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HEALTH CONSULTATION

HEBBRONVILLE ARSENIC EXPOSURE INVESTIAGATION
HEBBRONVILLE, JIM HOGG COUNTY, TEXAS


SUMMARY AND STATEMENT OF ISSUES

This report provides results of the biological indicators of exposure investigation for arsenic in Hebbronville, Jim Hogg County, Texas. The Texas Department of Health (TDH) carried out this investigation with support from the Agency for Toxic Substances and Disease Registry (ATSDR). The purpose of this investigation, which was conducted from August 4, 2003 through August 8, 2003, was to assess current individual exposure to arsenic of people living in Hebbronville. Total inorganic urine arsenic levels were measured in 140 individuals (14 children and 126 adults). The people tested were residents of homes that received utility bills from the Jim Hogg Water Control and Improvement District (WCID) #2.

The primary objectives of this testing program were to:

  • Provide residents of Hebbronville with the opportunity to have an assessment of their current exposure to arsenic through confidential, independent laboratory testing of their urine.

  • If required, provide individuals with scientifically based advice on how to reduce their exposure.

  • Provide summary results (not linked to any one individual) to help with the broader efforts in the community to reduce potential health risks.

BACKGROUND

Site Description and History

Hebbronville, located in Jim Hogg County, Texas, has a population of 5,097 persons living in 1,654 households. Ninety-one percent of the people living in Hebbronville describe themselves as being of Hispanic origin [1]. Historically, the water system in Hebbronville (Jim Hogg County WCID#2) has reported arsenic in the public drinking water supply1. According to a 1989 TDH report, arsenic concentrations in the drinking water supply for WCID#2 ranged from less than 10 micrograms per liter (g/L) to 52 g/L between November 1979 and December 1988. Over this ten-year period, 21 water samples had an average arsenic concentration of 37 g/L [2, 3], a level below the current Maximum Contaminant Level (MCL) but higher than the new MCL that will take effect in 2006 [4].

Over the years, new water wells have been drilled to replace older wells (Table 1). From March 1995 to October 2001, the concentration of arsenic in water from Well #5 ranged from 47 g/L to 96 g/L, with an average concentration of 73 g/L (n=11) [5]. Well #5 has not been used since the fourth quarter of 2001. From March 1993 to February 2003, the concentration of arsenic in water from Well #6 ranged from 12 g/L to 22 g/L, with an average concentration of 16 g/L (n=9). From July 1995 to February 2003, arsenic concentrations in water from Well #7 ranged from 42 g/L to 66 g/L, with an average concentration of 55 g/L (n=5). Because some mixing of water from the wells can occur in the distribution system, at times the arsenic level in water being delivered to the residents has been below the MCL. On February 24, 2003, the concentration of arsenic in a distribution sample was 57 g/L; however, the water system has been attempting to make more use of the well with lower arsenic concentrations to reduce arsenic levels in the water [6]. During the week that the exposure investigation was being conducted, arsenic levels in the drinking water ranged from 43.7 to 52.1 g/L [7].

In January 2003, a resident of Hebbronville contacted the Texas Department of Health (TDH) to report concerns of high arsenic in the water. TDH personnel visited Hebbronville in February 2003 to meet with the WCID and other involved agencies. TDH and ATSDR have been working with the following agencies and groups to address community concerns:

  • Texas Commission on Environmental Quality
  • The Texas Department of Health Region 11 Harlingen
  • The Laredo City-Webb County Health Department
  • Jim Hogg WCID#2

Residents expressed concern over possible health effects from exposure to the arsenic in the water. In response to community concerns and with support from ATSDR, TDH conducted the exposure investigation to evaluate current exposure to arsenic through confidential laboratory testing of urine. From August 4, 2003 to August 8, 2003, urine samples were collected from 140 people (14 children and 126 adults) living in 99 households.


RATIONALE FOR AN EXPOSURE INVESTIGATION

Assessment of exposure is usually accomplished by looking at contaminant concentrations and pathways of exposure to construct exposure scenarios. These scenarios are used to calculate the amount of the contaminant that gets into the body. The resulting exposure estimates often are made with considerable scientific uncertainty. A more direct way to assess whether exposure is occurring is to measure directly the level of the substance of concern in tissues or body fluids. The purpose of this exposure investigation was to assess individual exposure to arsenic among people who live in Hebbronville, Texas and drink water from Jim Hogg WCID#2. Arsenic has been found in the public water supply system at levels near or slightly above the current MCL (50 g/L) and significantly above the MCL that will take effect in 2006 (10 g/L) [4]. Because ingested arsenic is primarily excreted from the body into the urine, generally within a few days following exposure [8], the TDH/ATSDR tested for arsenic in urine as an indicator of recent exposure.

Methods

Investigation Participants

TDH/ATSDR solicited participants to the exposure investigation by sending 1,368 letters to Hebbronville households that received a utility bill from the public water system. To assess exposure to arsenic, TDH/ATSDR tested urine from Hebbronville residents who responded that they used the tap water for drinking and/or cooking and with whom we were able to schedule an appointment. Urine samples were collected from 140 individuals (14 children and 126 adults)2 representing 7.4 percent3 of the households on the public water system.

The urine samples were analyzed for speciated arsenic (inorganic arsenic, dimethyl arsenic acid, and methylarsonic acid). In this health consultation, the term inorganic arsenic is used interchangeably with speciated arsenic to refer collectively to all inorganic forms of arsenic, including the metabolites dimethyl arsenic acid and methylarsonic acid. Conducting speciated analysis permitted differentiation of exposure to inorganic arsenic from exposure to less toxic forms of arsenic found in food such as fish and shellfish [8].

In addition to the urine analysis, a "Brief Arsenic Exposure Questionnaire" (Attachment A1) was reviewed with each participant at the time he/she came in to pick up the urine-sampling bottle and instructions. The questionnaire asked participants questions pertaining to 1) their source of tap water, 2) their primary drinking water source, and 3) other possible routes of exposure to arsenic (smoking, gardening, use of pesticides, and other sources).

Test Procedures

TDH/ATSDR staff distributed clean specimen containers and instructions to all participants. Participants were advised not to eat fish or shellfish for the three days before a first-morning void urine sample. In an attempt to collect urine at a time of high likelihood of exposure, samples were collected in August, one of the hottest months in Texas. During August, water use is high; because of the high water demand, more water is drawn from water well #7–a well that has higher levels of arsenic than the water from the only other available well, #6–than would be drawn in other months.

The urine samples were sent to the National Medical Services laboratory in Willow Grove, Pennsylvania. The samples were speciated for total inorganic arsenic, so that inorganic arsenic and its metabolites are separated from marine organic arsenic interferences. The inorganic arsenic was analyzed by use of an inductively coupled argon plasma instrument with a mass spectrometer as the detection system (ICP-MS). Urine creatinine also was analyzed. Test results were reported as micrograms of arsenic per liter of urine (g/L) and as micrograms of arsenic per gram of creatinine (g/g creatinine) [9]. The creatinine correction adjusts for differences in urine output and the state of hydration (the concentration or dilution of the subject's urine).

Results

Individual test results and an explanation of their meaning were provided to each of the participants in writing. A TDH physician and a toxicologist were available to discuss individual results by telephone. Recommendations for follow-up actions were made as appropriate. In accordance with state confidentiality law, individual test results were not made available to the general public.

Total inorganic arsenic levels for the 140 participants ranged from <2.5 micrograms per liter (g/L) to 340 g/L. The mean and median total inorganic arsenic levels were 26.0 g/L and 15.0 g/L, respectively. Creatinine-corrected concentrations ranged from <1.1 micrograms per gram (g/g) creatinine to 103 g/g creatinine, with mean and median concentrations of 19.8 g/g creatinine and 13.6 g/g creatinine, respectively. Both the non-creatinine-corrected and the creatinine-corrected inorganic arsenic concentrations for this population followed lognormal distributions (Figures 1 and 2). A summary of the urinary inorganic arsenic results can be found in Table 2.

Approximately 66 percent of the participants had urinary inorganic arsenic concentrations greater than 10 g/L (Figure 1)–the reference concentration for non-occupationally exposed individuals [10]. After correction for creatinine, approximately 64 percent of the participants had inorganic arsenic levels above the reference concentration (Figure 2). Thirteen of the 14 children who were tested had inorganic arsenic levels above 10 g/L. Ten of the children had corrected inorganic arsenic levels above 10 g/g creatinine.

Thirty-two participants (23%) had inorganic arsenic levels above 35 g/L–a Biological Exposure Index ® (BEI) established by the American Conference of Governmental Industrial Hygienists (ACGIH) as guidance for assessing exposure in occupational settings [11]. Twenty-two individuals (16%) had inorganic arsenic levels above 35 g/g creatinine.

Of the 140 people who were tested, 137 (97%) reported that the WCID water was the source of their tap water; the remaining 3 residents reported a private well as their source of tap water. One hundred and sixteen people (83%) reported using the WCID water as their primary source of drinking water, 59 people (42%) reported drinking bottled water, and 19 people (14%) reported using water from other sources. With respect to other possible routes of exposure to arsenic, 24 people (17%) reported that they smoked during the 3 days prior to the testing, 133 people (95%) reported that they cook with the tap water, 86 (61%) reported that they garden, 13 (9%) reported that they eat vegetables from their garden, 21 (15%) reported using pesticides, 5 (3%) reported eating Chinese food the 3 days prior to the urine test, 17 (12%) reported eating seafood the 3 days prior to the urine test, and 10 (7%) reported using chemically treated wood.

Ninety percent of the participants with urine inorganic arsenic levels above 10 g/g creatinine reported WCID as their primary source of water (Chi-square=8.5, p=0.0035). Ninety percent of the participants with urine inorganic arsenic levels above 10 g/g creatinine reported that they drank water from the faucet (Chi-square=11.3, p=0.0008). Seventy percent of the participants with urine inorganic arsenic levels above 10 g/g creatinine reported that they did not use bottled water as a source of drinking water (Chi-square= 14, p=0.0002). All other sources of exposure surveyed were not found to be associated with urine inorganic arsenic levels greater than 10 g/g creatinine.


DISCUSSION

Arsenic is a naturally occurring element in the earth's crust; it is usually found in combination with other elements. Arsenic compounds can be classified into three main groups: 1) inorganic arsenic compounds, 2) organic compounds, and 3) arsine gas. In the environment, arsenic is most often found as inorganic arsenic, which is formed when arsenic combines with other elements such as oxygen, sulfur, and chlorine. Organic forms of arsenic, which result when arsenic combines with carbon and hydrogen, generally are considered less toxic than the inorganic forms.

For the purpose of exposure evaluation, arsenic can be measured in blood, hair, fingernails, and urine. Measurement of arsenic in blood is not considered to be a reliable indicator of chronic exposure to low levels of arsenic because arsenic is cleared from the blood within a few hours. Because of large inter-individual variability and potential contamination from other sources, nail and hair samples also are not considered to be reliable indicators. Urine arsenic is considered to be the most reliable method for measuring exposure to arsenic–particularly exposures occurring within a few days of the specimen collection. Fluctuations in urine excretion rates make a 24-hour collection the optimal sample; however, the difficulties associated with collecting a 24-hour sample have resulted in the use of a first-morning void or a random spot sample in most exposure studies. First-morning void urine results have correlated well with 24-hour results [12].

Speciated urinary arsenic is preferable to total urinary arsenic as a measurement option because the speciated forms can distinguish between exposure to inorganic arsenic and the relatively nontoxic forms of organic arsenic commonly found in seafood and other foods [9, 12]. Individuals in this exposure investigation had their urine tested for speciated arsenic (inorganic arsenic, methylarsonic acid, and dimethyl arsenic acid).

Public Health Implications

Clear guidelines for interpreting urinary inorganic arsenic levels do not exist; however, the results do show that the urinary inorganic arsenic levels measured in this community were higher than those reported for other communities (Table 3; Figure 3) [13-20]. Approximately two-thirds of the participants had urinary inorganic arsenic levels above the level considered to be background for non-occupationally exposed individuals, and 16 percent of the participants had creatinine-corrected urinary arsenic levels above the level used in occupational settings to determine if excess exposure is occurring.

According to the Chi-square analyses, participants who indicated that they drink WCID water were more likely to have urinary inorganic arsenic levels greater than the reference value for non-exposed populations. Participants who indicated that they drink bottled water were more likely to have urinary inorganic arsenic levels less than the reference value for non-exposed populations. In Hebbronville, exposure to arsenic through other sources is possible. Ninety-one percent of the people living in Hebbronville describe themselves as being of Hispanic origin [1]. The Hispanic diet, which often includes beans and rice, may provide an additional source of exposure to arsenic. Beans and rice absorb water, and the manner in which they are cooked–an open pot with added water–could result in a significant uptake of arsenic. We estimated that cooking beans and rice with water containing arsenic at a concentration of 50 g/L could result in the consumption of 8-9 g of arsenic per serving of rice and 20-24 g of arsenic per serving of beans4.

While the tests used in this investigation represent exposure and not the likelihood for adverse health effects, published reports and the concentrations of arsenic commonly found in the water do not result in an expectation that the arsenic in the water poses an immediate public health hazard. Therefore, TDH/ATSDR have classified exposure to the levels of arsenic in this public water system as posing no apparent public health hazard. The greatest concern associated with long-term ingestion of low levels of arsenic is an increase in the long-term risk of various cancers. EPA classifies arsenic as a known human carcinogen on the basis of sufficient evidence from human exposure. An increase in lung cancer mortality has been observed in multiple human populations exposed primarily through inhalation. Also, increased mortality from multiple internal organ cancers (liver, kidney, lung, and bladder) and an increased incidence of non-malignant skin cancers were observed in populations consuming water high in inorganic arsenic [8].

The TDH Cancer Registry Division analyzed available cancer incidence and mortality data for Jim Hogg County. The analysis of incidence data from January 1, 1995-December 31, 1999 and mortality data from January 1, 1992-December 31, 2001 showed that incidence and mortality data for cancers of the lung and bronchus, prostate, kidney and renal pelvis, bladder, and liver and intrahepatic bile duct were within the ranges expected for the State of Texas as a whole [21].


CONCLUSIONS

According to the information collected during this investigation,

  1. The urinary inorganic arsenic levels measured in the exposure investigation participants were higher than those found in other non-occupationally exposed populations.

  2. Approximately one-fifth of the people tested had urinary inorganic arsenic levels higher than the Biological Exposure Index recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) for assessing occupational exposure to arsenic.

  3. Participants who indicated that they drank WCID water were more likely to have urinary inorganic arsenic levels greater than the reference value for non-occupationally exposed populations.

  4. While the tests used in this investigation represent exposure and not the likelihood of adverse health effects, on the basis of published reports and the concentrations of arsenic commonly found in the water, TDH/ATSDR would not expect the levels of arsenic in the water to pose an immediate public health hazard.

  5. The greatest concern associated with long-term ingestion of low levels of arsenic is an increase in the long-term risk for various cancers. A review of available cancer incidence and mortality data for Jim Hogg County did not find any differences between the observed and the expected rates of the cancer types of interest.

RECOMMENDATIONS

  1. Individuals with inorganic arsenic levels greater than 20 g/g of creatinine should be retested to confirm previous results.

  2. All the individuals should be encouraged to discuss their results with a personal health care provider. Exposure investigation participants or their health care providers may discuss their results with a TDH physician/toxicologist if they choose to do so.

  3. The relative contribution of other sources of exposure, particularly dietary contributions, should be explored, and recommendations to reduce these exposures should be provided.

  4. The WCID should continue its efforts to reduce the arsenic levels in the public water system.

PUBLIC HEALTH ACTION PLAN

Actions Completed

N/A

Actions Recommended

  1. Individuals with inorganic arsenic levels greater than 20 g/g of creatinine should be retested to confirm previous results.

  2. All the individuals should be encouraged to discuss their results with a personal health care provider; individuals or their health care providers can discuss the results with a TDH physician/toxicologist if they choose to do so.

  3. The relative contribution of other sources of exposure, particularly dietary contributions, should be explored, and recommendations to reduce these exposures should be provided.

  4. The WCID should continue its efforts to reduce the arsenic levels in the public water system.

Actions Planned

  1. TDH plans to offer retesting to individuals with urinary arsenic levels above 20 g/g creatinine.

  2. TDH plans to provide summary information, answer questions, and encourage concerned individuals to discuss their results and concerns with their personal health care providers (either through a community meeting or through other means).

  3. The public water system plans to increase water production capacity and to install an electrodialysis reversal (EDR) water treatment system to reduce arsenic concentrations in the water system.

AUTHORS, TECHNICAL ADVISORS, AND ORGANIZATIONS

Report Prepared by

Susan L. Prosperie, MS, RS
Nancy Ingram, BS
Tina Walker, EMT
Keller Thormahlen, MS
Shari Shanklin, MS
Richard Beauchamp, MD
John F. Villanacci, PhD, EMT
Environmental Epidemiology and Toxicology Division
Texas Department of Health


ATSDR Regional Representative
George Pettigrew, PE
Senior Regional Representative
ATSDR Region 6


Robert Knowles, MS, REHS
Environmental Health Scientist
Division of Health Assessment and Consultation
Superfund Site Assessment Branch
State Programs Section
ATSDR


REFERENCES

  1. U.S. Bureau of the Census, Database: C90STF3B. Summary Level: Zip Code 78361. 1990.

  2. Texas Department of Health. Inter-Office Memorandum from Judy Henry and Jean Brender, RN, PhD, Environmental Epidemiology Program, to Diane Simpson, PhD, MD, Chief, Bureau of Disease Control and Epidemiology. September 15, 1989.

  3. Agency for Toxic Substances and Disease Registry. Letter to Individual from Robert Williams, Director of the Division of Health Assessment and Consultation. July 7, 1998.

  4. Federal Register. Part VIII Environmental Protection Agency, 40 CFR Parts 9, 141, and 142 National Primary Drinking Water Regulations; Arsenic Clarifications to Compliance and New Source Contaminants Monitoring; Final Rule. Vol. 66, No. 14/ Monday, January 22, 2001 / Rules and Regulations.

  5. Texas Department of Health personal communication with Marie Knipfer, Texas Commission on Environmental Quality Public Drinking Water Section. Arsenic concentrations in Jim Hogg WCID#2. February 2003.

  6. Texas Commission on Environmental Quality. Email from Tony Bennett to Susan Prosperie (TDH) et al. Subject: Jim Hogg County WCID2-Hebbronville. March 11, 2003.

  7. ATSDR/TDH. Data sheets concerning metals levels in Hebbronville water distribution system. Samples collected August 6, 2003 by Karl Markiewicz (ATSDR).


  8. Agency for Toxic Substances and Disease Registry. Toxicological profile for arsenic (update). Atlanta: US Department of Health and Human Services; 2000 Sept.

  9. National Medical Services. Product services manual. Willow Grove, PA: National Medical Services; 2001.

  10. Lauwerys R., Hoet P. Industrial chemical exposure, guidelines for biological monitoring. Lewis Publishers. Second Edition, 1993.

  11. American Conference of Governmental Industrial Hygienists (ACGIH). Documentation of the threshold limit values and biological exposure indices, arsenic and soluble inorganic compounds. 7th Ed. ACGIH 2001.

  12. Kalman DA et al. The effect of variable environmental arsenic contamination on urinary concentrations of arsenic species. Environ Health Perspect 1990; 89:145-51.

  13. Nova Scotia Department of Health and the Cape Breton District Health Authority. Lead and arsenic biological testing program in residential areas near the coke ovens site. November 2001.

  14. Goss Gilroy Inc. (for Ontario Ministry of Health). Deloro Village environmental health risk study final report. December 1999.

  15. Goss Gilroy Inc. Survey of arsenic exposure in Wawa. January 2001.

  16. Nova Scotia Department of Health. Program to examine current exposure to lead and arsenic in the residents around the Coke Oven Site. June 2001.

  17. Vahter M, Lind B. Concentrations of arsenic in the urine of the general population of Sweden. Sci Total Environ 1986; 54:1-12.

  18. Ontario Ministry of the Environment. Deloro Village environmental health risk study summary report. July 1999.

  19. Polissar L, Lowry-Coble K, Kalman DA et al. Pathways of human exposure to arsenic in a community surrounding a copper smelter. Environ Res 1990; 53:29-47.

  20. Seifert B, Vecker K, Helm D, Krause C. et al. The German environmental survey. 1990/1992 (GerES II): reference concentrations of selected environmental pollutants in blood, urine, hair, house dust, drinking water and indoor air. J Expo Anal Environ Epidemiol 2000; 10:552-565.

  21. Texas Department of Health. Email from Brenda Mokry (TDH Cancer Registry Division) to Dr. Brian Smith (Director TDH Region 11). Jim Hogg County cancer cluster investigation 1992-2001 (Investigation #03029). February 27, 2003.

CERTIFICATION

This R & H Oil Company/Tropicana Energy Company Public Health Assessment was prepared by the Texas Department of Health under a cooperative agreement with the Agency for Toxic Substances and Disease Registry (ATSDR). It is in accordance with approved methodology and procedures existing at the time the health assessment was initiated.

Robert Knowles
Technical Project Officer, SPS, SSAB, DHAC, ATSDR


The Division of Health Assessment and Consultation, ATSDR, has reviewed this public health assessment and concurs with its findings.

Roberta Erlwein
Chief, State Programs Section, SSAB, DHAC, ATSDR


APPENDICES

APPENDIX A: FIGURES

Frequency Distribution of Observed Urinary Arsenic Levels (g/L) vs Idealized Lognormal Distribution
Figure 1. Frequency Distribution of Observed Urinary Arsenic Levels (g/L) vs Idealized Lognormal Distribution

Frequency Distribution of Observed Urinary Arsenic Levels (g/gcreatinine) vs Idealized Lognormal Distribution
Figure 2. Frequency Distribution of Observed Urinary Arsenic Levels (g/gcreatinine) vs Idealized Lognormal Distribution

Comparison between Urinary Arsenic Levels among Different Communities
Figure 3. Comparison between Urinary Arsenic Levels among Different Communities


APPENDIX B: TABLES

Click here to view Table 1 in PDF format (91KB, PDF)


Table 2.

Summary of Hebbronville Urinary Inorganic Arsenic Results for All Ages and for Children Ages 4 to 17
  N Mean GeometricMean Median Min Max %>10 %>35
All Ages g/L 140 26.0 14.6 15 <2.5 340.0 65.7 22.9
g/g-c 140 19.7 13.2 13.4 <1.1 103.8 63.6 15.7
Children 4 to 17 g/L 14 40.0 23.7 20.5 <8.3 110.0 92.9 21.4
g/g-c 14 18.2 13.4 13.6 <4.5 83.4 71.4 7.1

N = Number of individuals
g/L = micrograms arsenic per liter urine
g/g-c = micrograms inorganic arsenic per gram creatinine


Table 3.

Summary of Inorganic Arsenic Results for Different Populations [13]
  N Mean GeometricMean Median Min Max
Wawa, Canada g/L 184 5.62   4.37 0.28 25.22
Havelock, Canada g/L 53 4.57     3.0 19.99
Deloro, Canada g/L 121 4.36      3.0 23.44
Sydney, Nova Scotia g/L 372 6.40 4.11 4.49 0.75 71.16
Stockholm, Sweden g/L 49 12.4 9.1 7.9 2.3 53.4
Vasteras, Sweden g/L 50 9.7 7.9 7.4 1.7 40.3
Tacoma, WA (0.3 mi from smelter) g/L 649   19.4 11.4    
Bellingham, WA Control Community g/L 61   10.1 9.5    
German Environmental Survey g/L 4001 10.52 6.29 7.1   206

N = Number of individuals
g/L = micrograms arsenic per liter urine


ATTACHMENTS

Attachment A1-TDH Exposure Investigation Questionnaire

Click here to view Attachment 1 in PDF format (96KB, PDF)

Attachment A2-TDH Hebbronville consent form (English and Spanish versions)

Click here to view Attachment 2 in PDF format (35KB, PDF)


1 The source of the water is groundwater from water wells.
2 Prior to the collection of the urine specimen, each participant-or a parent or guardian of each child participant-was asked to sign an informed consent form. Sample copies of these forms are in Attachment A2.
3 102 households
4 TDH assumed that a resident cooked 1 cup of dried beans with a minimum of 6 cups of water and 1 cup of rice with 2-3 cups of water. A serving size is assumed to be approximately -2/3 cup of cooked rice and -1 cups of cooked beans.

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