Inorganic arsenic exposure and health effects Rebecca Fry, Ph.D. Associate Professor, Department of Environmental Sciences and Engineering Director, UNC SRP-NC-Center for Environmental Risk Analysis Director, Graduate Studies, Curriculum in Toxicology Lineberger Comprehensive Cancer Center

Arsenic: continues to poison the water of millions around the globe Smedley, Pauline L.. 2008 Sources and distribution of arsenic in groundwater and aquifers. In: Appelo, Tony, (ed.) Arsenic in Groundwater : a World Problem. British Geological Survey EPA limit 10 ppb

Arsenic: continues to poison the water of millions around the globe Smedley, Pauline L.. 2008 Sources and distribution of arsenic in groundwater and aquifers. In: Appelo, Tony, (ed.) Arsenic in Groundwater : a World Problem. British Geological Survey EPA limit 10 ppb

Arsenic: continues to poison the water of millions around the globe Smedley, Pauline L.. 2008 Sources and distribution of arsenic in groundwater and aquifers. In: Appelo, Tony, (ed.) Arsenic in Groundwater : a World Problem. British Geological Survey EPA limit 10 ppb

Health effects in adults chronically exposed to arsenic Adults at risk of disease from chronic exposures Classified as Group 1 Carcinogen by the International Agency for Research on Cancer (IARC): Chronic exposure results in many cancers: skin, bladder, lung, liver, prostate and kidney Exposure is associated with non-cancer endpoints: neurological disorders, reproductive effects, cardiovascular disease, diabetes

Health effects in children: prenatal and early life exposure Lower birthweight Preterm birth Neurocognitive effects Increased susceptibility to disease Birth defects

Stable gene expression Prenatal/early life exposure to arsenic is associated with later life disease CD1 mice/85 ppm iAs increase in hepatocellular carcinomas DNA methylation Stable gene expression Prenatal exposure pup adulthood Waalkes, M. et al 2004. Xie, Y. et al, 2007.

Prenatal/early life exposure to arsenic is associated with later life disease Cancer Non-Cancer Smith et al 2012, Liaw et al., 2008; Smith et al., 2006 Smith et al 2012 Studies suggest potential developmental reprogramming associated with later life disease

Hou L et al. Int. J. Epidemiol. 2012;41:79-105

Private Drinking Water Wells More than 40 million in the U.S. rely on private water wells for drinking water. The EPA does not regulate private drinking water wells. The safe Drinking Water Act does not include federal enforcement of domestic well water quality Many states and towns do not require sampling of private wells after installation. It is the responsibility of the homeowner to maintain the safety of their water. Domestic well users have an excess lifetime risk of bladder and lung cancer that is five-times higher than public well users (Kumar, 2010)

Arsenic in North Carolina Areas of North Carolina have natural geologic deposits of arsenic (Foley, 2001) An estimated 2.3 million residents use domestic wells (Kenny, 2009)

Mapping Arsenic Levels in North Carolina UNC SRP Research Translation Core partnered with the Medical Evaluation and Risk Assessment (MERA) program of the North Carolina Department of Health and Human Services (NCDHHS)

Goals of the Partnership To develop the capacity of NC-DHHS to identify NC populations at greatest potential risk from well water contamination. To assist the agency in developing public health action strategies to reduce exposure.

Collaborators Partners from NC Division of Public Health (DPH, NC Department of Health and Human Services) UNC Project Team (UNC Superfund Research Program, Gillings School of Global Public Health) Dr. Mina Shehee – Supervisor, Medical Evaluation and Risk Assessment, Occupational and Environmental Epidemiology Branch Dr. Ken Rudo – State Toxicologist, Epidemiology Section Dr. Leslie Wolf – Director, State Laboratory of Public Health (SLPH) Dr. John Neal – Unit Supervisor, Environmental Sciences Branch, SLPH Patrick Fleming – Acting Unit Supervisor, Computer Services, SLPH Dianne Enright, GISP – Manager, Health and Spatial Analysis Unit, State Center for Health Statistics Dr. Rebecca Fry – Associate Professor, Department of Environmental Sciences and Engineering (ESE) Kathleen Gray, MSPH – Co-Leader, Research Translation Core of the UNC Superfund Research Program and Associate Director for Outreach and Public Service, UNC Institute for the Environment (IE) Dr. Fred Pfaender – Professor, ESE and Research Translation Core Leader Dr. Marc Serre – Associate Professor, ESE Brennan Bouma – Research Associate, IE Kyle Messier – Research Assistant, ESE Alison Sanders – Research Assistant, ESE DHHS - Department of Health and Human Services : www.ncpublichealth.com DPH - Division of Public Health : http://www.ncpublichealth.com/ SLPH - State Laboratory of Public Health : http://slph.state.nc.us ES - Epidemiology Section: http://www.epi.state.nc.us/epi/index.html OEEB - Occupational and Environmental Epidemiology Branch http://www.epi.state.nc.us/epi/oee/index.html MERA - Medical Evaluation and Risk Assessment http://www.epi.state.nc.us/epi/medeval.html UNC - University of North Carolina : www.unc.edu ESE - Env. Sciences and Eng. Dept. : http://www.sph.unc.edu/envr/ SRP - Superfund Research Program : http://www.uncsrp.org/

Data Analysis: Application of Geocoding Algorithm Pre-applied algorithm (n=2295) Post-applied algorithm (n=43991) 10-fold increase in knowledge of contaminant locations Unfiltered well water samples analyzed under EPA Method 200.8 via ICP-MS Electronic records from Oct. 19, 1998 – Feb. 25 2010 Database filtration excluded records with insufficient information (n=~5, 000), Yielded 63,856 for spatial and temporal analyses Type 1. A data point will be Type 1 if the recorded GPS coordinates are assigned and the longitude coordinate is between -85 and -72 decimal degrees and the latitude coordinate is between 33 and 37 decimal degrees (inside North Carolina). Type 2. A data point will be Type 2 if it is not a Type 1 and DHHS-recorded county name is the same as the assigned county based on the zipcode AND if the Address Locator program used was based on the street address (not postal code). The corresponding street-address geocoded coordinates are assigned. Type 3. A data point will be Type 3 if it does not meet the requirements for Type 1 or Type 2 and the DHHS-recorded zipcode is available and was assigned a value in North Carolina. The corresponding zip code centroid is assigned. Type 4. A data point will be Type 4 is it does not meet the requirements for any of the previous types and it contains a DHHS-recorded county (all points have at least county information). This is assigned a county-centroid. 15

Arsenic levels highest along the NC Piedmont 89 32 273 Identified 1436 wells that exceed EPA limit 233 that are >50 ppb (max 806 ppb) County averages and number of wells sampled (number appears in county).

Arsenic and other toxic metals are Contaminating the water in NC Sanders et al. BMC Public Health 2014 Arsenic and manganese co-occur North Carolina Birth Defects Monitoring Program Increased prevalence of birth defects in counties where toxic metals are high, mn with conotruncal defects

In counties in NC where toxic metals are high, there is increased prevalence of specific birth defects

Public health considerations Questions related to water sources for drinking in the home? Water testing? Biomonitoring?

Major Take Home Points Arsenic is impacting the health of adults and children in NC and globally Increased awareness of potential sources of exposure including through private drinking wells Public health considerations: well water screening, biomonitoring

Thank you! Funding NIEHS (ONES): R01ES019315 NIEHS CEHS UNC: P30ES010126 NIEHS Superfund: P42 ES005948