Fetal Deaths

1. Fetal Deaths NPL Sites and Fetal Deaths: A Simple Correlation Issue of Census Tracts and NPL Sites.

2. The Purpose The purpose of this study is to attempt to assess correlation of Infant and Fetal Mortality with hazardous waste sites, specifically Florida’s National Priority List (NPL) sites with distance and carcinogenicity of toxicants present as a proxy for exposure.

3. Outline • Statement of the Problem • Definitions • Introduction/Statement of the Problem • Project Overview • Procedure • Data/ Observations • Conclusion/Future Studies

4. Definitions (1) • "Stillbirth" means the death of a fetus of more than 20 weeks gestation." (s. 467.003 Florida Statutes, Definitions)  • "Fetal death" means death prior to the complete expulsion or extraction of a product of human conception from its mother if the 20th week of gestation has been reached and the death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles."  • "Live birth" means the complete expulsion or extraction of a product of human conception from its mother, irrespective of the duration of pregnancy, which, after such expulsion, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, and definite movement of the voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached." (Emphasis added, s. 382.002 Florida Statutes, Definitions)  http://www.volusia.org/medicalexaminer/stillbirth.htm

5. Definitions (2) • Fetal death: "Stillbirth" means an unintended, intrauterine fetal death after a gestational age of not less than 20 completed weeks. • Fetal mortality rate: The ratio of fetal deaths divided by the sum of the births (the live births + the fetal deaths) in that year. Fetal Deaths (Stillbirths) = Average Number of Fetal Deaths/ Average Number of Live and Still Births http://www.medterms.com/script/main/art.asp?articlekey=3420

6. Definitions (3) • Infant Mortality: • The death of a live born infant which occurs within the first year of life. • Infant Mortality Rate = Number of Infant Deaths /Number of Live Births “The Fetal mortality rate is considered a good measure of the quality of health care (and environment) in a country or a medical facility.” (Florida DOH: 2010 aims)

7. Definitions (4) • “National Priorities List (NPL) site” EPA's list of the most serious uncontrolled or abandoned hazardous waste sites identified for possible long-term remedial action under Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA): Superfund . The list is based primarily on the score a site receives from the Hazard Ranking System. EPA is required to update the NPL at least once a year (National Safety Council). • “Carcinogenicity " The ability or tendency to produce cancer .

8. Statement of the Problem (1) The assumption is that toxicity affects the embryo, as there is evidence in animal and human research that endorses individual Chemicals as ‘toxic’. However, the mixture of chemicals and especially its exposure from the environment are scarce and riddled limitations.

9. Research • Washington State (Mueller, 2007) • NO • England (Morgan, 2004); EUROHAZCON, Vrijheid) • Maybe, however: ½ of the population live within ‘kilometers’ of hazardous waste sites • Middle East: Israel (Bentov, 2006): • Yes, but only in the Bedouin population (intermarriage as a confounder?) • History: • Dwarfs, Gnomes, one eyed monsters, two headed beasts… • Beowulf: steps in ‘lighted underground lake’, and begets a monster

10. Introduction

11. Statement of the Problem (2) “Is there a correlation between National Priority List (NPL) Sites and infant/fetal deaths in the surrounding population?” Toxicants Fetal Deaths?

12. Facts • NPL sites: • 1641 sites in the USA • Region 4 • Florida: 72 sites • 2 proposed (Hillsborough and Broward) • Fetal Deaths: Health Indicator 8 • 2010 objective 4.1 (Target 16-1a, Florida’s objective for reducing fetal deaths) • 2000 Baseline 8.2 (Fetal deaths at 20 or more weeks of gestation)

13. National Priorities List Sites in Florida From: EPA, Superfund

14. Adverse Health Effects in Population

15. Prototype for Diagnosis Environmental Markers Personal Biomarker Contaminants Verification of Possible Disruption ? NPL Location Monitoring System

16. Project Overview Prototype of Diagnostic and Interference Analysis NPL Sites: Framework Location: Geography Contaminant: Nature Fetal /Infant Death Rate vs. Distance as a Proxy Environmental Interactions

17. Variables • Average Fetal/ Infant Mortality Rates • Census Tracts (CHARTS): Years 1997-2001, 2002-2006 • Contaminant Toxicity • Types of Media Contaminated (Surface water, Groundwater, Soil, Sludge, Other) • Flooding: partial, total; + sludge, + sediment, + surface water • Grade Contaminant Risk Assessment (EPA list of Carcinogen Classification: A, B1, B2, C, D, N/A) • Distance from Exposure Site • 0.5, 1.1, 2.8, 7 miles with the County averages of the same year as reference population

18. Character of Contaminants Classification by Effects: Carcinogenicity Year of Deletion of NPL list Fetal Deaths by Census Tract Overall Site Risk Assessment Distance vs. Fetal Death mortality Vs Risk/Site Matching Ho: µ0= FD0.5 = FD1.1 =FD2.8 = FD7 = FDCounty Ha: µ1= FD0.5 > FD1.1 >FD2.8 > FD7 > FDCounty Project Overview Part 1 Character of Site Classification by site: Geography Construction Status Location Characteristics General Assessment Data Collection Structure Hypothesis Statement Character of Site

19. Limitations: • Location: Centroid Coordinates • NPL site & Census tract fetal death rate • Toxicants: Site Contaminant Algorithm • Carcinogenic Potential Classification • Exposure: Dyad fetus-mother • Personalized risk assessment of environmental factors: behavior/addictions, genetics • Exposure interval • Others: • Missing Information _X_ sites

20. Research Component The detailed analytical work on the characterization of ALL contaminants and identification of risk factors. The next step will involve the analysis of the correlation with fetal deaths by distance from the NPL site These then will be further analyzed by GIS through superimposition of the sites for added strength of correlation

21. Proceedure • Contaminants • Categorized (=n) • Assigned a risk value these will be added by computerized risk factor for contaminated media, identified for flooding characteristics • Risk factors • Added Toxicity Algorithm: compared with the results of the estimates of Fetal Deaths/ Infant Deaths per thousand according to census tracts and distance (categorical variables) of the sites (0.5, 1.1, 2.8 and 7 miles). • GIS • Superimposition of similar sites in magnitude of carcinogenicity for added strength of correlation

22. Tools • U.S. Census Bureau American FactFinder. Reference Maps: 2000 Census Tracts and Blocks • EPA • National Priority List (NPL). National Priority List Sites in Florida: NPL Sites in Florida by County • Integrated Risk Information System (IRIS) • Florida Charts: Community Health Assessment Resource Tool Set. Fetal and Infant Death Indicators • Computer analysis software • Geographical positioning: ArcGIS • Excel (2007) • IRB: Public Data

23. IRB & HIPPA Geographical Coordinates: Plotted on Graph instead of Map

24. Project Overview: FINAL Fetal Death by Census Tract (FDOH) Toxicant Risk (IRIS, ATSDR) Exposure Route (EPA) Fetal Mortality In Census tracts @ 0.5, 1.1, 2.8, 7 M Carcinogenicity Soil, Water, Air Flooding NPL Status Step 1 Step 2 Step 3 GIS Analysis Step 4

25. Procedure: Step 1 Fetal Deaths: Distance as a Proxy

26. Fetal Death by Census Tract Fetal Mortality In Census tracts @ 0.5, 1.1, 2.8, 7 M and County Tracts found by entering the geographical Coordinates from the sites

27. Fetal Deaths by Census Tracts # of Fetal Mortality/Tract = (Deaths/ Mile radius)/1000 live births (?)

28. Miami Flood Oct 4 2000??? SOIL AND GROUNDWATER

29. Procedure: Step 2 Contaminants: By Type, Media & Periculosity

30. By Type of Contaminant • Inorganic • Metals • PAH • VOC • PCBs • Base Neutral Acids • Pesticides • Radioactive • Petroleum Hydrocarbon

31. 2. By Toxicant Risk 1 Locate Contaminant • EPA NPL list • By County • Contaminated Media • Classify for Carcinogenicity (IRIS) 2 3 4

33. Procedure: Step 3 Site Exposure Route

34. 3. By Exposure Route (EPA) Site Characteristics: 1. Flooding 2. Groundwater and Soil contamination 3. Population within one mile: 10,001-50,000 • Contaminated Media • Air • Soil • Water • Groundwater • Surface Water • Sludge/ Sediment/ Other • Flooding • NPL Status

35. Procedure: Step 4 Site: Toxicity Algorithm

36. Simulation Example

37. Miami Flood Oct 4 2000??? SOIL AND GROUNDWATER

38. Data/Observations

39. Data/Observations:

42. Conclusions Need to get HRS SCORES! The HRS uses a structured analysis approach to scoring sites. This approach assigns numerical values to factors that relate to risk based on conditions at the site. The factors are grouped into three categories: likelihood that a site has released or has the potential to release hazardous substances into the environment; characteristics of the waste (e.g. toxicity and waste quantity); and people or sensitive environments (targets) affected by the release. Four pathways can be scored under the HRS: • Ground water migration (drinking water) • Surface water migration (drinking water, human food chain, sensitive environments); • Soil exposure (resident population, nearby population, sensitive environments); • Air migration (population, sensitive environments). After scores are calculated for one or more pathways, they are combined using a root-mean-square equation to determine the overall site score. Superfund Hazard Ranking System(HRS): Quickscore

43. Future Research • Address limitations • Add to the study: • Mutagenicity (ATSDR) • NonCA Effects (RfD, ToxFAQsTM) • Address Outcomes adding • Birth defects • Cancer (children) • Adults • Mutagenicity • Non- Carcinogenic Effects (inverse RfD/10)

44. The Future ‘Life in a bud’ Most Precious Form of Life We Do not see DO WE CARE? Butterfly Chrysalis. (Frederik Meijer Gardens & Sculpture Park, butterfly exposition March 5, 2008)

45. References • Integrated Risk Information System (IRIS): Carcinogenicity Assessment for Lifetime Exposure. http://www.epa.gov/iris/links.htm • EPA. National Priorities List (NPL): National Priorities List Sites in Florida. http://www.epa.gov/superfund/sites/npl/fl.htm • U.S. Census Bureau: American Fact Finder. Reference Maps: 2000 Census Tracts and Blocks. State: Florida. http://factfinder.census.gov/jsp/saff/SAFFInfo.jsp?_pageId=referencemaps&_submenuId=maps_2 • Florida Charts: Community Health Assessment Resource Tool Set. Fetal and Infant Death Indicators. http://www.floridacharts.com/charts/CensusTractMap.aspx?DataType=3&Rate=Y • Mueller, B. A., Kuehn, C. M., Shapiro-Mendoza, C. K., & Tomashek, K. M. (2007). Fetal Deaths and Proximity to Hazardous Waste Sites in Washington State. Environmental Health Perspectives, 115(5), 776-780. • Bentov, Y., Kordysh, E., Hershkovitz, R., Belmaker, I., Polyakov, M., Bilenko, N. & Sarov, B. (2006). Major congenital malformations and residential proximity to a regional industrial park including a national toxic waste site: An ecological study. Environmental Health: A Global Access Science Source, 5, 1-9 • Morgan, O. W., Vrijheid, M., Dolk, H. (2004). Risk of low birth weight near EUROHAZCON hazardous waste landfill sites in England.Archives of Environmental Health, 59(3),149-51.

46. ?

47. Thanks • Dr. Ribeiro • Dr. Harris • Dr. Kearney • Dr. Camerom • Dr. Groetsch • Dr. Merchant • Dr. Van Horn • Ms. Rebecca Shultz • Ms. Larrieux • Mr. DeSousa