1. 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

2. Arsenic: continues to poison the water of millions around the globe
Smedley, Pauline L 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

3. Arsenic: continues to poison the water of millions around the globe
Smedley, Pauline L 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

4. Arsenic: continues to poison the water of millions around the globe
Smedley, Pauline L 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

5. 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

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

7. 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 Xie, Y. et al, 2007.

8. 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

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

10. 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)

11. 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)

12. 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)

13. 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.

14. 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 :
DPH - Division of Public Health :
SLPH - State Laboratory of Public Health :
ES - Epidemiology Section:
OEEB - Occupational and Environmental Epidemiology Branch
MERA - Medical Evaluation and Risk Assessment
UNC - University of North Carolina :
ESE - Env. Sciences and Eng. Dept. :
SRP - Superfund Research Program :

15. 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 via ICP-MS
Electronic records from Oct. 19, 1998 – Feb
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

16. Arsenic levels highest along the NC Piedmont89 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).

17. 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

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

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

20. 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

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