Questions and Answers

1. What is ATSDR?

ATSDR is a federal public health agency. Our full name is the Agency for Toxic Substances and Disease Registry.

Our mission is to take responsive public health actions to promote healthy and safe environments and to prevent harmful exposures. We work with communities, environmental groups, and local, state and other federal agencies to protect public health.

2. What is ADHS?

ADHS is the state of Arizona’s health department. ADHS stands for Arizona Department of Health Services. The mission of ADHS is to promote, protect, and improve the health and wellness of individuals and communities in Arizona.

3. What is ATSDR doing in Hayden and Winkelman in 2017?

ATSDR is offering a urine arsenic retest to urine arsenic participants from the 2015 exposure investigation.

4. Why an arsenic retest?

We are offering a urine arsenic retest during a time when the smelter is operating normally to see what level of arsenic is in participants’ bodies typically. Less-than-typical levels of arsenic were in the air before and during the 2015 testing because the smelter was shut down for maintenance. Participants may have breathed in less arsenic than they typically do, reducing the amount of arsenic in their urine.

5. What did ATSDR and ADHS do in Hayden and Winkelman in 2015?

In 2015 ATSDR offered free, voluntary lead and arsenic testing for people who live in Hayden and Winkelman. Lead testing is done with a blood sample and arsenic testing is done with a urine sample. ADHS helped ATSDR do this work. See Question 3 for information about why ATSDR and ADHS did this work in Hayden and Winkelman.

6. Who was eligible for lead and arsenic testing in 2015?

When we began the recruitment period in March 2015, children living in Hayden or Winkelman between the ages 9 months to 11 years were eligible for lead testing. Children living in Hayden or Winkelman between the ages of 6 years to 11 years were eligible for arsenic testing.

Pregnant women of any age living in Hayden and Winkelman were also eligible to participate in both lead and arsenic testing.

Later in the recruitment period, ATSDR expanded the eligibility criteria to also include

• Children aged 12 – 17 years living in Hayden and Winkelman
• Women of childbearing age (up to age 44) living in Hayden and Winkelman

We did not offer arsenic testing to children ages 9 months to 5 years because it is difficult to collect urine samples from young children – especially those wearing diapers – and we cannot interpret the testing results because national comparison values do not exist.

7. How was the testing done?

Blood lead testing is done by taking about a tablespoon of blood from a vein in the arm, hand, or wrist into a plastic tube. The tube is labeled with a unique identification number. Names are NOT put on the tubes. The tube is sent to a laboratory at the Centers for Disease Control and Prevention and the laboratory measures the amount of lead in the blood.

Urine arsenic testing is done by collecting about ¼ cup of urine in a special cup. The cup is labeled with a unique identification number. Names are NOT put on the collection cups. The cup is sent to a laboratory and the laboratory measures the amount of arsenic in the urine.

The laboratory provided the results to ATSDR and wrote a letter to participants that includes their results. If you have questions about the results, you can call ATSDR at 1-888-320-5291 or the Arizona Department of Health Services at (602) 364-3128. You can also take your results letter to your doctor or your child’s doctor for consultation or follow up.

The blood and urine will not be tested for any other chemical and will be destroyed by the laboratory once the investigation is completed and the final report is issued.

8. How will my privacy or the privacy of my child be protected?

ATSDR will keep participant names and contact information confidential. We will use unique identification number on your blood tube and urine cup, not your or your child’s name. Dr. Tierney, ATSDR’s lead investigator for the planned Hayden/Winkleman Exposure Investigation, will have a list that links names to unique identification numbers. The laboratory will give Dr. Tierney a list of the test results by unique identification number. The list will be checked against results from the laboratory using a unique identification number. Every participant will receive an individual and confidential letter with his or her specific results. Other employees of ATSDR or ADHS who work on the exposure investigation team may also review the letter or contact you to discuss the results with you.

9. How could my results or the results of my child be shared?

The state of Arizona requires that results of blood lead testing be reported to the Arizona Department of Health Services.

During the informed consent paperwork process, participants or the parent or guardian of a participant may choose whether their results are shared with other governmental organizations, like the Environmental Protection Agency.

10. What are the benefits to me or my child of having the tests done?

• Parents will
  • Know the amount of lead in their child’s blood at the time of the test.
  • Know the amount of arsenic in their child’s urine at the time of the test.
  • Know if their child has more lead or arsenic in their body than most other children.
  • Have information to share with their child’s doctor for consultation and follow up.
  • Have information to help identify and remove sources of lead or arsenic in their child’s daily life.
• Pregnant women will
  • Know the amount of lead in their blood at the time of the test.
  • Know the amount of arsenic in their urine at the time of the test.
  • Know if they have lead or arsenic in their body at levels that could harm their developing baby.
  • Have information to share with their doctor for consultation and follow up.
  • Have information to help them identify and remove sources of lead or arsenic in their lives.

11. What are the risks to me or my child of having the tests done?

• Participants will feel a sting or pinch in their arm when the blood is drawn.
• Participants may feel frightened or emotional when the blood is drawn.
• After the blood draw, participants may feel throbbing at the place where the needle entered.
• Participants may have some bruising on their arm where the blood is drawn.
• Parents and participants may feel anxious or emotional when they receive the results of their test.

12. Why offer testing here in Hayden and Winkelman?

In 2013, based on requests from community members, EPA asked ATSDR to offer biological testing for residents of Hayden and Winkelman.

Nearly 100 years of smelting and processing activities, as well as ongoing operations, have deposited lead, arsenic, and copper across residential and industrial areas in Hayden and Winkelman.

Despite the 1,000-foot-tall stack installed to try to move contaminated air into the upper atmosphere and away from the communities, air quality monitoring in the two towns has measured elevated levels of arsenic, lead, copper, cadmium and chromium from site operations. In 2014, EPA designated the Hayden, Arizona, area as not meeting the 2008 Lead National Ambient Air Quality Standards, the national standards set by EPA for protecting human health. In 2015, ASARCO entered into an agreement with EPA to install new equipment and pollution control technology to reduce emissions of toxic heavy metals.

Residents live near the industrial areas and can come into contact with contaminated areas. Therefore, residents may be exposed to contaminants in soil and mine tailings.

Many of the homes in Hayden and Winkelman were built before 1960 and likely contain lead-based paint.

13. Why test for lead and arsenic (and not other metals)?

ATSDR has established methods for testing for lead and arsenic and interpreting the results. While there is always more to learn, we know a good deal about the potential health effects of lead and arsenic exposure.

Cadmium, copper, chromium, and other metals are also present in the air and soil. ATSDR does not have established methods to test for and interpret results for copper and chromium. Cadmium and arsenic exposures both present cancer risks. While cadmium is present in Hayden’s air, EPA data suggest that it presents less of a health risk than arsenic.

14. What are the health effects of lead?

Lead exposure can cause learning and behavior problems in children. Potential health effects can include speech and language delay; problems with paying attention; decreased IQ; and anemia (fewer red blood cells than normal). Some of the effects of lead may never go away.

15. What are the health effects of arsenic?

Potential health effects from inorganic arsenic exposure can include nausea and vomiting, abnormal heart rhythm, damage to blood vessels, a sensation of “pins and needles” in the hands and feet, or anemia (fewer red blood cells than normal).

Exposure to low levels of inorganic arsenic for a long time can cause darkening of the skin and the appearance of small “corns” or “warts” on the palms of the hand, soles of the feet, and upper body. Inorganic arsenic exposure over many years may also increase the risk of cancer of the skin, bladder, lung, and liver.

16. Why test only children and pregnant women?

When we began the recruitment period we offered testing to children and pregnant women because they are most at risk. Children have a high risk for exposure to contaminants in the soil because they play in areas where soil, dust, and paint may be found and then put toys and hands in their mouths. Young children and developing fetuses are more sensitive to the health effects of lead exposure because their bodies are still developing.

We did not offer arsenic testing to children ages 9 months to 5 years because it is difficult to collect urine samples from young children – especially those wearing diapers – and we cannot interpret the testing results because national comparison values do not exist.

During the course of recruitment we learned that parents also wanted testing for children ages 12 – 17 living in Hayden and Winkelman. Children ages 12 – 17 are not as likely to be exposed to lead and arsenic from soil because they play differently than younger children do. However, because they are still growing and developing they have more susceptibility to health effects of lead and arsenic than adults. Because of parental interest and because we had resources available to offer appointment slots, we expanded the eligibility to include children ages 12 – 17 before the testing appointments began.

During the recruitment period we also expanded eligibility to include women of childbearing age (up to age 44) who live in Hayden and Winkelman. We expanded to this group because we had resources available to offer appointment slots and because if a woman is pregnant, the developing baby is sensitive to lead and arsenic in the mother’s body.

17. Does ASARCO know you are doing this?

Yes, ATSDR staff have provided information about their work to ASARCO since 2014 and continue to do so.

18. Will your work hurt the smelter?

We recognize that there is a long history of copper production in this area and that the smelter is an important part of the local economy. ATSDR’s goal is to help protect the health of the community by learning more about possible exposures.