# Presentation: 118336

## Region 8Superfund Human Testing

- 	VBI-70, CO				Urinary Arsenic
- 	Leadville, CO 			Blood Lead
- 	Eureka, UT 			Blood Lead
- 	East Helena, MT 			Blood Lead
- 	Minot, ND derailment (NH4)	Lung Testing
- 	Libby, MT				Asbestos

## Libby, Montana Site & Human Research

-       Aubrey K. Miller, MD, MPH

## Libby, Montana

- Located northwest Montana
- Population: 2600 city; 5000 city + surrounding area
- About 1100 homes: city

## Zonolite Mine 

- Vermiculite mine started 1920’s
- Produced up to 80% of worlds vermiculite
- WR Grace bought 1963 & closed in 1990 (>> 5 million tons)
- Typically 150-200 working at mine & facilities (> 1800 workers employed in total)

- _EXPOSURES_
- Earlier up to 130 f/cc
- depending on job; reduced later
- (OSHA PEL 0.1 f/cc)

## Vermiculite Mining (Zonolite Mine)

- Raw ore surface mined (up to 100% asbestos)
- Sent to _dry mill_ (later wet mill) at site for beneficiation
- Beneficiated ore transported across US for heat exfoliation

**Raw Asbestos Ore**

**  ****Vermiculite**

**Exfoliated**

**RAW**

## Ore Transported to > 300 Processing Plants Nationwide

**Ore Transported to > 300 Processing Plants Nationwide**

## Town 6 miles downwind from mine

**Town 6 miles downwind from mine**

**Est. 5000 lbs/day of asbestos into Libby airshed**

## Ambient Air

- Grace records 1975: 0.7 to 1.5 f/cc  (PCM) downtown
-  EPA 1982:  0.5 f/cc (PCM) in Libby                           **OSHA PEL O.1 f/cc**

## Libby Non-occupational ExposuresHistorical & Present

- Family Contact with workers
- Other
- Playing in vermiculite piles
- School Areas
- Garden use

## Vermiculite Attic Insulation

- 		Insulation made from Libby ore

## How Many Homes?

- EPA has no information prior to Grace.
- Estimates range between 10 - 35 million homes.
- EPA, ATSDR, & NIOSH issued national warnings in 2003.

## Asbestos: Non-Cancer Diseases

- _All types of asbestos_
- _Mortality_
- Under-reported
- _Severity_
- Dose, Duration, Personal Factors
- Usually 10+ yrs to develop (Latency Period)
- Clinical: No impairment to severe disease & death

- Asbestosis: Fibrosis of lung parenchyma (air sacs)
- Pleural Fibrosis: Scarring / thickening lining around lung

## Asbestos: Carcinogenic Disease

- Lung Cancer
- Mesothelioma
- GI Cancer
- Other Cancers
- Laryngeal, Kidney, Ovaries

- Cancer reported 1935

- Clearly associated

- Most studies

- Some studies

## Libby Health Data Since 1999 

- Mortality Studies
**Medical Testing**
- Case-Series
- Other

## Libby Medical TestingGroups Involved

- EPA Region 8
- ATSDR
- US Public Health Service Region 8
- Montana DHHS
- Libby local government & medical community

## Major Roles & Responsibilities

- Protocol development was collaborative
- EPA: provided $11M & physical infrastructure
- ATSDR: actual testing & HSRB
- PHS Region 8: health care delivery efforts
- HRSA, SAMHSA, CMS, MT Primary Care Assoc.

## HSRB Requirements

- Full testing protocols
- Health pros & cons of all tests
- Info regarding any benefits of participation
- Draft letters to convey participant results
- All consent forms (easily understandable)
- Consent to send results to designated MDs
- Record keeping plans

##     Medical Testing          

**    ****Medical Testing****          **
**         ****7307 Tested **
** ****July-Nov. 2000 (6149)         July – Sept. 2001 (1158)**

## Eligibility

- Community
- Ad
- Campaign

**Eligibility**

## Assessment Interview

## Chest X-ray

## Pulmonary

- Function
- Test

##      Crude Pleural Abnormality Rates (%)     All CXR Views, 2/3 B-readers *

-      Crude Pleural Abnormality Rates (%)     All CXR Views, 2/3 B-readers *

**                   ****All Participants****	****   18 % **** **
**     **
**	****	****	****	****	****            **_**Play Verm. Piles**_**                      **
**Ever WRG employed                51              Sometimes                          19**
**Secondary Contractor              35              Frequently                          25**
**Lived with WRG worker          26            **_**Popped Verm**_**.                 **
**	****	****	****	****	****	**** ****Sometimes                          22**
**Verm. Insul. In Home****	****          21              Frequently                           26**
**Vermiculite Gardening****	****          20                **
_**Handled Verm. Insulation**_**                       **_**Recreated along road to mine**_** **
**	****Sometimes                          21               Sometimes                          17**
**     ****Frequently                           26               Frequently                          21**
**	****                                                              **
**                                                                         **

- *n=6668 participants (PA view only 14%)
- *Peipins et al; Environ Hlth Persp.; 111:1753-1759 (2003).

## HSR Medical Testing Issues

- Health Study vs Exposure Investigation
- Generalizable knowledge & intent
- Cost / Benefit of medical testing
- Risks of procedures (kids vs adults)
- Lack of effective treatments
- Risk of losing/not getting insurance coverage
- Confidential Record Keeping

## Health Care Issues

- Evaluation of those with abnormalities
- Needs Assessments
- Federal Programs / Financial Aid
- Increase coverage medicare & medicaid
- Eligibility designations (MUP, HPSA)
- Community Health Center (opened Dec 01)

## Health Care	Results	

- Development effective community coalitions
- Center for Asbestos-related Disease
- Support for specialty care for those affected
- Community Health Clinic
- Primary care for Libby & surrounding communities
- Application submitted 5/01, started 12/01
- Mental health services

## QUESTIONS????

## More information is widely available on Libby & Asbestos Issues

**More information is widely available on Libby & Asbestos Issues**
**EPA & ATSDR websites, books, scientific literature, news & magazine articles.**