Evaluating How Actions to Reduce Environmental Tobacco Smoke Exposure are Working

Secondhand smoke, also known as environmental tobacco smoke (ETS), is a known human carcinogen (causes cancer). Non-smokers, both children and adults, who are exposed to ETS are at increased risk for adverse health effects, including sudden infant death syndrome (SIDS), exacerbation of asthma, heart disease and lung cancer. The total cost of health conditions attributable to ETS exposures in Minnesota is about $229 million (1).

Freedom to Breathe legislation passed in Minnesota in 2007 banned smoking in almost all indoor public places and indoor work places, including bars and restaurants. In 2011 there were attempts to repeal this legislation for restaurants and bars.

To evaluate the impact of Minnesota's Freedom to Breathe legislation, data was needed to evaluate trends over time and assess the effectiveness of public health actions addressing ETS exposure. The Minnesota Environmental Public Health Tracking Program published new ETS data and measures on MDH’s data portal, Minnesota Public Health Data Access.

The data show a 20 percent decrease in exposure to ETS among children since implementing Freedom to Breathe legislation. The data also show a significant gap in ETS exposure between youth in the Twin Cities metro and non-metro youth which has widened from 5% in 2000 to over 14% in 2011. Non-metro youth continue to have a higher likelihood of ETS exposure (see Youth Exposed to ETS by Region).

Based on these data, it appears that Freedom to Breathe legislation has reduced ETS exposure for nonsmokers in Minnesota. However, a significant number of adults and youth are still exposed to ETS. Based on surveys conducted in 2010-2011, ETS exposure among Minnesota adults and youth is relatively common (e.g., 2010-11 surveys indicate that 37% of nonsmoking adults and 39% of youth in Minnesota report being exposed to ETS).

Tobacco prevention programs and other parters, including the American Lung Association of MN, American Cancer Society, and ClearWay Minnesota use data to evaluate the effectiveness of initiatives and programs. To view tracking data and learn more about ETS, see: Minnesota Public Health Data Access (Environmental Tobacco Smoke).

(1) Source: Waters HR, Foldes SS, Alesci NL, Samet J. The Economic Impact of Exposure to Secondhand Smoke in Minnesota. Am J Public Health. 2009; 99 (4): 754-759 (table 4). Adjusted to 2008 dollars.

Tracking the Impact of Minnesota’s Statewide Carbon Monoxide Alarm Law 

Each year, especially in winter, unintentional carbon monoxide (CO) poisonings result in several deaths and hospitalizations in Minnesota. In 2007-2009 Minnesota implemented a state law requiring CO alarms in all single family homes and multi-dwelling units. However, without a tracking system for CO poisonings, there was no means to evaluate the impact of the law on CO poisoning prevention in Minnesota.

The MN Environmental Public Health Tracking Program (MN EPHT) collaborated with the CDC National Tracking Network to develop data and measures for CO poisonings, including:

• hospitalizations
• emergency department visits
• deaths

These data are available through MDH’s data portal, Minnesota Public Health Data Access. In addition, MN EPHT, in partnership with the state Behavioral Risk Factor Surveillance System (BRFSS), initiated collection of data on the number of Minnesota homes that have CO alarms.

MN EPHT uses the CO tracking and BRFSS data to assess the effectiveness of the state CO alarm law. Tracking data also are used by Minnesota indoor air and healthy homes programs and the MN Department of Public Safety to target and evaluate outreach activities to prevent CO poisonings.The timing of the implementation of the CO alarm law and the establishment of data and measures for CO created the perfect environment in which tracking data may be used to evaluate trends and the impact of policy changes. To view tracking data and learn more about CO poisonings, see: Minnesota Public Health Data Access (CO Poisoning).

Evaluating Ways to Prevent Heat-Related Illnesses and Deaths During Extreme Heat Events

Heat significantly impacts public health in Minnesota. Each year hundreds of emergency department visits and hospitalizations occur due to heat-related illnesses. Nationally, over the last decade, heat claimed more lives on average than any other severe weather event. However, data to evaluate national and state efforts to prevent illnesses and deaths during extreme heat events has been difficult to find.

The MN Environmental Public Health Tracking Program (MN EPHT), along with the CDC National Tracking Network, has developed data and measures on heat-related illnesses and deaths. These data help to inform state and local strategies to prevent heat-related illnesses and deaths particularly in vulnerable populations; and to evaluate the effectiveness of local actions over time.

For instance, MN EPHT data showed that elderly and younger age groups (15-34 years of age) are more likely to visit the emergency department for heat-related illnesses. While the elderly are known to be at an increased risk from heat exposures, these new data helped identify 15-34 years old as an at risk age group. In addition, the data showed higher rates of hospitalizations and emergency department visits in greater Minnesota than the 7-county metro area. While the emphasis historically has been on urban areas (urban heat island effect); these data confirm that areas in greater Minnesota also experience public health impacts from extreme heat events.

These data, together with local maps of vulnerable populations developed at the state and local level, help health professionals and emergency preparedness officials target outreach and education to vulnerable populations.

The MDH Climate and Health Program and Office of Emergency Preparedness use the data to evaluate trends over time and to assess the effectiveness of outreach and planning efforts. To view tracking data on heat-related illnesses, see: Minnesota Public Health Data Access (Heat-related Illnesses).

Tracking Actions to Prevent and Treat Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, is the 5th leading cause of death in Minnesota. COPD is estimated to effect 24 million men and women in the US – but as many as half remain undiagnosed. Few states track COPD hospitalizations. And prior to 2011, no national-level surveillance data on COPD prevalence existed. Given the public health and economic impacts of COPD in the U.S., this was an important gap in information needed to inform public health actions and policy.

Starting in 2010 the MN Environmental Public Health Tracking Program (MN EPHT) developed and published state-specific data and measures for COPD hospitalizations on MDH’s data portal, Minnesota Public Health Data Access. MN EPHT developed these data using methods that are consistent with the CDC National Tracking Network, making them easily adaptable by other states and at the national level.

In addition, Minnesota was one of the first states in the country to measure COPD prevalence statewide using the Minnesota Behavioral Risk Factor Surveillance System. Together these data provide useful information to evaluate trends and spatial patterns over time, and to inform health professionals and the public about important risk factors and public health actions.

The American Lung Association in Minnesota is working with MN EPHT to use COPD data to inform and evaluate plans to prevent and treat COPD in Minnesota. This activity has started discussions with key partners regarding ways to raise awareness about this poorly recognized, costly, and underestimated public health issue, and resulted in additional media coverage of COPD in the state. In 2013, MN EPHT and the American Lung Association in Minnesota published a joint report, The Scope of COPD in Minnesota (PDF: 1.9 KB/4 pages).

In addition, MN EPHT is working with other states and the CDC to share surveillance methods and develop a national standard for defining COPD hospitalizations. To view tracking data and learn more about COPD, see: Minnesota Public Health Data Access (Chronic Obstructive Pulmonary Disease).

Measuring People's PFC Exposures to Evaluate Efforts to Reduce PFCs in Drinking Water

Environmental testing conducted by MDH and other state agencies discovered drinking water contamination from historical disposal of wastes containing perfluorochemicals (PFCs) in communities located east of Minneapolis-St. Paul (the “East Metro”). Measures to reduce exposures to PFCs in drinking water were implemented in 2006, including installation of carbon filtration systems in public and private water supplies and provision of alternative water sources for households using private wells.

As a result of community and policymakers’ concerns, MDH conducted a biomonitoring project in 2008 to measure PFCs in the blood of 196 East Metro residents exposed to contaminated drinking water. Findings showed that residents’ blood levels were higher than the national average. Biomonitoring data helped to inform citizens and policy-makers about PFC exposures in the East Metro.

Were actions in the East Metro to reduce drinking water exposure to PFCs successful?

MDH conducted a follow-up biomonitoring project in 2010-2011. PFC blood levels were measured in 164 participants from the earlier project. Results showed that blood levels of the three most commonly detected PFCs declined substantially (from 13-26% on average) since 2008. The findings showed that the public health actions were working.

MDH held public meetings with concerned citizens and helped to connect people in the study with a health care provider for consultation. Biomonitoring data helped to provide important reassurances to the community. State funding provided for sample collection and analysis, and federal (CDC) funding supported communication and outreach and development of PFC data on MDH’s data portal.

For more information, see the East Metro PFC Biomonitoring Follow-Up Project and PFC data available at Minnesota Public Health Data Access (PFCs).

Using Tracking Data to Inform Local Communities about Actions to Prevent Cancer

Cancer data are not only useful for evaluating strategies to prevent and treat cancer, but also to help communities concerned about possible cancer clusters. Each year in Minnesota citizens and communities raise questions about cancer and the environment through the media, environmental review processes, and other channels. City and county officials also need data to help answer their community's questions.

People want to know:

• Are cancer rates higher in my community compared to other areas?
• Could environmental contamination be causing excess cancer?
• What can our community do to prevent cancer?

In 2012 the Minnesota Environmental Public Health Tracking Program (MN EPHT), in partnership with the MN Cancer Surveillance System (MCSS), launched a series of new interactive maps, charts, and queries for state and county-level data on MDH’s data portal, Minnesota Public Health Data Access. At the same time, residents in Anoka County, Minnesota became concerned about cancer excesses and environmental contamination (Superfund sites; volatile organic chemicals in groundwater), and many turned to the portal’s cancer data.

Tracking data showed that the total number of cancers in Anoka County was about 4% higher than the state average, and lung cancer accounted for most of the cancer excess. Further analysis showed that smoking rates in Anoka County were much higher than in surrounding communities. The tracking data informed the local community and decision-makers about smoking and radon (leading causes of lung cancer), and educated citizens about actions to prevent cancer. MN EPHT and MCSS worked jointly to develop a fact sheet addressing local concerns (see Community Concerns about Cancer in Fridley and Anoka County).

MN EPHT is using the information gathered from this effort and relationships with partners (American Cancer Society, MN Cancer Alliance, MN Cancer Surveillance System) to enhance cancer data available on MN Public Health Data Access and to inform communities about actions to prevent cancer. MN EPHT also has developed tracking measures for other key risk factors for cancer, including obesity, smoking, and environmental tobacco smoke. To view tracking data on cancer, see Minnesota Public Health Data Access (Cancer).

Tracking Data to Prevent and Treat Developmental Disabilities (Autism)

About one in six children in the U.S. have one or more developmental disabilities or other developmental delays. National survey data shows the percentage of Minnesota children (<18 years old) with special health care needs increased from 12.4% in 2001 to 14.3% in 2009-2010. In Minnesota, there is no public health system that tracks autism or other developmental disabilities.

The Minnesota Environmental Public Health Tracking Program (MN EPHT) is partnering with staff in Community and Family Health and at the Minnesota Department of Human Services to evaluate available data sources for tracking developmental disabilities in Minnesota and to make this information accessible on MDH’s data portal, Minnesota Public Health Data Access.

Making data on developmental disabilities accessible through Minnesota Public Health Data Access can inform public health action and policy, and help evaluate the effectiveness of initiatives over time. These data also may be used to:

• Promote research about chemicals and other harmful substances that are known to affect children's developing nervous systems
• Help families to prevent harmful exposures, and
• Evaluate services and costs associated with caring for children with special health care needs

For more information about the development of tracking data for developmental disabilities, contact EPHT.

Informing Efforts to Prevent Chronic Diseases and Achieve National Public Health Accreditation

The costs of treating and managing chronic diseases and conditions, such as cancer, asthma, and heart disease, are high. Nationwide, 75% of the $2.6 trillion spent for health care goes for chronic disease treatment. Minnesota’s costs are estimated to be about $5 billion per year.

Local health departments in Minnesota conduct periodic community health assessments to help guide programs and initiatives to reduce the prevalence and impact of chronic diseases and conditions, such as asthma, cancer, and obesity, and promote healthy behaviors at the community level. Local health and environment data are often difficult to access, despite the fact that they are important to track and measure progress with assessments over time.

To improve access to local health and environment data, the Minnesota Environmental Public Health Tracking Program (MN EPHT) developed data on over 17 health and environment topics. Local health departments across the state are using these data to identify priorities and measure effectiveness of programs and initiatives. The data include interactive maps and charts and custom queries for county and state data for many chronic diseases and their risk factors.

Local health departments in Minnesota also are using these data to meet national standards for public health accreditation (see Public Health Accreditation Board (PHAB)). Accreditation through PHAB is voluntary, however, many local health departments and MDH see it as an important step to improve public health services, and will likely be a factor considered in grants and federal funding proposals. For more information, see Minnesota Public Health Data Access and Minnesota Local Health Assessment and Planning.

Melanoma Tracking Raises Awareness of Rising Rates

Melanoma is the most dangerous form of skin cancer and one of the most rapidly increasing cancers among Minnesotans. The incidence of melanoma in Minnesota has doubled since 1988 for both males and females, with a notable increase among young women (20-49 years of age) over the last 15 years.

These increases are likely the result of exposure to ultraviolet (UV) light, both natural (sunlight) and artificial (tanning beds), and better medical detection. The Centers for Disease Control and Prevention (CDC) estimate that exposure to UV light causes 65-90% of all melanoma. Use of tanning beds continues to be common in Minnesota.

These circumstances provided a unique opportunity to use tracking data to inform outreach and policy to prevent melanoma and stop this alarming trend. The MN Environmental Public Health Tracking Program (MN EPHT) published interactive maps and charts showing trends and geographic patterns of melanoma (see: Minnesota Public Health Data Access, Melanoma: Basic Facts and Figures).

MN EPHT collaborated with state programs and other partners, including the American Cancer Society in Minnesota and the MN Cancer Alliance, to use tracking data to support program and policy initiatives to prevent melanoma. These partners identified reducing the use of artificial UV light for tanning as a key objective in Cancer Plan Minnesota: 2011-2016. Tracking data are helping to raise awareness about this important public health issue and to evaluate the effectiveness of program and policy initiatives over time.

MN EPHT also worked with partners to integrate state and county-level melanoma data into the MN County Health Tables, a combined set of indicator profiles used by state and county health professionals. Incorporating melanoma data into these tables enables state and local health professionals to use melanoma data to inform their planning and assessment activities.

Lastly, MN EPHT worked with our partners to issue a press release, entitled Melanoma rates on the rise in Minnesota, which led to statewide coverage on radio and television networks in the state. This press release highlighted the importance of reducing exposure both to natural UV light and tanning beds and included a link to the melanoma data and maps available at MN Public Health Data Access. The press release was a joint effort of three federally funded programs (MN EPHT, American Cancer Society of MN, and MN Cancer Alliance), providing a good example of how state programs can leverage funding and work together to address an important public health issue.

MN EPHT continues to work with partners to identify opportunities for using data to support outreach and education initiatives on melanoma. We also are working with the MN Cancer Surveillance System to develop and evaluate additional tracking data and measures that inform cancer prevention initiatives (such as data on colon cancer, radon, and smoking).

Using Tracking Data and Maps to Inform a Minneapolis Community about Health and the Environment

Some Minnesota communities are faced with multiple health and environmental inequities like high rates of asthma, lack of health care access, poverty, high density traffic and air pollution, and aging or deteriorating housing. However, it’s often difficult for citizens and local officials to evaluate priorities and the progress of public health initiatives over time, since neighborhood-level public health data is hard to get. This information is often not easily accessible to the public, or unavailable for geographies smaller than the county level such as zip code or census tract.

Recently, the Minnesota Environmental Public Health Tracking (MN EPHT) Program collaborated with the Minnehaha-Hiawatha Corridor Environmental Collaboration in Minneapolis (Hiawatha CARE project) which aims to identify priorities for public health, safety, and environmental issues affecting the Minnehaha-Hiawatha corridor in south Minneapolis. This project was done with funding from the US Environmental Protection Agency, in conjunction with Hennepin County.

MN EPHT was able to provide community-level data for asthma hospitalizations and childhood lead poisoning, allowing the Hiawatha CARE project to see how these environmental public health issues affected their community. Viewing this information by census block group level and zip code level revealed that asthma hospitalization rates in two of the zip codes were higher than the rate for Hennepin County and the statewide average. It also showed that almost all children in the Hiawatha CARE project area born between 2006 and 2008 had their blood lead levels tested before 3 years of age, and about 1% of children tested had an elevated blood lead level. MN EPHT staff developed a fact sheet (PDF - 618KB) to inform the community of its childhood lead poisoning status, including maps at the census block group level for two key blood lead measures: the percent of children tested and the percent of children with elevated levels).

Using this type of information, the Hiawatha CARE project staff worked with community residents to select five areas that posed the greatest risk and concern to the community: air pollution and vehicle emissions, asthma, economic instability, nutrition and obesity, and water quality. With these priority areas, the group will develop a plan to use existing resources and propose new projects to improve these five areas. A future grant application, informed by MN EPHT data, will be pursued to fund these proposed projects. MN EPHT will continue working with Hiawatha CARE Project partners to identify any additional local data needs and provide consultation and interpretation of data to inform the project’s action plan and grant application.

For more information, contact MN EPHT.