Oral

Consumption of drinking water with high levels of inorganic arsenic (over 1000 ppb or µg/l), such as found in southwestern Taiwan, results in increased risk of coronary heart disease , vascular diseases, skin lesions, and various forms of cancer. This area has been the site of numerous studies since the 1960’s. More recent studies from other areas throughout the world including India, Bangladesh, Turkey, Mexico, and the United States have examined effects of lower levels of exposure (e.g., 100 – 250 ppb), and some of these studies also provide data on levels of < 50 ppb. Arsenic concentrations in drinking water at levels of 10 – 50 ppb are common in the United States, particularly in mountainous areas. Over 3 million people in the United States are exposed to arsenic in drinking water. How best to protect the public from potential hazards of low-level, chronic arsenic exposure is a current issue for public health practitioners and drinking water providers. The range of health effects examined in the studies in areas with low to moderate levels of exposure is very broad, including skin lesions, indicators of coronary artery disease, blood pressure, diabetes incidence, and cancer-related mortality. Three investigators involved in studies of long-term exposure will discuss the spectrum of arsenic-related health effects examined in these studies, focusing on associations at relatively low drinking water arsenic levels. The studies have also evaluated demographic and genetic markers of susceptibility, and have used various measures of exposure including indices of cumulative exposure, biomarkers and spatial and temporal modeling. The speakers will discuss their results in relation to the emerging literature pertaining to health effects at arsenic exposure levels < 50 ppb, gaps and unanswered questions pertaining to these effects, public health impacts and potential mitigation strategies for different exposure situations.

Session Objectives: 1. Describe the history of awareness of arsenic in drinking water as a public health problem, exposure levels and current status of regulation and control efforts in the United States and other areas throughout the world. 2. Describe recent health studies in a variety of countries examining low- to moderate levels of exposure to arsenic, become familiar with the types of health effects examined in these studies, and understand strengths and limitations of these studies. 3. Discuss implications of recent studies for future efforts to protect public health in the United States.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH)