10a - MI Results Reporting

Attachment 10a. Michigan Results Communications

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

DIVISION OF ENVIRONMENTAL HEALTH

Biomonitoring of Persistent Toxic Substances

in Michigan Urban Fisheaters

Results Letters

Revised June 27, 2012

State programs will work with their respective ethics sub-committees and ATSDR to improve and revise these letters.  ATSDR and the states will take into consideration current guidelines via subject matter experts on the communication of results and potential follow-up with biomonitoring program respondents.

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Attachment 10a1.

Letter 1

Full results letter to participants

whose results do not exceed action levels.

Date

Name

Address

City, State Zip Code

Dear:

Last summer, you agreed to be part of the Michigan Department of Community Health Fish Eaters Study. We tested your blood and urine for chemicals that are often found in fish.

We are pleased to tell you that your test results for cholesterol, mercury, lead, arsenic, and cadmium were normal. And, your other test results are like those of people your age in the United States.

The second and third pages of this letter have your test results. The first row gives the name of each chemical that we looked for in your blood and urine. Your test results are in the second, or blue row, under “Your Test Results”.

The orange, or third row, under “Study Results” has the results for the other people from the Detroit and Saginaw areas who were in the study. We gave you these test results so you can compare your results to theirs. The results are given as a range, meaning the lowest to the highest test results for the group are shown in this row.

We also thought you might like to know the test results of people around the country who have been in similar studies. Their blood and urine were also tested for chemicals. Their results are in the purple, or fourth, row under “U.S. Results”.

The fourth page has a table labeled “Units”. It gives the units of measurement for each chemical. If you take your results to your doctor, he or she will need to know the units for each chemical your blood and urine were tested for.

There is a lot of information in this letter. If you have questions, please feel free call 1-800-648-6942 and ask for Sue Manente.

Thank you very much for being part of this important study, we really appreciate your time and effort.

Sincerely,

Linda Dykema, Manager

D

CAPITOL VIEW BUILDING  201 TOWNSEND STREET  LANSING, MICHIGAN 48913

www.michigan.gov  517-373-3740

ivision of Environmental Health

Test Results - Tests for the chemicals were done on blood or urine, except for mercury. Some chemicals are easier to find in blood and some are easier to find in urine. Mercury can be found in both blood and urine.

Blood Test Results

Test	Your Test Results	Study Results	U.S. Results
		Range	Range
Chlordane – Oxychlordane			11.4 – 39.2
Chlordane – Heptachlor epoxide			<LOD – 20.6
Chlordane - trans-Nonachlor			17.3 – 74.7
p,p'-Dichlorodiphenyltrichloro-ethane (DDT)			<LOD – 20.7
p,p'-Dichlorodiphenyldichloro-ethene (DDE)			233 – 1,990
o,p'-Dichlorodiphenyltrichloro-ethane (DDT)			<LOD - <LOD
Hexachlorobenzene			15.1 – 29.0
Lead			1.3 – 3.9
Lindane			< 0.002
Manganese			4.7-18.3
Mercury			0.89 – 5.32
Mirex			<LOD – 15.4
PBB-153 (Polybrominated Biphenyl number 153)			Age 18-39 years: 1.6 – 12.2 Age 40 -59 years: 2.9 – 36.9 Age 60 years and older: 3.4 – 52.8
Dioxins			Age 18-39 years: < 18.7 Age 40-59 years: < 32.0 Age 60 years and older: < 63.2
Total PCB (Polychlorinated Biphenyls)			TBD

Test	Your Results	Study Results	U.S. Results
		Range	Range
Arsenic			7.55 – 59.4
Cadmium			0.24 – 1.05
Mercury			0.50 – 2.56

Test	Your Test Results	U.S. Guidelines
Total Cholesterol		Less than 200 mg/dL is Desirable 200-239 mg/dL is Borderline High 240 mg/dL is High

Urine Test Results

Units of Measurement

This table gives the “units of measurement” for each of the chemicals.  For example, cholesterol is measured in mg/dL (milligrams of cholesterol per deciliter of blood).  If you give your results to your doctor, he or she will want to know these units of measure.

Blood Tests	Units of Measurement
Cholesterol	mg/dL
Chlordane	ng/g of lipid
DDT (Dichlorodiphenyltrichloroethane)	ng/g of lipid
Dioxins	pg-TEQ/g of lipid
Hexachlorobenzene	ng/g of lipid
Lead	μg/dL
Lindane	μg/mL
Manganese	ng/mL
Mercury	μg/L
Mirex	ng/g of lipid
PBB (Polybrominated Biphenyls)	ng/g of lipid
PCB (Polychlorinated Biphenyls	ng/g of lipid
Urine Tests	Units of Measurement
Arsenic	μg/g of creatinine
Cadmium	μg/g of creatinine
Mercury	μg/g of creatinine

Attachment 10a2.

Letter 2

Action level exceedences letter

sent to participants with elevated blood or urine

results for arsenic, cadmium, lead, or mercury

Date

Name

Address

City, State Zip Code

Dear:

Last summer, you agreed to be part of the Michigan Department of Community Health Fish Eaters Study. We tested your blood and urine for chemicals that are often found in fish.

We found that your (arsenic/cadmium/lead/mercury) in your (blood/urine) level is (………{μg/dl, μg/l}). This means that your (arsenic/cadmium/lead/mercury) level is higher than most people. This does not mean that you are sick or will get sick. But we do strongly recommend that you visit your doctor and take this letter with you.

I have enclosed a fact sheet with more information about (arsenic/cadmium/lead/mercury) and your health.

We will send your other tests as soon as they are available. If you move, please let us know so we can send your results to your new address.

If you have questions, please call 1-800-648-6942 and ask for Sue Manente.

Thank you for being part of this important study. Your time and effort are greatly appreciated.

Sincerely,

Linda Dykema, Manager

Division of Environmental Health

Attachment 10a3.

Letter 3

Action level exceedences letter

with elevated cholesterol levels

Date

Name

Address

City, State Zip Code

Dear:

Last summer, you agreed to be part of the Michigan Department of Community Health Fish Eaters Study. We tested your blood and urine for chemicals that are often found in fish.

We also tested your total cholesterol on (date) and found that your level is (………mg/dl). This means your cholesterol level may be (borderline high/high). This was a non-fasting blood test, meaning we did not ask you to stop eating in the 12 hours before the test. Usually you are asked to fast before routine cholesterol tests. Fasting was not necessary for the Fish Eaters Study.

I have included a fact sheet about cholesterol. We recommend that you talk to your doctor to find out if you should have another blood cholesterol test. Your doctor can tell you whether or not your health is at risk from high cholesterol.

We will send your other tests results as soon as they are available. If you move, please let us know so we can send your results to your new address.

If you have questions, please call 1-800-648-6942 and ask for Sue Manente. Thank you for being part of this important study. Your time and effort are greatly appreciated.

Sincerely,

Linda Dykema, Manager

D

ivision of Environmental Health

Attachment 10a4.

Letter 4

Full results letter for participants

who previously received Letter 2 or 3

Date

Name

Address

City, State Zip Code

Dear:

Last summer, you agreed to be part of the Michigan Department of Community Health Fish Eaters Study. We tested your blood and urine for chemicals that are often found in fish.

Earlier, we sent you a letter because your (arsenic/cadmium/lead/mercury/cholesterol) level was higher than most people. The letter recommended you make an appointment your doctor for medical advice. A copy of that letter is also included. If you have not seen your doctor yet, please make an appointment and take this information with you.

The second and third pages of this letter have all of your test results. The first row gives the name of each chemical that we looked for in your blood and urine. Your test results are in the second, or blue row, under “Your Test Results”.

The orange, or third row, under “Study Results” has the results for the other people from the Detroit and Saginaw areas who were in the study. We gave you these test results so you can compare your results to theirs. The results are given as a range, meaning the lowest to the highest test results for the group, are shown in this row.

We also thought you might like to know the test results of people around the country who have been in similar studies. Their blood and urine were also tested for chemicals. Their results are in the purple, or fourth, row under “U.S. Results”.

The fourth page has a table called “Units”. It gives the units of measurement for each chemical. If you take your results to your doctor, he or she will need to know the units for each chemical your blood and urine were tested for.

If you have questions, please feel free call 1-800-648-6942 and ask for Sue Manente.

Thank you very much for being part of this important study, we really appreciate your time and effort.

Sincerely,

Linda Dykema, Manager

D

CAPITOL VIEW BUILDING  201 TOWNSEND STREET  LANSING, MICHIGAN 48913

www.michigan.gov  517-373-3740

ivision of Environmental Health

Test Results - Tests for the chemicals were done on blood or urine, except for mercury. Some chemicals are easier to find in blood and some are easier to find in urine. Mercury can be found in both blood and urine.

Blood Test Results

Test	Your Test Results	Study Results	U.S. Results
		Range	Range
Chlordane – Oxychlordane			11.4 – 39.2
Chlordane – Heptachlor epoxide			<LOD – 20.6
Chlordane - trans-Nonachlor			17.3 – 74.7
p,p'-Dichlorodiphenyltrichloro-ethane (DDT)			<LOD – 20.7
p,p'-Dichlorodiphenyldichloro-ethene (DDE)			233 – 1,990
o,p'-Dichlorodiphenyltrichloro-ethane (DDT)			<LOD - <LOD
Hexachlorobenzene			15.1 – 29.0
Lead			1.3 – 3.9
Lindane			< 0.002
Manganese			4.7-18.3
Mercury			0.89 – 5.32
Mirex			<LOD – 15.4
PBB-153 (Polybrominated Biphenyl number 153)			Age 18-39 years: 1.6 – 12.2 Age 40 -59 years: 2.9 – 36.9 Age 60 years and older: 3.4 – 52.8
Dioxins			Age 18-39 years: < 18.7 Age 40-59 years: < 32.0 Age 60 years and older: < 63.2
Total PCB (Polychlorinated Biphenyls)			TBD

Test	Your Results	Study Results	U.S. Results
		Range	Range
Arsenic			7.55 – 59.4
Cadmium			0.24 – 1.05
Mercury			0.50 – 2.56

Test	Your Test Results	U.S. Guidelines
Total Cholesterol		Less than 200 mg/dL is Desirable 200-239 mg/dL is Borderline High 240 mg/dL is High

Urine Test Results

Units of Measurement

This table gives the “units of measurement” for each of the chemicals.  For example, cholesterol is measured in mg/dL (milligrams of cholesterol per deciliter of blood).  If you give your results to your doctor, he or she will want to know these units of measure.

Blood Tests	Units of Measurement
Cholesterol	mg/dL
Chlordane	ng/g of lipid
DDT (Dichlorodiphenyltrichloroethane)	ng/g of lipid
Dioxins	pg-TEQ/g of lipid
Hexachlorobenzene	ng/g of lipid
Lead	μg/dL
Lindane	μg/mL
Manganese	ng/mL
Mercury	μg/L
Mirex	ng/g of lipid
PBB (Polybrominated Biphenyls)	ng/g of lipid
PCB (Polychlorinated Biphenyls	ng/g of lipid
Urine Tests	Units of Measurement
Arsenic	μg/g of creatinine
Cadmium	μg/g of creatinine
Mercury	μg/g of creatinine

Attachment 10a5.

Letter 5

Full results letter for participants with

exceedences of other chemicals

Date

Name

Address

City, State Zip Code

Dear:

Last summer, you agreed to be part of the Michigan Department of Community Health Fish Eaters Study. We tested your blood and urine for chemicals that are often found in fish.

If applicable, Your test result for (chemical) was higher than most people. This does not mean that you are sick or will get sick. We recommend that you call our office or talk to your doctor to find out how to limit future contact with this chemical.

The second and third pages of this letter have all of your test results. The first row gives the name of each chemical that we looked for in your blood and urine. Your test results are in the second, or blue row, under “Your Test Results”.

The orange, or third row, under “Study Results” has the results for the other people from the Detroit and Saginaw areas who were in the study. We gave you these test results so you can compare your results to theirs. The results are given as a range, meaning the lowest to the highest test results for the group, are shown in this row.

We also thought you might like to know the test results of people around the country who have been in similar studies. Their blood and urine were also tested for chemicals. Their results are in the purple, or fourth, row under “U.S. Results”.

The fourth page has a table called “Units”. It gives the units of measurement for each chemical. If you take your results to your doctor, he or she will need to know the units for each chemical your blood and urine were tested for.

If applicable, Earlier, we sent you a letter because your (arsenic/cadmium/lead/mercury) level was higher than most people. The letter recommended you make an appointment your doctor for medical advice. A copy of that letter is also included. If you have not seen your doctor yet, please make an appointment and take all of this information with you.

Thank you very much for being part of this important study, we really appreciate your time and effort.

If you have questions, please feel free call 1-800-648-6942 and ask for Sue Manente.

Sincerely,

Linda Dykema, Manager

D

CAPITOL VIEW BUILDING  201 TOWNSEND STREET  LANSING, MICHIGAN 48913

www.michigan.gov  517-373-3740

ivision of Environmental Health

Test Results - Tests for the chemicals were done on blood or urine, except for mercury. Some chemicals are easier to find in blood and some are easier to find in urine. Mercury can be found in both blood and urine.

Blood Test Results

Test	Your Test Results	Study Results	U.S. Results
		Range	Range
Chlordane – Oxychlordane			11.4 – 39.2
Chlordane – Heptachlor epoxide			<LOD – 20.6
Chlordane - trans-Nonachlor			17.3 – 74.7
p,p'-Dichlorodiphenyltrichloro-ethane (DDT)			<LOD – 20.7
p,p'-Dichlorodiphenyldichloro-ethene (DDE)			233 – 1,990
o,p'-Dichlorodiphenyltrichloro-ethane (DDT)			<LOD - <LOD
Hexachlorobenzene			15.1 – 29.0
Lead			1.3 – 3.9
Lindane			< 0.002
Manganese			4.7-18.3
Mercury			0.89 – 5.32
Mirex			<LOD – 15.4
PBB-153 (Polybrominated Biphenyl number 153)			Age 18-39 years: 1.6 – 12.2 Age 40 -59 years: 2.9 – 36.9 Age 60 years and older: 3.4 – 52.8
Dioxins			Age 18-39 years: < 18.7 Age 40-59 years: < 32.0 Age 60 years and older: < 63.2
Total PCB (Polychlorinated Biphenyls)			TBD

Test	Your Results	Study Results	U.S. Results
		Range	Range
Arsenic			7.55 – 59.4
Cadmium			0.24 – 1.05
Mercury			0.50 – 2.56

Test	Your Test Results	U.S. Guidelines
Total Cholesterol		Less than 200 mg/dL is Desirable 200-239 mg/dL is Borderline High 240 mg/dL is High

Urine Test Results

Units of Measurement

This table gives the “units of measurement” for each of the chemicals.  For example, cholesterol is measured in mg/dL (milligrams of cholesterol per deciliter of blood).  If you give your results to your doctor, he or she will want to know these units of measure.

Blood Tests	Units of Measurement
Cholesterol	mg/dL
Chlordane	ng/g of lipid
DDT (Dichlorodiphenyltrichloroethane)	ng/g of lipid
Dioxins	pg-TEQ/g of lipid
Hexachlorobenzene	ng/g of lipid
Lead	μg/dL
Lindane	μg/mL
Manganese	ng/mL
Mercury	μg/L
Mirex	ng/g of lipid
PBB (Polybrominated Biphenyls)	ng/g of lipid
PCB (Polychlorinated Biphenyls	ng/g of lipid
Urine Tests	Units of Measurement
Arsenic	μg/g of creatinine
Cadmium	μg/g of creatinine
Mercury	μg/g of creatinine

Attachment 10a6.

Blood Pressure Fact Sheet