Health Effects Monitoring Program

Regions: North Slave Region

Tags: contaminants, health, arsenic, monitoring, remediation, Giant Mine

Principal Investigator: Chan, Laurie H. M. (8)
Licence Number: 16151
Organization: University of Ottawa
Licensed Year(s): 2019 2018 2017
Issued: Jul 25, 2017
Project Team: Renata Rosol (Project Coordinator, University of Ottawa), Janet Cheung (MSc/PhD Student , University of Ottawa), Claudia Tanamal (MSc STudent, University of Ottawa)

Objective(s): To assess the exposure and health impact of arsenic and other contaminants on the human population of Yellowknife, Ndilo and Dettah in the Northwest Territories.

Project Description: The Health Effects Monitoring Program is a human biomonitoring study aimed to assess the exposure and health impact of arsenic and other contaminants on the human population of Yellowknife, Ndilo and Dettah in the Northwest Territories, as part of the Giant Mine Remediation Project.

The overall objective of the program is to establish current or baseline levels of arsenic exposure among residents in Ndilo, Dettah and Yellowknife before remediation work begins. Then, during remediation, new monitoring results will be compared to the baseline to ensure participant’s arsenic levels are not increasing because of work being done at Giant Mine.

Participants will range from 6 to 79 years of age for the Yellowknife general population as well as include elders older than 79 years of age from the Yellowknives Dene First Nations and Métis communities. Data collection will be conducted over two years with the first 1000 participants starting in September 2017, and continue with a second wave of participants the following year. Then, in 5 years (2022/2023), participants ages 6 to 18 will be invited to participate in a follow-up study, and in 10 years (2027/2028) a follow-up study for all participants, including adults will be planned.

The study will use three different sampling strategies to recruit the following three population groups: the general Yellowknife (YK) population, the Yellowknives Dene First Nations (YKDFN) and the North Slave Métis Alliance (NSMA).

1) General YK population: A total sample size of 1500 Yellowknife residents will be recruited through random selection using City of Yellowknife address list where participants are selected proportionally from 10 different districts. The sampling strategy was developed with the assistance from Statistics Canada to ensure a representative sample size. One adult (19+) and one child (6-18) from each selected address will be randomly selected based on whose birth date is next. The first 750 participants will be sampled in the fall 2017, and another 750 participants will be sampled in the fall 2018.

If a Yellowknife resident approaches the research team asking to participate in the study, that individual will be allowed to participate. However, results of these volunteer participants will not be included in the sample population of the Yellowknife residents as they are not randomly sampled and therefore can introduce sampling bias.

Letters of recruitment will be sent to selected participants either by mail or dropped off in person. Participants will then be contacted by research assistants to get consent, and to arrange an appointment for an on-site home interview and biological sample collection.

YKDFN: mixed approach sampling will be adopted as suggested by the YKDFN leadership. Participation will be extended to all YKDFN members from ages 6 and above including elders. Volunteer participants will be checked off from a list of households within the YKDFN. If a certain demographic is lacking, in order to reflect a representative sample, that demographic will be contacted and invited to participate. It is expected to recruit a total of 300-400 YKDFN members over two years, beginning with 150 to 200 members to be sampled in the fall 2017. Community meetings will be held to reach out to YKDFN members asking them whether they would like to participate. Appointments will then be set up with the nurse practitioner at the participant’s home or at a designated location, whichever will be most convenient.

NSMA: Samples will be collected from a group of volunteer participants ages 6 and above including elders, as recommended by the North Slave Métis Alliance leadership. It is expected to recruit a total of 50-100 Métis over two years, beginning with 25-50 members to be sampled in the fall 2017. Community meetings will be held to reach out to NSMA members, and then appointments set up with a research assistant at the participant’s home or at a designated location, whichever will be most convenient.

Participants from the Yellowknife general population who self-identify as either a member of YKDFN or NSMA will be separated from the general population pool and included in the YKDFN and NSMA pool accordingly.

If a participant self-identifies as a First Nation from a band other than Ndilo or Dettah, that participant will be included with the general Yellowknife population.

All participants, who provide consent, will be asked to complete a Lifestyle Questionnaire. The lifestyle questionnaire contains two components: general information and exposure history (e.g. lifestyle, diet, water source, occupational history). Participants will also be asked to complete a 10-minute Food Frequency questionnaire on a variety of wild fish consumed and the sources. Information of serving sizes will be collected using food models.

Urine, toenail and saliva samples
Research assistants will provide participants with a kit to collect toenail clippings, urine (taken first thing in the morning), and saliva samples (taken with a buccal swab inside a person’s cheek). Instructions will be provided to arrange for pick up at the participant’s home or drop off at the Institute for Circumpolar Health Research in Yellowknife.

Saliva samples taken with buccal swabs will be sent to Génome Québec in Montreal for sequencing of selected polymorphisms and genes related to arsenic. The buccal swab will be used to test whether an individual has or does not have 20 specific genes that can help them to get rid of arsenic in their body more easily.

Review of medical records (general Yellowknife population and NSMA only)
A part-time Medicare researcher will access medical records for the past 5 years of those individuals who gave consent, from the Yellowknife resident population and NSMA members. Medical record data will only be used to investigate possible associations between contaminant exposure and specific health outcomes at the population level. No medical files will be removed from the office. The researcher will go over the files and compile information into a database.

Brief medical examination of (YKDFN only)
Based on the recommendation from YKDFN leadership, YKDFN members will not have their medical records reviewed. YKDFN participants, who provide consent to have a medical examination, will be given an appointment to visit a nurse practitioner, assisting specifically for the monitoring program. The nurse will conduct a short medical examination which will include weighing (using a scale), measuring height (using a measuring tape), and taking blood pressure (with a cuff), as well as complete a medical history questionnaire.

Residents of Yellowknife, Ndilo and Dettah had, and will continue to have opportunities to attend community meetings to learn about the upcoming Health Effects Monitoring Program aimed to assess current levels of arsenic in people’s bodies. Initial community meetings were held on April 26 and 27, 2017. The Principal Investigator, Dr. Laurie Chan, gave a presentation to the Yellowknives Dene First Nation, North Slave Métis Alliance and the general Yellowknife population followed by a question and answer period during which individuals had the opportunity to ask questions, raise their concerns, and provide feedback on the study protocols.

Program brochure has also been created and distributed at various events, providing residents with additional information on how they can contact the research team, such as email and website, to ask questions, ask to participate in the program, and/or find out more details.

Research Assistants (up to 6): will receive training, and then conduct interviews and collect samples of toenail clippings, urine and saliva (taken with a buccal swab on the inside of a person’s cheek).

Participants who agree to participate in the study will first receive their personal results in a letter addressed directly to them with an explanation of their result. For children age 6 to 12, their results will be addressed to their parents/guardians. For children age 13 to 18, their results will be addressed directly to them.

In addition, the overall results from all the participants, once complete, will be compared to the data of the Canadian populations from the Canadian Health Measures Survey, and final results presented in a report that will be shared publicly.

Any public messages will be devised, with approval from the Government of Northwest Territories Health Authority, to ensure the public is made aware of any pertinent findings. Various media outlets will be used including radio, newspapers, newsletters, website, Facebook, and television to share overall findings with the affected communities.

The fieldwork for this study will be conducted from September 5, 2017 to December 15, 2017.