1. 2012 Bunker Hill Superfund Site Coeur d’Alene Basin Blood Lead Levels Panhandle Health District Idaho Department of Environmental Quality United States Environmental Protection Agency Idaho Department of Health and Welfare November 7, 2012

2. Public health service offered by the State Not a study or experiment Box since 1974/1985 Basin since 1996 Lead Health Intervention Program (LHIP) Annual Blood Lead Surveys

3. No cash incentive for participants that live:  within the Box and are between 6 months and 9 years of age, or $20.00 cash incentive for participants that live:  within the Coeur d’Alene River Basin and are between 6 months and 6 years of age Prior to blood draws, the parent/legal guardian or adult participant must sign a Consent Form and complete the appropriate Questionnaire Panhandle Health District LHIP Procedures

4. Screening blood test is done by skin puncture (capillary or fingerstick - FS) Results of capillary test are provided to the participant or parent immediately after analysis Panhandle Health District LHIP Procedures

5. Health Effects

6. Decreasing “elevated” blood lead levels Blood Lead Concentrations Considered to be Elevated by the Centers for Disease Control and Prevention. *N Engl J Med 2003; 348: p1517-26 (1950 – 1991) *CDC. Recommendations in “Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention”. (2012)

7. Neurotoxic Effects Neurobehavioral effects in early development persist into adolescence and young adulthood Neurocognative effects associated blood lead levels of 5-10 μg/dl A decline of 6.2 IQ points results from a blood lead change from 1 to 10 μg/dl (pooled results from 7 studies)

8. Cardiovascular Effects Increase in blood pressure (hypertension)

9. Other Organ and System Effects Renal effects Immune system effects Bone and teeth effects Heme-synthesis effects Reproductive and developmental effects Adrenal effects Liver Effects Gastrointestinal Effects Metabolism Effects Genotoxic Effects Carcinogenic Effects

10. At Risk Populations Children Pregnant women Adults with cumulative exposure Genetically pre-disposed Individuals

11. “There is no level of Pb exposure that has yet been identified, with confidence, as clearly not being associated with possible risk of deleterious health effects.”

12. Box History

13. Bunker Hill Box Average Blood Lead: 1974-2002 * * * U.S. Average * “Elevated” blood lead level

14. Bunker Hill Box Superfund Site Remedial Action Objective  95% of all children in each community with blood lead levels <10 µg/dl  No children (i.e. 15 µg/dl

15. Box Lead Health Intervention Summary Statistics 1988-1994 Number ofMean Number of children Percent children blood Pb with blood Pb (  g/dl) of children Year in survey(  g/dl)>25>15 >10 > 10  g/dl 1988* 230 9.9 73510546% 1989* 27511.4 87115456% 1990362 8.9 24113437% 1991365 6.3 217 56 15% 1992415 7.4 33111027% 1993445 5.6 110 6615% 1994416 6.2 115 7117% *does not include Pinehurst

16. Box Lead Health Intervention Summary Statistics 1995-2002 Number ofMean Number of children Percent children blood Pb with blood Pb (µg/dl) of children Year in survey(µg/dl) >25>15 >10 > 10 µg/dl 1995405 6.0 220 6215% 1996397 5.8 213 4912% 1997337 5.4 0 6 3611% 1998 375 4.8 0 5 31 8% 1999370 4.7 0 3 23 6% 2000320 4.3 0 5 17 5% 2001 322 3.2 0 4 10 3% 2002368 3.1 0 3 7 2%

17. 2012 Blood Lead Summary Statistics – Box (age 0-9) Total Number of Children (N) 8 Minimum (μg/dl) 1.6 Maximum (μg/dl) 4.1 Average (μg/dl) 2.6 Standard Deviation 0.8 Geometric Mean (μg/dl) 2.4 Geometric Standard Deviation 1.4 Number Percentage Children’s blood lead > 5 μg/dl 0 0% Children’s blood lead > 10 μg/dl 0 0% Children’s blood lead > 15 μg/dl 0 0%

18. Basin History

20. 2012 Blood Lead Summary Statistics – Basin (age 0-6) Total Number of Children (N) 83 Minimum (μg/dl) 1.0 Maximum (μg/dl) 8.0 Average (μg/dl) 3.3 Standard Deviation 1.2 Geometric Mean (μg/dl) 3.1 Geometric Standard Deviation 1.4 Number Percentage Children’s blood lead > 5 μg/dl 5 6% Children’s blood lead > 10 μg/dl 0 0% Children’s blood lead > 15 μg/dl 0 0%

21. Basin Blood Lead Summary by Year, 1996 - 2003 (age 0-6 only) *1 child from 2000 was removed from the summary because the associated address was outside the Basin boundaries. Year19961997199819992000200120022003 N581370162101*11710375 N ≥ 10 μg/dl8292614743 % ≥ 10 μg/dl14%15%13%16%14%6%4% N ≥ 15 μg/dl314124202 % ≥ 15 μg/dl5%8%6%7%4%2%0%3% N ≥ 20 μg/dl00241000 % ≥ 20 μg/dl0% 3%2%1%0%

22. Basin Blood Lead Summary by Year, 2004 - 2012 (age 0-6 only) *2 children from 2004 were removed from the summary because the associated addresses were outside the Basin boundaries. Year200420052006200720082009201020112012 N80*816971731751087583 N ≥ 10 μg/dl211013210 % ≥ 10 μg/dl 2.5%1% 0%1.4%1.7%1.9%1.3%0% N ≥ 15 μg/dl100000100 % ≥ 15 μg/dl1%0% 0.9%0% N ≥ 20 μg/dl000000100 % ≥ 20 μg/dl0% 0.9%0%

23. Basin Blood Lead Summary by Year, 1996 - 2003 (age 0-6 only) *1 child from 2000 was removed from the summary because the associated address was outside the Basin boundaries. Year19961997199819992000200120022003 N581370162101*11710375 Min (μg/dl)122111.4 1 Max (μg/dl)18.019.021.029.027.016.013.017.1 Ave (μg/dl)5.26.06.36.45.84.53.74.1 GeoMean (μg/dl) 4.24.95.45.24.83.73.23.4

24. Basin Blood Lead Summary by Year, 2004 - 2012 (age 0-6 only) *2 children from 2004 were removed from the summary because the associated addresses were outside the Basin boundaries. Year200420052006200720082009201020112012 N80*816971731751087583 Min (μg/dl)1.4 1.0 Max (μg/dl)16.712.010.09.014.010.020.012.08.0 Ave (μg/dl)3.92.92.82.92.43.12.53.13.3 GeoMean (μg/dl) 3.42.32.42.62.12.72.12.63.1

25. 2012 Basin Blood Lead Summary Statistics by Area AreaBurke (Ninemile) MullanOsburnWallace N1132219 Min (μg/dl)1.01.61.82.2 Max (μg/dl)8.04.5 7.0 Ave (μg/dl)3.43.03.13.8 GeoMean (μg/dl)3.02.83.03.6

26. 2012 Basin Blood Lead Summary Statistics by Area AreaKingstonLower Basin Side Gulches Silverton N11395 Min (μg/dl)1.01.72.13.2 Max (μg/dl)4.92.34.6 Ave (μg/dl)2.82.13.53.9 GeoMean (μg/dl)2.62.03.43.8

27. Age123456 N161217141311 Min (μg/dl)1.01.41.02.51.72.2 Max (μg/dl)5.27.05.54.64.98.0 Ave (μg/dl)3.13.33.43.33.4 GeoMean (μg/dl) 2.9 3.13.23.33.1 2012 Basin Blood Lead Summary Statistics by Age (years)