1. Drinking Water Contaminants and Child Health in Woburn and Tom ’ s River EH757 October 11, 2011 Richard Clapp, D.Sc., MPH Professor Emeritus Boston University School of Public Health

2. Major Types of Water Pollution Microbiological –Ex: cholera, cryptosporidium, Giardia, Hepatitis A Heavy metals –Ex: lead, arsenic Radiation –Ex: radium, radon Chemicals –Ex: disinfection byproducts, solvents, fluoride, –pesticides

3. Drinking Water Pollution Improper treatment of surface water –Lack of filtration, inadequate filtration –Underchlorination, overchlorination Groundwater pollution –Geological deposits of radium, arsenic, uranium –Improper disposal of chemicals Faulty distribution system –Lead pipes and lead solder –Leaks and intrusion

4. Epidemiologic Studies Birth outcomes studies –Silicon Valley, CA (Swan, et al.) –Tucson, AZ (Goldberg, et al.) Cancer studies –Woburn, MA –Tom ’ s River, NJ

5. Woburn Citizens ’ Concerns Years of toxic waste dumping from leather tanneries, chemical plants Strong odors in East Woburn Water tasted bad periodically Apparent cluster of childhood leukemia in East Woburn neighborhood Local and State officials unresponsive

6. Citizen Action Created grassroots organization called FACE (For A Cleaner Environment) Called for health and environmental studies Demanded clean-up of contaminated properties Several families filed lawsuit (subject of book and movie, “A Civil Action”)

7. Results of 1981 Study Case-control study of 12 childhood leukemia cases diagnosed 1969-1979 No association with any particular exposure, family history, medical history Elevated Standardized Incidence Ratio SIR=2.3, p=.007 (see Cutler JJ, et al. Childhood Leukemia in Woburn, Massachusetts. Public Health Reports 101(2):201-205, 1986)

8. Woburn Childhood Leukemia Cases 1969-1979

9. Harvard/FACE Study Citizens and researchers conducted town- wide telephone survey Used Woburn water distribution model from Dept. of Env. Quality Engineering Estimated exposure to contaminated wells G & H was two-fold higher in childhood leukemia cases diagnosed 1964-1983 (see Lagakos SW, et al. J Am Stat Assoc 81:583-596, 1986)

11. Lagakos, et al. survey Volunteer interviewers (235), scripted telephone interviews, random batches Introductory text said purpose was to examine environmental influences on health –5,010 completed interviews (57% of residences) Analyzed 20 leukemia cases using Cox proportional hazards model Discussed biases, misclassification of exposure Criticized by Chair of Epidemiology

13. Lagakos, et al. additional results Eye/ear birth anomalies, and increased CNS/chromosomal/oral cleft anomalies associated with water from Wells G & H. –Authors referred to these as “ environmental ” birth defects Perinatal deaths since 1970 also associated Increased childhood lung/respiratory tract and kidney/urinary tract disorders associated

14. DPH Case-control Study Used more detailed water distribution model with estimates of G & H exposure by month Used same method as in 1981 study, but with more cases; estimated prenatal exposure Case-control study of childhood leukemia cases diagnosed 1969-1986

15. Wells G and H Water Distribution

17. Costas, et al. conclusions “ Consistently positive association between exposure and risk, a statistically significant dose-response relationship, and a decrease in risk after removal of the pathway of exposure. ” Major finding: association of “ fetal exposure(s) to contaminated water and childhood leukemia ”

18. Number of Cases of Childhood Leukemia Diagnosed by Year of Diagnosis in Woburn, MA Jan. 1, 1969 - Aug. 1, 1999 Contaminated Wells Closed

19. Groundwater Treatment Process

22. Tom ’ s River study Role of Ocean of Love support group –Recognition of cases, calls for investigation –Political support from Gov. Whitman, Sen. Lautenberg Preliminary studies by NJDHSS –Childhood cancer incidence –Decision to conduct case-control study of 22 children with leukemia and 18 with nervous system cancer Water contaminated with TCE, PCE, radium, Styrene-acrilonitrile trimer

23. Childhood cancer incidence Tom ’ s River 1979-1995 childhood cancer all sites SIR (24 cases) = 1.7 (95% CI 1.07- 2.49) –Females age 0-4 all sites SIR = 6.5 (95% CI 3.13-12.0) –Female age 0-4 brain cancer SIR = 11.3 (95% CI 2.27-33.0) –Female age 0-4 ALL SIR = 9.4 (95% CI 2.52- 24.0)

24. Case-control study methods Interviews inquired about family history, residential history, diet, medical history, etc. Included children born in Tom ’ s River but diagnosed when living elsewhere; controls met same criteria Detailed estimates of exposure to well water, other contamination sites –Attempted to estimate radiation from Oyster Creek nuclear power plant; unlikely very substantial

27. Tom ’ s River Main Results Parkway well field high prenatal exposure associated with leukemia in females (OR = 6.0; 95% CI 1.1-32) Ciba-Geigy high-medium air exposure associated with leukemia in females under age 5 (OR = 7.5; 95% CI 0.8-71) Other findings regarding brain cancer not highlighted (see vol. ii of final report)

28. Legal case Mediation between plaintiffs and defendants for 18 months –Compiled evidence and testimony that would be used in trial –Settlement agreed to just prior to NJDHSS results announced Sixty plaintiffs agreed not to sue in subsequent class actions