study ● Multi-agency, prospective study to assess pregnancy outcomes and child development in relation to uranium waste exposures among Navajo mother- infant pairs ● Cohort characterized with respect to mobility, exposures, co-exposures, demographic and cultural characteristics that may influence birth and developmental outcomes ● Extensive public outreach, communication of results ● NBCS is only cohort study exclusively studying environmental impacts on development in Native American children in the U.S. ● Approved by Institutional Review Boards of the http://www.nativeamericanlinks.co m/postcards.htm Navajo Nation, UNM, and CDC/ATSDR, and by federal Office of Management and Budget

Navajo Birth Cohort Study Cooperating Organizations Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Navajo Area Indian Health DiNEH Project Team Birth Cohort Service (NAIHS) • UNM Community Environmental Health Program (CEHP) Navajo mothers, PL93-638 Facilities • UNM Pediatrics Department, Center fathers and (Tséhootsooí, Tuba City) for Development and Disability babies; other • Southwest Research and Information community Center (SRIC) Navajo Nation members; • Consultants Department of Health chapters With Help From Other Navajo Nation Agencies Growing in Beauty USEPA Environmental Protection Agency, WIC, Health Education, (developmental disabilities Region 9 Office of Uranium Workers services provider)

NBCS Enrollment Updated: July 18, 2016 NBCS Enrollment (Mothers, Fathers, and Babies) Participant # Enrolled as of 7/18/16 Mothers 704 Fathers 211 Babies 574 TOTALS 1,489 Mother Enrollments by Service Unit Hospital Service Unit # Enrolled as of 7/18/16 Chinle 310 Gallup 105 Kayenta 23 Shiprock* 49 Tséhootsooí* 52 Tuba City 165 TOTALS 704 *New enrollments ceased at Shiprock and Tséhootsooí in September 2015.

Enrollment Map (July 2016) Map by Joseph Hoover, PhD

NBCS field staff (CHERS, RFS, CCLs) conduct surveys, collect environmental and biological data to assess exposure and health outcomes Qeturah Event Staffing Timing Content Anderson CHERS (photos Prenatal Participant and family lifetime uranium exposures, Enrollment Survey at L), RFS period occupations, water & land use, health histories, demographics Nikki RFS (photos Prenatal Outdoor & indoor gamma radiation screenings; indoor Home Environmental Begay below) period radon; metals on dust wipe samples from 2 locations; Assessment (HEA) preferred drinking water use (Analyses of dust wipes, water samples @ USEPA-9 lab ) Biomonitoring CCLs Pre- and Blood, serum, urine for 36 metals, metalloids, Melissa post-natal micronutrients;meconium for alcoholmetabolites Samuel (Biomonitoring analyses at CDC lab, Atlanta, GA) At left, Community Health and Environmental Roxanne Research Specialists (CHERS) Thompson Research Field Staff (RFS) – from left, Lynda Lasiloo, All photos above by C. Shuey. L: Enrollment survey; middle: Teddy Nez, Sandy Ramone, Maria Welch. HEA; R: blood sample processing in hospital lab 11

Child Developmental Assessments: Ages and Stages Questionnaire-Inventory (ASQ-I) Birth outcomes, immunity, and overall health to Age 1 — ASQ-I’s are performed when babies’ are 2, 6, 9 and 12 months old -- establish Navajo specific normative values. — Medical record abstractions performed — Data analysis will look for how outcome measures are associated with exposure data

Home Environmental Assessments Purpose: To ascertain participants’ exposures to contaminants in and around their homes. Major contaminant categories are gamma radiation, radon, metals in dust and contaminants in drinking water. All exposure pathways considered. Contaminants exceeding screening guidelines and HEAs Conducted by Service Unit, 2013-2016 percentage of homes having detectable levels of (thru 7/15/16) uranium in indoor dust (results through 7/15/16) Tuba City 129 Ft. 40 Defiance Shiprock 47 Kayenta 21 Gallup 71 Chinle 220 0 50 100 150 200 250

Biological sample collection in NBCS ● Purpose: Obtain biological specimens for exposure assessment while maintaining routine standard of care ● Specifics on samples from baby: Ø Cord blood Ø Meconium when possible Ø Blood from baby at 2-6 months (well-baby visits) and 12 months Ø Urine collected at birth and well-baby clinic visit Blood Urine Meconium Ø Enrollment Ø Enrollment Mother Ø Delivery Ø Delivery Ø Enrollment Ø Enrollment Father Ø Birth (cord blood) Ø Birth Ø Birth Baby Ø 2-6 months of age Ø 2-6 months of age Ø 12 months of age Ø 12 months of age

Biomonitoring for the NBCS samples ● To understand relationships between uranium exposures and birth outcomes and early developmental delays ● Why are we looking at so many metals? To fully understand uranium exposures on health Ø — U wastes are a combination of a wide range of metals — Metals often interact through similar toxicity pathways (arsenic and antimony, arsenic and uranium) To identify other metals of potential health concern on Ø the Navajo Nation Metals from other than mining wastes sources Ø