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Drinking Water Contaminants and Child Health in Woburn and Tom ’ s River. EH757 October 11, 2011 Richard Clapp , D.Sc., MPH     Professor Emeritus     Boston University School of Public Health. Major Types of Water Pollution. Microbiological

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Drinking water contaminants and child health in woburn and tom s river l.jpg

Drinking Water Contaminants and Child Health in Woburn and Tom’s River


October 11, 2011

Richard Clapp, D.Sc., MPH

    Professor Emeritus

    Boston University School of Public Health

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Major Types of Water Pollution Tom

  • Microbiological

    • Ex: cholera, cryptosporidium, Giardia, Hepatitis A

  • Heavy metals

    • Ex: lead, arsenic

  • Radiation

    • Ex: radium, radon

  • Chemicals

    • Ex: disinfection byproducts, solvents, fluoride,

    • pesticides

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Drinking Water Pollution Tom

  • Improper treatment of surface water

    • Lack of filtration, inadequate filtration

    • Underchlorination, overchlorination

  • Groundwater pollution

    • Geological deposits of radium, arsenic, uranium

    • Improper disposal of chemicals

  • Faulty distribution system

    • Lead pipes and lead solder

    • Leaks and intrusion

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Epidemiologic Studies Tom

  • Birth outcomes studies

    • Silicon Valley, CA (Swan, et al.)

    • Tucson, AZ (Goldberg, et al.)

  • Cancer studies

    • Woburn, MA

    • Tom’s River, NJ

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Woburn Citizens Tom’ Concerns

  • Years of toxic waste dumping from leather tanneries, chemical plants

  • Strong odors in East Woburn

  • Water tasted bad periodically

  • Apparent cluster of childhood leukemia in East Woburn neighborhood

  • Local and State officials unresponsive

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Citizen Action Tom

  • Created grassroots organization called FACE (For A Cleaner Environment)

  • Called for health and environmental studies

  • Demanded clean-up of contaminated properties

  • Several families filed lawsuit (subject of book and movie, “A Civil Action”)

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Results of 1981 Study Tom

  • Case-control study of 12 childhood leukemia cases diagnosed 1969-1979

  • No association with any particular exposure, family history, medical history

  • Elevated Standardized Incidence Ratio SIR=2.3, p=.007 (see Cutler JJ, et al. Childhood Leukemia in Woburn, Massachusetts. Public Health Reports 101(2):201-205, 1986)

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Woburn Childhood Tom

Leukemia Cases


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Harvard/FACE Study Tom

  • Citizens and researchers conducted town-wide telephone survey

  • Used Woburn water distribution model from Dept. of Env. Quality Engineering

  • Estimated exposure to contaminated wells G & H was two-fold higher in childhood leukemia cases diagnosed 1964-1983 (see Lagakos SW, et al. J Am Stat Assoc 81:583-596, 1986)

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Lagakos, et al. survey Tom

  • Volunteer interviewers (235), scripted telephone interviews, random batches

  • Introductory text said purpose was to examine environmental influences on health

    • 5,010 completed interviews (57% of residences)

  • Analyzed 20 leukemia cases using Cox proportional hazards model

  • Discussed biases, misclassification of exposure

  • Criticized by Chair of Epidemiology

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Lagakos, et al. additional results Tom

  • Eye/ear birth anomalies, and increased CNS/chromosomal/oral cleft anomalies associated with water from Wells G & H.

    • Authors referred to these as “environmental” birth defects

  • Perinatal deaths since 1970 also associated

  • Increased childhood lung/respiratory tract and kidney/urinary tract disorders associated

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DPH TomCase-control Study

Case-control study of childhood leukemia cases diagnosed 1969-1986

  • Used more detailed water distribution model with estimates of G & H exposure by month

  • Used same method as in 1981 study, but with more cases; estimated prenatal exposure

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Wells G and H Tom

Water Distribution

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Costas, et al. conclusions Tom

  • “Consistently positive association between exposure and risk, a statistically significant dose-response relationship, and a decrease in risk after removal of the pathway of exposure.”

  • Major finding: association of “fetal exposure(s) to contaminated water and childhood leukemia”

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Number of Cases of Childhood Leukemia Diagnosed Tomby Year of Diagnosis in Woburn, MA Jan. 1, 1969 - Aug. 1, 1999

Contaminated Wells Closed

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Tom Tom’s River study

  • Role of Ocean of Love support group

    • Recognition of cases, calls for investigation

    • Political support from Gov. Whitman, Sen. Lautenberg

  • Preliminary studies by NJDHSS

    • Childhood cancer incidence

    • Decision to conduct case-control study of 22 children with leukemia and 18 with nervous system cancer

  • Water contaminated with TCE, PCE, radium, Styrene-acrilonitrile trimer

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Childhood cancer incidence Tom

  • Tom’s River 1979-1995 childhood cancer all sites SIR (24 cases) = 1.7 (95% CI 1.07-2.49)

    • Females age 0-4 all sites SIR = 6.5 (95% CI 3.13-12.0)

    • Female age 0-4 brain cancer SIR = 11.3 (95% CI 2.27-33.0)

    • Female age 0-4 ALL SIR = 9.4 (95% CI 2.52-24.0)

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Case-control study methods Tom

  • Interviews inquired about family history, residential history, diet, medical history, etc.

  • Included children born in Tom’s River but diagnosed when living elsewhere; controls met same criteria

  • Detailed estimates of exposure to well water, other contamination sites

    • Attempted to estimate radiation from Oyster Creek nuclear power plant; unlikely very substantial

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Tom Tom’s River Main Results

  • Parkway well field high prenatal exposure associated with leukemia in females (OR = 6.0; 95% CI 1.1-32)

  • Ciba-Geigy high-medium air exposure associated with leukemia in females under age 5 (OR = 7.5; 95% CI 0.8-71)

  • Other findings regarding brain cancer not highlighted (see vol. ii of final report)

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Legal case Tom

  • Mediation between plaintiffs and defendants for 18 months

    • Compiled evidence and testimony that would be used in trial

    • Settlement agreed to just prior to NJDHSS results announced

  • Sixty plaintiffs agreed not to sue in subsequent class actions