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  • br Mounting evidence of the health


    Mounting evidence of the health impacts of Libby asbestos in ex-posed communities such as Libby, Montana and Northeast Minneapolis, MN, makes a case for active intervention by public health practitioners to educate the public and promote safe removal of vermiculite attic insulation by asbestos abatement contractors in all communities.
    5. Conclusions
    Our analysis provides further evidence that low-dose Protease Inhibitor Cocktail exposure to Libby amphibole asbestos from a neighborhood vermiculite processing plant is associated with increased asbestos-related disease and mortality. Even when accounting for possible occupational asbestos exposure, we observed significant excess mesothelioma and lung cancer deaths in females. Lung cancer incidence was significantly elevated in both genders, even after adjusting for an overall cancer deficit, and deaths from all respiratory cancers combined were elevated in both genders.
    Given that mesothelioma rates are not declining in women, future research should continue to focus on the effects of low-level, non-oc-cupational sources of asbestos exposure. This includes investigating the  Environmental Research 175 (2019) 449–456
    possible health impacts and prevalence of ongoing residential exposure to vermiculite attic insulation. It is essential to consider the impact of smoking by examining interactions of smoking and asbestos exposure. In this Minneapolis community cohort, continued clinical follow-up and surveillance are warranted to assess latent respiratory disease.
    Author contribution
    Tess Konen: Completed formal analysis, data management, project administrator and coordinator. Developed the original manuscript draft and completed editing.
    Jean Johnson: Contributed to conceptualization and methodology. Provided the funding support through CDC grant. Supervised and oversaw analysis work. Contributed to the original draft writing and reviewed and edited.
    Paula Lindgren: Contributed to formal analysis through statistician consultation and cancer subject matter expert. Part of team in metho-dology development. Reviewed and edited the manuscript. Allan Williams: Contributed to conceptualization and metho-dology. Contributed to formal analysis for proportional incidence ratios analysis. Reviewed and edited manuscript.
    We the authors gratefully acknowledge the community of Northeast Minneapolis, Tannie Eshenaur, Jim Kelly, Dr. Rita Messing, Dr. Greg Pratt, and numerous staff at the Minnesota Department of Health who contributed to establishing the Northeast Minneapolis Community Vermiculite Investigation cohort and exposure analyses. We also thank Dr. Bruce Alexander for his helpful advice and encouragement throughout this study.
    Adgate, J.L., et al., 2011. Modeling community asbestos exposure near a vermiculite processing facility: impact of human activities on cumulative exposure. J. Expo. Sci. Environ. Epidemiol. 21, 529–535.
    Alexander, B.H., et al., 2012. Radiographic evidence of nonoccupational asbestos ex-posure from processing libby vermiculite in minneapolis, Minnesota. Environ. Health Perspect. 120, 44–49. Amandus, H.E., et al., 1987. The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part III. Radiographic findings. Am. J. Ind. Med. 11, 27–37.
    Amandus, H.E., Wheeler, R., 1987. The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Protease Inhibitor Cocktail Part II. Mortality. Am. J. Ind. Med. 11, 15–26. Anderson, B.A., et al., 2005. Exposure pathway evaluations for sites that processed as-bestos-contaminated vermiculite. Int. J. Hyg Environ. Health 208, 55–65.
    Antao, V.C., et al., 2012. Libby vermiculite exposure and risk of developing asbestos-related lung and pleural diseases. Curr. Opin. Pulm. Med. 18, 161–167. ATSDR, 2001. Toxicological Profile of Asbestos. Agency for Toxic Substances and Disease Registry, Atlanta, GA:U.S.