Oak Ridge Reservation
Environmental Health Archives
Current as of 10FEB99
Compiled by
Captain John R. Stockwell, M.D., M.P.H.
U.S. Public Health Service
Compendium of Public Health Activities at the U.S.
Department of Energy Oak Ridge Reservation
c. 01AUG98
Oak Ridge Reservation
Environmental Health Archives
(ORREHA)
Document Number
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Compendium of Public HE&TH^cnviTiES
At The
US Depar tmen t of Knergy
OAK RlDGBl^SEiiAJK)N
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Aa|p$el|p8
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Contributions by:
US EPA REGION 4 LIBRARY
AFC-TOWER 9™ FLOOR
61 FORSYTH STREET SW
ATLANTA, GA. 30303
Tennessee Department of Health
Agency for Toxic Substances and Disease Registry
National Center for Environmental Health
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Table of Contents
1.0. Introduction 1
1.1 Background 1
,:¦??; S-
1.3 Agencies Involved w-.' 1
1.4 Publij Health Issues ,, ,. 2
1.4.1 Issue 1 - Worker Exposure : „ +< t 2
1.4.2 Issue 2 - Off-Site Exposure ^ /, ....... /.*. . 2
1.4.3 Issue 3 - Reported Illnesses Cv/ . 2
*• ••• • . •••. •... ..•.¦>>>:•:::«•< ••• *
1.4.4 Issue 4 - Community Involvement .... J ¦. + -Mr 2
2.0 Proposed public Health Activities 3
2.1 Issue 1 - Worker Exposure 3
2.1.1 Occupational Exposure Asses$fttent<&nd Epidemiology r 3
2.2 Issue 2 - Off-Site Exposure .. , t 3
2.2.1 Public Health AssessmMt ¦¦¦¦ £¦ ¦ 3
2.3 Issue 3 - Reported Illnesses .... ,.. .... 77' 3
2.3. U. Public Healtft Assessment v V; 3
2.4 I ssu e 4 - Community ^Involvement 3
2.4.1 7 PuMmHealth Assessment. 3
3.0 ONGQPG'MOC1IEALT1-IActivities 4
3.1 tissue 1 - Worker-I§$|pjpBre 4
3.1.1 Leukemia Case-Control Study 4
. ;: 3.1.2 Exposur^A ssessment of Hazardous Waste, Decontamination and
Decommissioning, and Clean-up Workers - Phase I Feasibility Study 5
3.1,3 .Pi^ention of Stress and Health Consequences of Downsizing
and Reorganization 6
jM 4 Cohrrt}Mortality Study 1fDOE ChemicalLahoroton' lir~ ,hn"s 7
3.1.5 Aii'! 1 .<; 'Myeloma Casj-,ahilrol Sti:u)• at K-25 Plant 8
3.1.6 Follow-up of Morbidity Study of Bladder Cancer and Chemical Exposures at
K-25, Oak Ridge, Tennessee 9
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3.1.7 Childhood Leukemia Case-Control Study 10
3.1.8 Study of Heat Stress and Performance in Carpenters at DOE Sites 11
2 1.9 Construction Workers Mortality Study 12
3 .2 Issue 2 - Off-Site Exposure 13
3.2.1 Phase 11 of Oak Ridge Health Studies 13
3.2.2 Public Health Assessment of the Doe Oak Ridge Reservation . . 14
3.3 Issue 3 - Reported Illnesses 15
3.3.1 Medical Evaluation ofK-25 Workers . . , ~ :-:-i 5
3.3.2 Scarboro Community Health Survey . . ..;! si# '. . ». '••¦:16
3.3.3 Health Consultation on the Scarboro Community <; t ;:. ,.. . . 17
•••- "• '
3.4 Issue 4 - Community Involvement 18
3.4.1 Oak Ridge Health Agreement Steering Panel „. < + 18
4.0 Completed Public Health Activities v.- 19
4.1 Issue 1 - Worker Exposure *. < ~ > < ~ , 19
4.1.1 Mortality Among Worker$:at Oak Ridge NgttQnal£iiboralory 19
4.1.2 Mortality of Workers at-aNucleq^'Material^;^^duction Plant at Oak Ridge . 21
4.1.3 Mortality Among Wwfcrs EmployedBetugdn 1945 and 1984 at a Uranium
Gaseous Diffusion Facility : 22
4.1.4 Mercury Worker$;0eaIth Study , . _ 23
4.1.5 Study of C6nWit0il Oak Rtdgv Fmiliiies (Tmnessee Eastman Corporation
' [TEC], k'25) 24
4.1.6^...M^jders at OakM^ge.facilities 25
4.1.7 tmmiim,Case-&mfrol0tidy (TEC, Y-12, Fernald, Malhnckrodt) 26
4.1.8 i;MuW^fe,Mvltiple W0ioma Case-ControlShidy 27
4.2 . Issue 2 - Off-Sit$3s£|>f^re 28
. 4.2.1 Phase 1 Q$c Ridge Health Study 28
4.2.2 Pilot SwMy of Mercury Levels in Oak Ridge 30
4.2.3 Healih'Z*onsullation on Y-12 Weapons Plant Chemical Releases into East Fork
Poplar Creek 31
42>.$W\BMlth Consultation on Proposed Mercury Cleanup Levels 32
4.2.5 ATSDR Science Panel Meeting on the Bioavailability of Mercury in Soil .... 33
4.2.6 Health Consultation on Lower Watts Bar Reservoir 34
4.2.7 Community and Physician Education on PCBs in Fish 35
4.2.8 Watts Bar Reservoir Exposure Investigation 36
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4.3 Issue 3 - Reported Illnesses 38
4.3.1 Health Statistics Review to Address Oak Ridge Physician's Concerns 38
4.3.2 Review of Clinical Information on Persons Living in or near Oak Ridge,
Tennessee 39
4.3.3 Clinical Laboratory Analysis 40
4.3.4 Health Statistics Review of ALS and MS Mortality Rates 41
4.3.5 Public Presentation on ALS and MS ., + 42
4.3.6 ORHASP: Feasibility of Epidemiologic Studies .. 43
4.3.7 Health Hazard Evaluation - Lockheed Martin Energy Systems, Inc. DOE Oak
Ridge at K-2 5 Site . „ ,44
4.3.8 Physician Health Education Program otfCyanide , ,-;^'45
4.3.9 Presentation of the Utah Leukemia and ffiryroid Disease Studies Related to
Fallout From the Nevada Test Site . ,,.. X : .... tu
4.3.10 Governor of Tennessee's bidependent Pawlthe DOE Toxic Substances
Control Act (TSCA) Incinerator at the Eo$t Tmm$kee Technology Park .... 47
4.3.11 Health Assessment of the East Tennessee Region; S&6fld Edition 49
4.4 Issue 4 - Community Involvement .. 50
4.4.1 Oak Ridge Health Studies Bulletin . < +, , + / 50
4.4.2 Technical Workshops for Phase I ofOak Ridge Health Studies 51
4.4.3 Community Feedback Sessions forPhase iWfQak Ridge Health Studies .... 52
4.4.4 Scarboro Meetings 1... . 0 53
4.4.5 Knowledge, Attitude,- and Beliefs Study + 54
4.4.6 Community Diagnosis Status Repor^Anderson County 55
v: x;
: S:'• ¦ : ' : v:: ^
••••• y.!
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l.o. Introduction
l.l Background
The Oak Ridge Reservation was established in 1942 as part of the Manhattan Project, the federal
government's World War II effort to build the atomic bomb. The Oak Ridge Reservation hosts
three major installations in Oak Ridge, Tennessee: the Oak Ridge Y-12 PJant, the Oak Ridge K-
25 Site (now known as the East Tennessee Technology Park), and X-ld'ffeow;.known as the Oak
Ridge National Laboratory).
In the early years, the mission of the installations concetlfated on plilSnium production andy
uranium enrichment. After the war, the installations' roJe.broadeogd widely to iitcludft & variety of
research and production projects. In recent years, the faelOli&i&id expertise deveibpMand
maintained in the interest of the national defense have beeadownsized. Presently, the missions
include environmental restoration, decontamination and:dec6nxnHSsioiling, waste management,
research and development, technology transfer, goverriiinent-indiil^. partnerships, and national
security programs.
1.2 Purpose
The purpose of the Compendium ofMBlic Health Activities'is to outline past and present
strategies implemented to evaluate|ffl::'addresspublic health issues related to chemical and
radioactive substances released frph the USlBepartiuetrt of Energy (DOE) Oak Ridge
Reservation,:1This compendium Serves as document that summarizes ongoing and
completed aWlyHies con
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1. determining the nature and extent of contamination,
2. identifying and characterizing pathways of human exposure,
3. determining the demographics of exposed population,
4. determining the public health implications, and
5. evaluating morbidity and mortality data.
1.4 Public Health Issues
This document outlines public health activities related to thftibllowing broad public health issues
at the DOE Oak Ridge Reservation.
1.4.1 Issue 1 - Worker Exposure
Employees of the DOE Oak Ridge Reservation have beeit ^Kpo&ed. to radiological and chemical
agents in the workplace. The health risks associated with bw*kv»]: :protracted exposure to
ionizing radiation and chemical hazards for the Oak Ridge worfcfoFC^mugt be determined.
1.4.2 Issue 2 - Off-Site Exposure
Off-site populations may have been exppSed to ch^calmdradibiogical substances released
from operations at the DOE Oak Ridge Reservation. The Jjealth risk associated with low-level
protracted exposure to chemical suj>$t$rices an$;ionizing radiation for these off-site populations
must be determined.
1.4.3 Issue S r ReportedlUnesses
Patterns of llinesis^ afflicting fesi:tfe.e.j?aMc health agencies.
1.4.4 Issue 4 - Comnptffity Involvement
Brosier representation <^tH§ Community is needed in the planing and implementation of current
an&lfiture public health&ctivities.
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2.0
Proposed Public Health Activities
2.1 Issue 1 - Worker Exposure
2.1.1 Occupational Exposure Assessment and Epidemiology
1. NIOSH will proceed with new and ongoing studies of Oak Ridge-Reservation worker
health. The Health-Related Energy Research Branch .will cond^-ihoitiugh and unbiased
analyses of the health risks from exposure to physical, bhemicakan&other stressors
potentially affecting current and former Oak Ridg£:ReservationW0® the best : :
available methods in order to promote adequate.;]S?otection.of workers.
2.2 Issue 2 - Off-Site Exposure
2.2.1 Public Health Assessment
ATSDR will begin conducting a public.Itealtli assessment onihepak Ridge Reservation
to assess the public health impact on;:6ff-Site populations from releases of hazardous
substances from the Oak Ridge Re'prvation &nd:ft>determine which public health actions
or studies are indicated.
ATSDR will be evaluatingij^d analy^ii|g the late#information, data, and findings from
previous and ongoing stilidjes and in'V^|igatioa| :of releases from the Oak Ridge
Reservation to identify .and characterize current and past exposures of off-site
p^platibfls to radiologic and chemical contaminants.
2.3 Issue 3-Eeported Illume
2.3.1 Public Health A$$e$$tnent
ATSDR will be conducting a health statistics review by evaluating morbidity and mortality
.¦iiii::. data to identify Excess health outcomes associated with contaminants of concern.
2.4 ' Issue 4 - jp&mmunity Involvement
2.4it :;;: PuWc Health Assessment
ATSDR will address community health concerns and will present and discuss with the
public ATSDR's findings and recommended follow-up public health actions or studies.
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3.0 Ongoing Public Health Activities
3.1 Issue 1 - Worker Exposure
3.1.1 Leukemia Case-Control Study
Purpose:
This multi-site case-control stud;, will explore the relationsjhlp: betweeft fi^t^rJial,ionizing radiation
and leukemia risk. Leukemia is the abnormal cell development of blood fonralig W^ causing
excessive white blood cell development. About 250 leukemia deaths:will be identified at four'
DOE sites and the Portsmouth Naval Shipyard (PNS) when the v^tal status is updated t%Pugh
1994. One of the four DOE sites included in the study is theC&k Ridge National Bao&raitory.
Confounding exposures to internal radiation, chemicals an&BM&will be evaluated for all cases
and controls. This study is a follow-up to recent positive findii]^:of:leukemia and radiation in
cohort studies. The study includes an update of vital status of H&fcfCfdi^nd Savannah River
cohorts.
Background and Agencies Involved: . ¦.
Exposure to ionizing radiation has begit;associated with excessive risk of leukemia mortality.
This excess risk has been observed ia persons;-exposed tqjigh dose acute radiation, as well as in
persons occupationally exposed ii> jprotracte3[:low dosesradiation. However, inconsistency of
findings across studies contiijbe§|o be a pfobiest $0fne studies of occupationally exposed
persons hM^ J!^onstra|^%|t6s4"resPons^:.^^0'lship between exposure to ionizing radiation
(Kendall, et al.» 1992; IARC, f^M; Cragle, et al., 1995). Wing, et al. (1991) observed and
elevated riskofleiifeemia, thou^tw apparent dose-response relationship with radiation
exposure. In a COifll5i8fc&,study of.tf^fcJacilities in the United States, Gilbert, et al. (1993) found
no overall iti<^€sa^iti,|^k^!r!Eia risk n&f any dose-response relationship. Many of these studies
have suffered from 1 imited jstati^ipal power due to the relatively small number of cases. As a
resulypf this limited statis^ica!. power, NIOSH investigators designed and began a multi-site
leuklrhia case control stpdy.
7me:jLine:
Expected completion is December 1999.
Status:
The protocol for this study has been developed and approved in 1996. The study is currently
underway and a combined personnel roster is being developed from which the cases
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3.1.2 Exposure Assessment of Hazardous Waste, Decontamination and Decommissioning,
and Clean-up Workers - Phase I Feasibility Study
Purpose:
This multi-site study will address exposures to current workers involved in environmental
restoration, decommissioning and decontamination and handling and storage of hazardous and
radiological waste. Exposures encountered by hazardous waste, clean-aj},:..and decontamination
and decommissioning workers will be characterized. In Phas&I, background information will be
collected at seven DOE sites to assess working condition^ atfd to identHy%$ye$,.and research
needs at the sites. This study also assesses the feasibility Mtracking ti^is vvorkf&ree for future;.;^'
studies and evaluates mixed exposures.
Background and Agencies Involved:
The DOE is developing new technologies to clean-up and treat hazardous and radiological wastes
that have accumulated within the DOE complex arou»d4he U.S. both new and
conventional technologies to clean-up the varied DOE sitesJnay expose the workers
to new and old occupational hazards. A broil array:.of;4Ctivit.i§s involving deactivation,
decontamination, decommissioning, dismptlement^and wastege^ration and treatment will
contribute to hazards potentially encountered byJtiie cleanup workforce. NIOSH investigators
designed this project to accomplish seylral task§f(l) compe recent information about clean-up
activities at these sites. (2) identHyHazards associated with the clean-up activities. (3) determine
the sites where these workplace:.faazards should:Re assessed. (4) determine the need to do
additional stifdies of these Workplace hazards.
Time Line:
Phase I had been pcoposedito be completed by late 1998; however, access problems will push this
completionidate back into jta^::1.999.:
Slatim
Currently the Phase I.Jfeasibility studies have been completed for two of the DOE sites under
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3.1.3 Prevention of Stress and Health Consequences of Downsizing
and Reorganization
Purpose:
This multi-site project is studying the effects of downsizing on organizational climate, worker
health, and performance. Work-related conditions implicated in disease developm#T include: job
dissatisfaction, lack of job control, and under utilization of abilities. Sudden job-efianges through
strike, retirement, layoff, relocation, or job loss may trigger stress and result in reduce health.
This study is applicable to current and future workers. A feasibility evalu&tio&Of interventions.
will be conducted following the completion of this study,!:*:
Background and Agencies Involved:
This study was proposed and is being conducted through:ft:;pef&tive Agreement between
NIOSH and the Boston University School of Public HsMth (Lew-Peppe*, M.D.).
Time Line:
This study is scheduled for completion inj>eptember:-l9$&
A survey of the workforce at^Oa&fRidge isjMlpg.developed and will soon be completed.
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3.1.4 Cohort Mortality Study of DOE Chemical Laboratory Workers
Purpose:
In limited studies of chemical laboratory workers, an increased risk of all cancers and several
specific cancers have been found. A multi-site mortality study of DOE chemical laboratory
workers is feasible using available data set. This study addresses chemical and n#iped exposure
hazards that are applicable outside the DOE complex. This workforce has. reiMlned quite stable
and should provide valuable information on mortality expected by other c^eiftical laboratory
workers across the United States.
Background and Agencies Involved:
Chemical laboratory workers have been identified from pre^a^ly studies of workers at DOE
Oak Ridge facilities. Identification of the laboratory workers ha&|>§en accomplished by cross
matching job titles and department titles and codes fro# work;&sf6ry records by personnel
familiar with these cohorts at Oak Ridge Associated University Ceirter-for;.Epidemiologic
Research. Worker potential exposures to groi^ of cljeaiieals and t&:klraizing radiation will be
assessed and their relationship to mortality jj&tterns wi|l .be.investigated. NIOSH is completing
this research under the Memorandum orUjfaerstan$%'::i(\^^ DOE and the U.S.
Department of Health and Human Services (Hl l S.) for analytical epidemiology studies.
Time Line:
The Standardized Mortalityi&atk* (SMR) analysis is expected to be completed by September
1999.
Status:
Vital status is curreritly:teiiig;updated for the chemical laboratory workers. Following the
updatejfjthc SMR Analy performed.
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3.1.5 Multiple Myeloma Case-Control Study at K-25 Plant
Purpose:
Multiple myeloma (MM) is a malignant growth of bone marrow causing bone pain and
deformities that result in anemia, pulmonary and kidney complications. This case-control study of
63 MM cases at K-25 complements the MM study that focused on external radiation. This study
addresses the question of whether multiple myeloma is related to interna^or external radiation
exposure, and evaluates potential confounders with reasonable statistieaipower.
Background and Agencies Involved:
The NIOSH Health-Related Energy Research Branch wJHco&dact this study
The K-25 workforce was exposed primarily to internal ra^ati^n.-.BOth radiation and chemical
exposure will be included in the exposure assessment.^..
Time Line:
Expected date of completion is June 199&F
Status: rifiiiiiiiii:
Updated work history and exposure infomjiitloti areJb^Hig compiled prior to analysis.
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3.1.6 Follow-up of Morbidity Study of Bladder Cancer and Chemical Exposures at K-25,
Oak Ridge, Tennessee
Purpose:
Determine the risk factors associated with the excess of bladder cancer cases which have been
identified in a K-25 worker cohort.
Background and Agencies Involved:
The NIOSH Health-Related Energy Research Branch wiilconduct this study.
Excess bladder cancer ca^s have been identified at the OaJt&idge K-25 facility aaiowg; workers
involved in the construction of components for the gas C$T$tiftAge> These workers were previously
reported as being at higher risk for developing bladder caae§r,.k# the exposure assessment was
very basic. Since the time of the initial evaluation, additional caseii have.been found in the cohort
and more extensive workplace monitoring data have been located:<::.:|l^.acidjtional data will result
in more precise estimates of exposures within numberif^f Bgents so that the
magnitude of the risk may be described. B&atise material? Used in construction of the gas
centrifuge are in use across industries, there would.be industrywide implications. Moreover, the
results may indicate the need for screening and ia&wentiofr wlieh could provide immediate
benefit to DOE workers. ' 3
Time Line:
Expected dit©:Bf:compl6tlpn:t&::;S^ptember, 2002.
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3.1.7 Childhood Leukemia Case-Control Study
Purpose:
This case-control study assessed the potential association between paternal exposure to ionizing
radiation and risk of leukemia in offspring, a finding observed by Gardner et al. (1990). The
leukemia study completed in Sellafield, England prompted the CDC evaluate occupational
exposures. The study follows up on previous findings of birth defects (GNS tutaiSrs) at Hanford.
Background and Agencies Involved:
The NIOSH Health-Related Energy Research Branch ;.$&ttelle Laboratories (Low^fl Sever;'
Ph.D.). ¦¦
The study, initiated at the Hanford Site, was expanded tft:0$k Ridge and Idaho, and also included
non-Hodgkin's lymphoma and central nervous system;{CNS) l| outcomes. A draft final
report has been reviewed by NIOSH. *:
Time Line:
Expected date of completion is Fall \9W. .J-
Status:
Receipt of,the:final report will occur in 1 9^S;:^:;1jj: action, notification efforts and submission of
data files to.CBDR are stii! reqaired.
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3.1.8 Study of Heat Stress and Performance in Carpenters at DOE Sites
Purpose:
This study will determine if heat stress from the use of protective clothing affects performance of
carpenters and other construction workers in remediation and hazardous waste work at Hanford
and Oak Ridge. Physiologic measures of heat stress and neurobehavioral perfornipfce will be
assessed under actual working conditions.
Background and Agencies Involved: . ,>•
The NIOSH Health-Related Energy Research Branch ; United Brotherhood of Carp^Qters Health
and Safety Fund (Kenneth Rosenman, M.D.) "rf*'-'*
Time Line:
Expected date of completion is Fall, 2000.
Status: ,-4
;f,
Receipt of the final report will occur in. 2001. .•
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2.1.9 Construction Workers Mortality Study
Purpose:
Relatively few mortality studies have been conducted among construction workers. This all-
cause retrospective cohort mortality study of former DOE construction workers provides an
opportunity to further define the risks associated with asbestos fibers, silica-containing dusts,
beryllium particulates, and other exposures regularly encountered by construction workers. It
will provide useful information applicable to the present consimctioa..worid(bf:ce.
Background and Agencies Involved:
The NIOSH Health-Related Energy Research Branch.
Time Line:
Expected date of completion is Fall, 1999.
Status:
A draft protocol is in preparation.
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3.2 Issue 2 - Off-Site Exposure
3.2.1 Phase II of Oak Ridge Health Studies
(dose reconstruction studies)
Purpose:
The purpose of the Oak Ridge Health Studies is to evaluate exposure of off-sile populations to
hazardous substances released into the environment from operations atthsO&k Ridge
Reservation since its creation. Phase II of the Oak Ridge Heatth Studies^!!, reconstruct past . :y
releases of mercury, polychlorinated biphenyls (PCBs), uranium, radioactiVeiodaie, and
radionuclides from White Oak Creek and estimate past e^posure.of doses of these;ltazardo«s
substances to off-site populations. The estimated exposup* Ojc doses, will be jsed .&?.4st£rmine
which off-site populations were exposed to hazardous sub$t&1Sc£i? and what resulting adverse
health effects they might experience.
Background and Agencies Involved:
As provided by the Health Studies Agreement between the state ofj^nnessee and DOE, the
TDH is conducting the Oak Ridge HealtJ* Studies (4ose reconstpption studies) which is an
independent state evaluation of exposure to hazardous subfpnces released from past operations
at the Oak Ridge Reservation. The Oak Ridge Health Agreement Steering Panel (ORHASP)—a
panel of experts and local citizens*^provide|!Hirection.» recommendations, and oversight. The
Centers for Disease Control.andff feventiosis reprfisented on the ORHASP by NCEH.
Time Line:
Final documents.wiib&released by
Status:
•:r
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3.2.2 Public Health Assessment of the Doe Oak Ridge Reservation
Purpose:
The purpose of this public health assessment is to assess the public health impact on off-site
populations from releases of hazardous substances from the Oak Ridge Reservation and to
determine which public health actions or studies are indicated. ATSDR will evaluate and analyze
the latest information, data, and findings from previous and ongoing stu&tes and investigations of
releases from the Oak Ridge Reservation to identify and characterize bo$i: current and past
exposures of off-site populations to radiologic and chemical pOiitamin&|t& ATSDR will also
evaluate morbidity and mortality data to identify excess health outcomes as$$$&e&with
contaminants of concern. The public health assessment Mil be usedPto identify^peopie exppsed at
levels of health concern, identify excess health outcomes^adfkess community heatifccoBcerns,
and recommend follow-up public health actions or studies
ATSDR will form an Oak Ridge working group to involve interesl^j?oinmunity members in the
public health process and to collect community coneeras.
Background and Agencies Involved: ; :
Under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA
[Superfiind]), ATSDR is mandated Conduct 8 public health assessment for each facility listed
on the US Environmental Protect&ft Agency.|EP A) National Priority List (NPL). In 1989, the
US Department of Energy's Qak Ridge Res€^Mio:n;:Was placed on the NPL.
Time Limt -¦ • ;>.
Public comment
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3.3 Issue 3 - Reported Illnesses
3.3.1 Medical Evaluation of K-25 Workers
Purpose:
The medical evaluation is assessing health complaints and symptoms of Lockheed Martin Energy
Systems workers at the East Tennessee Technology Park (formerly caUkTthe-Oalc Ridge K-25
Site). This medical evaluation includes review of prior health studies,vi$it$$tKvvorkers'
workplaces and environs, work history interviews with indjwlual work$r$,'?.§vi^w of worker .../
medical records, physical examinations, and specialized Jaflow-up inquires an&testing.
Background and Agencies Involved:
In the fall of 1995, Lockheed Martin Energy Systems worfesiand residents living near the East
Tennessee Technology Park, reported illnesses believed to be associated :with possible exposure
to hazardous substances from the East Tennessee.Te§ftiSc>logy Par%^ th&fall of 1996, Lockheed
Martin Energy Systems arranged for James Lgdce^ ::'MS and AriireW Freeman, MD, MS
from the University of Cincinnati, College ofsMedicine, Department # Environmental Health, and
Richard Bird, MD, MPH to conduct thisfpedical evaluation.
Time Line: , ^
A summary report will be releaser in late Fall 199&
Status: <
1.
In March 1^98,i^|ndependent ph^icians held a public meeting in Oak Ridge to release the
results of tfe&r (indoor air) and soil sampling conducted at the
East Tennessee Techi&iogy Park in the fall of 1997. Also, the physicians released the finding
ofifieir study in intergr^ing normal values for urinary thiocyanate. They presented their
interpretation of theserresuits and recommendations for addressing pertinent findings.
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3.3.2 Scarboro Community Health Sur\>ey
Purpose:
The Scarboro Community Health Survey, which includes a medical evaluation of children under
age 18 years, is being conducted to investigate a reported excess of respiratory illness among
children.
x':':
Background and Agencies Involved:
In November 1997, the TDH received notification of anipiisual number of^hUdrett affectedly
chronic respiratory illnesses in the Scarboro community. a predominantly African American/
neighborhood of Oak Ridge, Tennessee. CDC was invited lo participate in an investigation of
these health complaints in early December.
The Scarboro community lies in close proximity to the:.;Y-12 jtfaat, part: of the Oak Ridge nuclear
weapons facility. This particular installation has beetrin,existence for over 50 years. Although
CDC was requested to provide assistance in the>i£v«S%atien of respiratory illnesses among
children, a variety of other health complaintsiafid pot&8|fe% lojcic exposures are under
investigation in the Oak Ridge area by C0C.
A team of investigators from CDC aftd ATSDR responded ;to the request. With the assistance of
the Scarboro Community Envirojttitental Justice Oversit&£ommittee, a study protocol was
developed and a questionnaire was administered.lo.the members of each household in the
community ^primarily asses&household eawontaental exposures and prevalence of respiratory
diseases.:$rt£0tyember 1997'? CDC received a request for assistance from the State of Tennessee. In
December 1997, a team of investigators began meeting with appropriate representatives for the
TDH and the Scarboro Community to develop a research plan and survey instruments. On May
16,199S, questionnaires wo e administer! rc> ccn inuiiity members. Ir. July 1098, CDC begai.
analyzing data from the survey and developed a protocol and logistics plan for the conduct of the
physical exams. This project is still being conducted.
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3.3.3 Health Consultation on the Scarboro Community
Purpose:
This health consultation is being conducted to identify and characterize exposure pathways in the
Scarboro Community to hazardous substances released in recent years from the Oak Ridge Y-12
Plant. ATSDR will evaluate on-site and off-site ambient air monitoring data and oftikr relevant
data and information on the Y-12 Plant releases. In addition, ATSDR Wilt evaluate data from
DOE's ongoing soil survey of the Scarboro community. (SCOPE OFHEAMfl
CONSULTATION UNDER DISCUSSION)
Background and Agencies Involved:
Under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA
[Superfiind]), ATSDR is mandated to conduct a public hedfth- assessment for each facility listed
on the EPA NPL. In 1989, the US Department of Energy's Oaki^lipi Reservation was placed on
the NPL.
In November 1997, the Tennessean reportecMftat thei^-wSS-au. apparent increase in the rate of
allergies, asthma, ear infections, and oth^pespiratQiy unusually large number of
children living in the Scarboro Community. The tfjtother of gae child with asthma reported to
ATSDR that she is concerned aboufcurrent Y.42 Plant releases exacerbating her child's asthma
and other community members reported to DOE that thef are concerned about current levels of
hazardous substances in the Sca&oro Community,.-This health consultation is in response to these
community.cdncerns.
Time line: .?¦
The public corraaeGtdraffc is scheduled to be released by October 1998.
Status:
ATsSpR staff collected,;§nd is currently reviewing, on-site and off-site ambient air monitoring
data:|i addition to other relevant data and information on the Y-12 Plant as it relates to current
expo sure pathways.
AliSpBLwiD-review the environmental data collected in the DOE Scarboro community soil survey
when available.
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3.4 Issue 4 - Community Involvement
3.4.1 Oak Ridge Health Agreement Steering Panel
Purpose:
The Oak Ridge Health Agreement Steering Panel (ORHASP) is appointed to direcfand oversee
the Oak Ridge Health Studies and provide liaison with the community.
Background and Agencies Involved: .
As part of the Health Studies Agreement between the slate of Teaii€ssee and
established the Oak Ridge health Agreement Steering .Cil panel is composed Scientific
and community representatives appointed by the Commissiaiser^f the TDH. The State of
Tennessee, Environmental Quality Advisory Board of Ihe City &f&ak,Ridge, Oak Ridge
Reservation workers, CDC, and DOE have one representative ^fllb^paael in addition to the the
nationally-recognized scientist and local community representatives*
Time line:
The panel was formed in 1992 and anticipates completion of Oak Ridge Health Studies by
January 1999.
Status:
Since Ja^y^^y the TDU &fi
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4.0 Completed Public Health Activities
4.1 Issue 1 - Worker Exposure
4.1.1 Mortality Among Workers at Oak Ridge National Laboratory
Purpose: .
This study was conducted to investigate the mortality rates ;#ik>ng worfs^fcS &tethe Oak Ridge
National Laboratory.
Findings:
White males hired at the Oak Ridge National Laboratory betweeni943 and 1972 were followed
up for vital status through 1984. A total of 8, 318 persons were studied. Relatively low
mortality compared with that in US white males was observed fci]f jhbk.Causes of death.
However, leukemia mortality was elevated in the tolfedhort (63% Mgh$f,::28 deaths) and in
workers who had at some time been monitored forMemalradionuclide contamination (123%
higher, 16 deaths). External radiation witb'iai 20-year e%d»iri%g.vims related to all causes of
death (2.68%, increase per 10 millisieverjt (niSv)),:!priman1^i.|lUei|ib an association with cancer
mortality (4.94%, per 10 mSv). '
A follow-up of the mortality experience of tNCcohort^pKvhite males employed at the ORNL,
originally described in 1991 (see above) was <2bipu^ed in 1994. An additional 586 deaths were
identified {^afi|>ared with :!524 deaths in the d|i§iifial follow-up). The all-cause Standardized
Mortality ^atij&.{SMR), theiall-C^nqer SMR, and lung cancer SMR were all unchanged from the
previous update; iow^yer, the i^£et^a:;SMR was 1.35, as compared with 1.63. The SMR for
leukemia declined tmX^Lfor the ngceiitifbllow-up years (1985-1990), possibly reflective of a
leukemia-radiation association due to relatively high doses in the 1940s and 1950s.
Background and Agencies fttv&hed:
Tjie;iRlOSH-managed siody was performed by investigators from the Center for Epidemiologic
Research of ORISE* tlfider the leadership of Donna Cragle, Ph.D. The analysis of the studies of
tW0:$tte$,-.X-lQ aftd Y-12, were conducted by investigators from the University of North
Caro&fm^as a, sub-contract to ORAU.
Publications:
Wing S, Shy C, et al: Mortality among workers at Oak Ridge National Laboratory. Journal of
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the American Medical Association 265(11): 1397-1402, 1991.
Shy C, Wing S: A report on mortality among workers at Oak Ridge National Laboratory:
Follow-up through 1990. Draft Final Report, March 31, 1994.
Time line:
The initial study was completed and published in 1991. A follow-up to.||i§ study was conducted
in 1994.
V'1-" •' •: y-:*.
.sir
¦x. ¦
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4.1.2 Mortality of Workers at a Nuclear Materials Production Plant at Oak Ridge
Purpose:
This study was conducted to investigate the mortality rates at the Y-12 Plant which is part of the
Oak Ridge Reservation.
Findings:
The mortality experience of a cohort of 10,597 males andj&p&fes who%Ork6(fiftt Y-12 between
1947 and 1974 was somewhat lower than that of the Un||^'d States populatioh^afKi cancer
mortality was equal to that of the general population. Deaths from king cancer were significantly
elevated (SMR=1.17, 95% Confidence Interval (CI)= U.05? 1,315 There was also; a small excess
of brain and lymphatic cancer (SMRs=1.13 and 1.27, respectively). A small increase in
pancreatic cancer deaths was also noted (SMR=1.14).
Background and Agencies Involved:
The study was managed by NIOSH and conducted by Isootfc&and Wblf.
Publication:
Loomis D, WolfS: Mortality of w.Cjfkers at a:8uclear materials production plant at Oak Ridge,
Tennessee, 1947 - 1990. Amer :J: Jndust MecB29.:. ..1,31^141, 1996.
Time Li ml
This study was com^esed and pi$>li$fi&iin 1996.
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4.1.3 Mortality Among Workers Employed Between 1945 and 1984 at a Uranium Gaseous
Diffusion Facility
Purpose:
This study was conducted to investigate the mortality rates at the K-25 Plant which is part of the
Oak Ridge Reservation.
Findings:
Mortality patterns among 35,712 workers ever employedjfbr 30 days Of more at'^-25 between1'
1943 and 1984 were investigated. For white males, the SMR for all: causes of death was
significantly elevated (SMR=1.03, CI=1.01, 1.05). Otl^statipically significaMlticrepes
among the white male population included: cancers of tMfisptifatory system (including lung
cancer and respiratory disease), cancer of the bone, mental and accidents. Nonwhite
males did not have a statistically significant increase in .death.
Background and Agencies Involved:
The study was managed by NIOSH and conducted Sy irivesiigilofsfrom the Center for
Epidemiologic Research of ORISE, under the leadership ofpOMa Cragle, Ph.D. The project
officer was Elizabeth Dupree.
Publication:
The results: ofstudy Av«re:$t»ftTOarized in an internal report.
Time Line:
This study was completed jp $994.
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4.1.4 Mercury Workers Health Study
Purpose:
This study was conducted to investigate neurologic health outcomes of workers exposed to high
levels of mercury.
Findings:
This was a follow-up study of neurologic health outcomes 9 workers exposed to high levels
of elemental mercury at the Y-12 plant (Oak Ridge) bety^en 1953-1.963. Stu3y participants pive
been notified individually of their test results, and the filial report has been receJvedJby NiOStl.
Neurologic effects of relatively he:
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4.1.5 Study of Combined Oak Ridge Facilities (Tennessee Eastman Corporation [TEC],
Y-12, X-10, K-25)
Purpose:
Manuscripts have been prepared from two mortality studies of Oak Ridge workers. The first Oak
Ridge facility combined mortality study (ORFCOM) was conducted with 118,588-Workers
employed at TEC, Y-12, K-25, or X-10. The second study is an analysts of 27^82 deaths
occurring among 106,020 persons employed for at least thirty .days at these four nuclear facilities
between 1943 and 1983.
Findings:
The manuscript for the ORFCOM study discusses issues yg}iciation and treatment of data for
study members, and characteristics of their radiation exposufv^"*-^
The manuscript for the second study reports that overall.mortality:8R.d:.oyerall cancer mortality
estimates were in close agreement with national only nota&te-:fixcesses occurred for
lung cancer (SMR=1.8) and nonmalignant r.|5piratory:<8$e&se:(SMR^i. 12) among white males.
Analysis showed that workers employed at TEC, K*25, and:Jtiuittpie facilities had higher death
rates than similar workers employed oo|f at X-lQ;and Y-12,; These elevations were due to
differences among the facilities for cancer;s:leukemia, -fed other lymphatic cancers.
Background and Agencies Involved: ..'
The NIO$H jSeiiiyi-RelaM Eoergy Research Branch; ORAU.
Publications: ' ."" : :
Watkins J^pragle D, B* Collection, validation, and treatment of data for mortality study of
nuclear Industry workers*- App] Occup Environ Hyg 12 (3): March, 1997.
Frosse E, Cragle D, et a||;: A mortality study of employees of the nuclear industry in Oak Ridge,
TftSSessee. Radiationitesearch 148:64-80, 1997.
Study manuscripts wi.r published in 1997.
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4.1.6 Welders at Oak Ridge Facilities
Purpose:
Overall mortality and all causes of death were examined among 1,211 white male welders
employed at three DOE facilities in Oak Ridge, from 1943 through 1989.
Findings:
There was a slight excess in emphysema deaths in the ovefaiiCDhort, at^ excess of deaths
from diseases of the respiratory system among workers exposed to nipkel The SMRjfpr
lung cancer in the total cohort also reached statistical significance (5>MR=1.rj.
Elc ations in deaths due to ulcers and prostate cancer were also noted among workers-exposed to
nickel oxides.
Background and Agencies Involved:
The NIOSH Health-Related Energy Research EM&fiCf^ORAU.
Publication: /¦,,,¦
Wells S, Cragle D, et al: An upd&f&of mort&py amongjifelders, including a group exposed to
nickel oxides. Final Report, Oafc$idge Associated: Universities Document 98-0790. National
Technical Information Services (I^TIS). .../
rime Line: - :
,¦ .,.l\
A draft final reporfowas completed iti. 1994.
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4.1.7 Uranium Case-Control Study (TEC, Y-12, Fernald, Mallinckrodt)
Purpose:
This study sought to examine the relationship between uranium dust exposure and lung cancer
mortality among workers employed in four uranium processing or fabrication operations located
in Missouri, Ohio, and Tennessee.
Findings:
A total of 787 cases was identified. Odds ratios for lung eaincer moitality for seven, cumulative
internal dose groups did not demonstrate increasing risfcWith increasing dose Hbwe^rvthWe
was a suggestion of an exposure effect for workers hired M ;ag©:^5 years or older.. FartiBer
analyses for cumulative external dose and exposures to tfjp^riiifiSj'Tadium, and radon did not reveal
any clear association between exposure and increased risk, itdr^4.'3l®g°r'zing workers by
facility.
Background and Agencies Involved:
The NIOSI I Health-Related Energy Research Brandh;
Publication:
Dupree E, Watkins J, et al: Uramtim dust .©^sureaM lung cancer risk in four uranium
processing operations. Epidemiology 6(4): 370-375, 1995.
Time Line:
The manuscriptiiM^ ifatbliafeed in 1995.
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4.1.8 Multi-Site Multiple Myeloma Case-Control Study
Purpose:
This multi-site case-control study evaluated possible etiologic risk factors for multiple myeloma,
focusing on external radiation and chemical exposures. The study complemented a leukemia
case-control study which is being done at the same sites and the multiple myeloma p&se-control
study with internal radiation exposure being conducted at the Oak Rjdgg&aseotts Diffusion Plant.
Five sites were included in this study: Savannah River, Los.^Jamos Nat|tS|Caboratory
(LANL), LANL-Zia, Oak Ridge National Laboratory, and Hatiford. Tlte ftoatreport and the
study files and data have been provided to NIOSH
Findings:
Extended penetrating radiation doses received at age 45 Were found to be associated
with multiple myeloma.
Background and Agencies Involved: Wf
The NIOSH Health-Related Energy Research Branch; UBtvefstty of North Carolina (Steven
Wing, Ph.D.).
Publication:
Publications art? currently b&i%.4iubmitted
Time Line: V : :
The report wasfegaiplet^^fl Marcl^s|:£97.
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4.2 Issue 2 - Off-Site Exposure
4.2.1 Phase I Oak Ridge Health Study
(dose reconstruction feasibility study)
Purpose:
Phase I of the Oak Ridge Health Studies is a feasibility study on conducting do^e reconstruction
studies on past releases of hazardous substances from operations at the Oak Ridge Reservation.
Phase I evaluates past releases and operations at the Oak.^jdge Reservation $i&ee its creation/.
The objective was to determine the quantity, quality, and potential usefulness of the available
information and data on these past releases and subsequent exposal pathways..Witli this
information, preliminary screening analyses were perfo^^i to identify priority hazSfdbus
substances of public health concern and determined the feasibility 1955-lhi"ough 1965;
3. polychlonnated blphefiyJSi^PCBs) in fish from the East Fork Poplar Creek, Clinch River, and
the'Watts Bar Reservoir;
•IS Mi ^
4. ^radionuclides from White Oak Creek associated with various chemical separation activities at
X-10 during 1943 through the 1960s.
$S:"'
BmkgramtdmjdMgencies Involved:
As provided by the Health Studies Agreement between the state of Tennessee and DOE, the
TDH is conducting the Oak Ridge Health Studies (dose reconstruction studies) which is an
independent state evaluation of exposure to hazardous substances released from past operations
at the Oak Ridge Reservation. The Oak Ridge Health Agreement Steering Panel (ORHASP)—a
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panel of experts and local citizens—provides direction, recommendations, and oversight. The
Centers for Disease Control and Prevention is represented on the ORHASP by NCEH.
Time Line:
Phase I began in August 1992 and the final documents were released in October 1993.
x :V'
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4.2.2 Pilot Survey of Mercury Levels in Oak Ridge
Purpose:
The pilot survey was conducted to document human body levels of inorganic mercury for people
with the highest potential for mercury exposure from contaminated soil and fish. It also
determined whether exposure to mercury contaminated soil and fish constituted afpitimediate
health risk to the Oak Ridge population. /
Findings:
The results of the pilot survey suggested that residents Mid workerrin Oak Ri%s^Tetitiessee are
not likely to be at increased risk for having significantly'f&gh .mercury levels. Urinar> and: fiair
mercury concentrations were below levels associated wit&lft&iva.health effects.
Background and Agencies Involved:
From 1953 through 1963 the Oak Ridge Y-12, Plant was .involved in a:8thium separation process
that used elemental mercury to produce lithktm deuteddfrfu# for thermonuclear weapons. In
1983, DOE released a declassified copy of a report ,«n thefaercaiytnventory at the Y-12 Plant
which estimated that 220,000 to 470, Q<|b poundsjBf merci&y:were discharged into the East Fork
Poplar Creek. Soil samples documeii&I mercitff levels as Nigh as 2,000 parts per million (ppm) in
the floodplain. ¦" .
In the fall of 19.83, the Te$l^e&:DepartmeRtof:Health and Environment developed an interim
soil merc«fy:|ev«l for use tft e»yirotimental management decisions. CDC reviewed the
methodology.fof :tb6::jnterim::nier
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4.2.3 Health Consultation on Y-12 Weapons Plant Chemical Releases into East Fork Poplar
Creek
Purpose:
This health consultation was conducted to evaluate the public health implications from all known
and potential, current, exposure pathways to chemical and radioactive contaminants released into
the East Fork Poplar Creek from the Y-12 Weapons Plant.
Findings:
ATSDR concluded the following:
1. Soil and sediments in certain locations along the Hast Fork Poplar Creek floodplain are
contaminated with levels of mercury that pose a public health concern.
2. Fish from the creek contain levels of mercury and JPCBs that posei.^^pderately increased risk
of adverse effects upon frequent and long-tetai iog&tioii of cont&|i$foated fish.
3. Shallow groundwater along the East Ifprk Poplar Creek jS^dplain contains metals at levels of
public health concern; however, thisphallow |^bundwafpi§s;;not used for drinking or other
domestic purposes.
Background and Agencies Involwd:
Under tbs O&ilpfehensiveBtivkoraiiental Response, Compensation, and Liability Act (CERCLA
[Superfund]), AJ!§|5R is martdatedio:Qonduct a public health assessment for each facility listed
on the EPA 1^8:9, the OSItejpartment of Energy's Oak Ridge Reservation was placed on
the NPL.
ATSE|K'Conducted the l^||h:^li'sultation in response to community concerns reported in 1993
aboui;<:urrent exposure to; hazardous substances released into the East Fork Poplar Creek from
ongpng and past operations at the Oak Ridge Y-12 Plant.
Ttme Line:
The health consultation was released in March 1993.
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4.2.4 Health Consultation on Proposed Mercury Cleanup Levels
Purpose:
This health consultation was conducted to evaluate the public health implications of proposed
DOE's clean-up levels of 180 mg/kg and 400 mg/kg mercury in the East Fork Poplar Creek
floodplain soil.
Findings:
ATSDR concluded that the East Fork Poplar Creek flood,plain soil Gtean-up lev$l$of 180 .
milligrams per kilogram (mg/kg) and 400 mg/kg mercury are protective of pubfeheakh attd-will
pose no health threat to children or adults.
Background and Agencies Involved:
Under the Comprehensive Environmental Responses-Compensation^-arid liability Act (CERCLA
[Superfiind]), ATSDR is mandated to conduct a puttie health assessro^ffor each facility listed
on the EPA NPL. In 1989, the US Departnj&it of Eftefg^?$.:0ak Ridge Reservation was placed on
the NPL.
In response to a request from comj&jfliiy mernfc&rs and the city of Oak Ridge, ATSDR evaluated
the proposed mercury clean-up levels.
Time Line:
The health coagulation was January 1996.
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4.2.5 A TSDR Science Panel Meeting on the Bioavailability of Mercury in Soil
Purpose:
The purpose of the science panel was to identify methods and strategies to allow the development
of data-supported, site-specific estimates of the bioavailability of inorganic mercury and other
metals (arsenic and lead) from soils.
Findings:
Three technical papers and an ATSDR overview paper (jMhe fmding§,of th$ paifehneeting wefe
published in the International Journal of Risk Analysis, 1?;(5), 527:4568 (1997).
ATSDR used information obtained from the panel meetiSg:&iM:le,chnical papers to evaluate the
East Fork Poplar Creek mercury clean-up level for soil.
Background and Agencies Involved: .. .
Under the Comprehensive Environmental Response, Coitt|)«8Sation, ;&nd Liability Act (CERCLA
[Superfiind]), ATSDR is mandated to conduct a public health-assessment for each facility listed
on the EPA NPL. In 1989, the US Department of Hnergy's P^;iilidge Reservation was placed on
the NPL. . V:,;-.1:
Upon reviewing the DOE studiqs-and investigations*^ the mercury in the flood plain and the
clean-up levels, ATSDR delpbalied it didi|^|fha^&:the expertise required to evaluate some
technicalbioavailability). In addition, ATSDR determined that an
assessment attfee technical Issues $y a scientific body that was seen by the community as
unbiased was warEaat:e£l:because:.ofpublic scrutiny and division in the community concerning the
proposed mercury elean^plevels
ATSDR: sponsored the psiaoj^jhtch consisted of private consultants and academicians
internationally known fo.dttilif metal bioavailability research, in addition to experts from ATSDR,
CDC;j EPA, and the National Institute for Environmental Health Science.
Time line:
The panel peeting was held in August 1995.
The papers were published in October 1997.
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4.2.6 Health Consultation on Lower Watts Bar Reservoir
Purpose:
This health consultation was conducted to evaluate the public health implications for all known
and potential, current, exposure pathways for chemical and radiologic contaminants released into
the lower Watts Bar Reservoir.
Findings:
ATSDR concluded that PCBs in lower Watts Bar Reservoir fish pose&putjltc health concern;;#'
Frequent and long-term ingestion of fish from the reservoir poses a moderately increased :risk' of
cancer and may increase the possibility of developmental effects in infants \vhose:motlieFS
consume fish regularly during gestation and while nursing,
ATSDR also found that current levels of contaminantsin the resej^oir surface water and
sediment were not a public health concern, and that;the teservoir was safe for swimming, skiing,
boating, and other recreational purposes. Additioijliiy^-water from the Municipal water systems
was safe to drink.
ATSDR also reported that DOE's selected remedial actions^*!! protect public health. These
actions include maintaining the fish ebBsumptiQjti'advisoriesf continuing environmental
monitoring; implementing institutional control^ to prevent-disturbance, resuspension, removal, or
disposal of contaminated sediment; and pravidm^..cosppunity and health professional education
about the PCB contaminatioii[ :
BackgroinkimtdAg&ncies Involved:
Under the Coi^dies^.y«;£nvironmeGtal Response, Compensation, and Liability Act (CERCLA
[Superfuad]j',' 'XTSDR%::n^38dated to conduct a public health assessment for each facility listed
on theJfPA NPL. In 1Department of Energy's Oak Ridge Reservation was placed on
the*#L.
AT SDR conducted th&Health consultation in response to the request from residents in the vicinity
Of tfee:DOE Oak Ridge Reservation and the Watts Bar Reservoir for an evaluation the public
healtfa^tiiplieatiofiS' of chemical and radiologic contaminants in the reservoir. ATSDR also
rendered^n: independent opinion on whether the DOE selected remedial actions will be protective
Of pubi:-" h'lrdth
Time Line:
The health consultation was released in February 1996.
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4.2.7 Community and Physician Education on PCBs in Fish
Purpose:
This health education program was conducted to inform local residents and physicians of the
health risk associated with PCBs in reservoir fish.
Findings:
1. Approximately 40 community members attended the c6l&flTunity heaiiit::&Ju&ation meeting Ut-
Spring City, Tennessee on September 11, 1996. A presentation oiHhe health t%k. associ^ied
with PCBs in fish was given, and health education materials developed for the presentation
were handed out.
2. A physician and health professional education meeting.fctr health care providers in the vicinity
of the Watts Bar Reservoir was held at the Methodtst MedlcllCerlt'er in Oak Ridge,
Tennessee on September 12, 1996. Physicians.specializing in fiilily practice, obstetrics and
gynecology, and pediatricians were mailed.Mt&s ofiavitation to||i&grand round, along with
a copy of two publications from the sen$fc'ATSDM-\nservationf:C|alc Ridge Reservation Local Oversight Committee, and Methodist Medical
Center.ia Oak id^e.
Time Line:
This program was initiated in September 1996, and is ongoing.
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4.2.8 Watts Bar Reservoir Exposure Investigation
Purpose:
The exposure investigation was conducted to measure actual polychlorinated biphenyls (PCBs)
and mercury levels in people consuming moderate to large amounts of fish and turtles from the
Watts Bar Reservoir and to determine whether these people are being exposed to high levels of
PCBs and mercury.
Findings:
1. The exposure investigation participants' serum PCBsJevels and blood mercury levels ate very
similar to levels found in the general population. 'v p:-
2. Only five of the 116 people tested (4%) had PCB level$'th&t"W£fe higher than 20 micrograms
per liter (mcg/L) or parts per billion (ppb), which is:considered:to Be an elevated level of total
PCBs. Of the five participants who exceeded 2G:i»cg/L, four had levels between 20 and 30
mcg/L. Only one participant had a serum P.pBs!t#stBf 103.8 mCg/In-fwhich is higher than the
general population distribution.
3. Only one participant in the exposurfe.investigafion had a total blood mercury level higher than
10 mcg/L, which is considered#* eleva|J3. The remaining participants had mercury blood
levels that ranged up to 10 mcgfli", as migp be expend to be found in the general
population.
Background and Agencies jftwlved:
In following up on thesfindings of previous studies and investigations of the Watts Bar Reservoir,
ATSDR conducted the.exposure investigation with cooperation from the TDH and the Roane
County Health Depamtsfeot;
Previous studies by state :|n
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Scarboro community. These participants were interviewed and blood was drawn for analyses
of serum PCB and blood mercury.
2. In November 1997, ATSDR sent all participants written notification and interpretation of
their individual results. In December 1997, an ATSDR physician conducted follow-up
interviews with participants identified as having elevated values.
3. Between March 16 and 19, 1998, ATSDR held public meetings in Glik Ridge, Kingston, and
Spring City to discuss the results of the exposure investigation.
¦ ' P?::.
: ::: Wwi1-.
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4.3 Issue 3 - Reported Illnesses
4.3.1 Health Statistics Review to Address Oak Ridge Physician's Concerns
Purpose:
To compare mortality rates and cancer incidence rates of counties sourounding oak kidge with
the rest of the state.
Findings:
Indirect age-adjusted cancer incidnce rate for Oak Ridge is significantly higher .for the $ears 1988
to 1990. For the years 1979-1988, the deaths for AndtirSOn, JvOfix, and Roane were:
total deaths significantly lower in Anderson and Roane, tQt|l.cfi||iQgr deaths signifaicant lower in
Roane, dath for stroke significaltlly lower in Anderson,^d^tS|.Brdm;iCipPD significally higher in
Anderson, death form health disease sighnifaclally lower in Andersen, Knox, and Roane Counties,
and death for congenital anomaliies signnifically low&m Anderson,
For the years 1980 to 1992, the age-adjust.ed:mortalhy fates were: Signaiicqally lowere in
Anderson, Roane, and Knox, signically jjjghcr in Cafnpbel, c?aiborne, Morgan.
Background and Agencies Involved:
In 1992, an Oak Ridge physiciatvfeported that fe& believed approximately 60 of his patients had
experienced.oecupationalaad eitvironment|;i :ex^$ures to several heavy metals. He felt that these
exposures had Suited in yi
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4.3.2 Review of Clinical Information on Persons Living in or near Oak Ridge, Tennessee
Purpose:
The purpose of this review was to evaluate clinical information on persons tested for heavy
metals and to determine whether metals were involved in these patients' illnesses.
Findings:
ATSDR concluded that the case series did not provide sufficient evidenC& tfr;&S$Qciate low levels
of metals with these diseases. The Tennessee Department of Health ,<$me t$ th§ $&irie
concludions.
Background and Agencies Involved:
In 1992, an Oak Ridge physician reported that he believed approximately 60 of his patients had
experienced occupational and environmental exposures to several ;hfeaVy metals. He felt that these
exposures had resulted in increased cancer, im)flun
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4.3.3 Clinical Laboratory Analysis
Purpose:
The purpose of the analysis was to provide clinical laboratory support to Howard Frumkin, MD
who conducted individual clinical evaluations of patients referred by an Oak Ridge physician.
Findings: P::.
Because of patient-to-physician and physician-to-physicia4^dtfidentia%} feSalts pf the clinical ¦
analysis have not been released to public health agencies;1;'-
Background and Agencies Involved:
In 1992, an Oak Ridge physician reported that he believed apgc<).^|ij3tely 60 of his patients had
experienced occupational and environmental exposuresito severakheavy metals. He felt that these
exposures had resulted in increased cancer, immunosuppression, aod aatoimmune disease. At the
request of Howard Frumkin, MD, DrPH, Emojy UMv^ity.School oflPpblic Health, ATSDR and
NCEH facilitated clinical laboratory support fcy the NOEfiEftyironmerital Health Laboratory for
patients referred by the Oak Ridge physidati.
Time Line
Clinical laboratory support vyas ipjvided
and. 1993
:::: •
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4.3.4 Health Statistics Review of ALS and MS Mortality Rates
Purpose:
The purpose of this review was to find the incidence and mortality rate of amyotrophic lateral
sclerosis (ALS) and multiple sclerosis (MS) in the counties around Oak Ridge and to compare the
background rate in the United States.
Findings: >
It is impossible to find the incidence rate because these diseases are no^ reportable
rates were not significantly different from rates in the rest.of the state.
Background and Agencies Involved:
In 1994, local residents reported an increase prevalenc#of AdS:and: ^iv-among community
members In consultation with Peru Thapa, MD from:;ManderbiltSchool of Medicine,
the TDH conducted a health statistics review ofAkS atld MS mortai%,:$tcs for select counties in
and the state of Tennessee. ATSDR also provided techria&i a$sistance to the TDH.
Time Line: 4-1'
The health statistics review was coHcf'ucted iri;l994.
:' .!£he mortality
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4.3.5 Public Presentation on ALS and MS
Purpose:
This presentation was conducted to provide the Oak Ridge Health Agreement Steering Panel
(ORHASP) and the general public with an overview of amyotrophic lateral sclerosis (ALS) and
multiple sclerosis (MS), and of epidemiologic studies.
Findings: 1
Dr. Kurland explained that there are three kinds of ALS: sporadic, g§oe£ic; aad Western Pacific.
He said that in the United States, 90% of ALS cases aresporadicatid 10% are genetic; He said
there are approximately 5,000 people per year in the Unit|3::S^|es who are diagnose&;wrth ALS.
He stated that researchers have not yet been able to identic#cluster of ALS for the following
reasons: 1) ALS is easy to misdiagnose; and 2) the incidef®^1$¦ approximately 2 ALS cases
per 100,000 people per year. He explained that if someone is g&ieficaily predisposed to having
ALS they will develop the disease if they live long.eaough and that tiereis no indication to
confirm a causal relationship between mercury expoSureaftd ALS artd.MS.
Dr. Kurland showed a video about his regjgarch in Guam a&diMicated that the Western Pacific
cases are probably attributed to a botanp toxin, /if'
Background and Agencies InvolvMM:
.v.v.-y.
In 1994, lqealfesidents reported an increase prevalence of amyotrophic lateral sclerosis (ALS)
and mul^pielijlitosis (MS):art)^rtg:CommuMf ::friembers. The TDH
sponsored Kurland, BfPH, a neuroepidemiologist and senior consultant with the
Mayo Clinic inlteshester, Minnesota t& give the presentation to the ORHASP and the general
public. ' ¦
Time 1Mb
Thii presentation was gf&e at the ORHASP public meeting on August 18, 1994.
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4.3.6 ORHASP: Feasibility of Epidemiologic Studies
Purpose:
This study was conducted to explore the feasibility of initiating meaningful, valid analytical
epidemiologic studies to address potential health concerns in the off-site populations of Oak
Ridge and its surrounding areas.
Findings:
See final report for complete listing of findings.
Background and Agencies Involved:
The Oak Ridge Health Agreement Steering Panel (ORHASP) r$^|tjized that there may be a
need to supplement findings of the main dose reconstruction studies as they are limited to
estimates of health risk in a given population. They w?efe;consideriQg adding epidemiologic
studies in the future to directly evaluate health o^tCCHMS^^he TDH ORH ASP commissioned
Puru B. Thapa, MD, MPH, Department of PSventive Me^cane at Viriderbilt University to
conduct this study. :4?"' ...
Time Line:
The study was released in July 1$96.
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4.3.7 Health Hazard Evaluation - Lockheed Martin Energy Systems, Inc. DOE Oak Ridge
at K-25 Site
Purpose:
The health hazard evaluation, which included a medical and environmental assessment, was
conducted to investigate reported releases of cyanide-containing compounds intQ;|£te work-
environment, chronic low level exposures, elevated levels of cyanide andtbiopyanate in the blood
and urine of workers, and health problems believed to be associated witfa'cyariide exposure.
Findings:
The results of the health hazard evaluation indicate that|:epjplpye.es at the East Tennessee
Technology Park were not occupationally exposed to hy^fOge& ^anide, cyanide salts, or a wide
variety of other compounds containing the cyanide ion. TMf£$ttU$:$l$o did not support a
relationship between the health problems reported by employeeS:^d ciirpnic occupational
cyanide intoxication. ..
Background and Agencies Involved:
A Lockheed Martin Energy Systems, lac1, employee requestfci assistance from ATSDR regarding
possible workplace exposure to cy.aai&f. ATSB& referredpie employee to NIOSH for a health
hazard evaluation. Hi-f"
NIOSH conducted the health hazard evaluation::® response to a confidential request from a group
of Lockh^iM&fti.n Energy: Sy&fetns, Inc. employees who work at the East Tennessee
Technology Pafk (formerly calfediOakRidge K-25 Site).
During the devdopmeatof the heaftkfcazard evaluation, ATSDR provided NIOSH with
backgroundiand historical4&itbfmation on the public health activities at the Oak Ridge
Reservation, names of exf^flslbr more information, a copy of the A TSDR Case Studies in
Environmental Medicine-r-*Ucyamde Toxicity", a copy of the "Toxicological Profile for
Cyaside", and a list of preliminary reference values for urine thiocyanate.
Tim&:;ldne:
Iri;^u^;:|996, a Lockheed Martin Energy Systems, Inc. employee requested assistance from
ATSDR. On January 29, 1996, NIOSI-j received the request for a health hazard evaluation.
Between February and June 1996 they made four site visits to conduct a medical and
environmental assessment. NIOSH released the health hazard evaluation in July 1996.
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4.3.8 Physician Health Education Program on Cyanide
Purpose:
The physician education program was conducted to provide information regarding the health
impacts of possible cyanide intoxication. In addition, the program was intended to assist
community health care providers in responding to health concerns expressed by employees
working at the East Tennessee Technology Park. \
Findings: :;;p ¦ ^ ^
1. ATSDR provided the employee and the local physicians with copies of
Studies in Environmental M'dicine—"Cyanide Tc).KicHy"iStfe NIOSH final health lazard
evaluation, and ATSDR public health statement for cyani-de,—-
2. ATSDR instituted a system through which local physicians cotilllliiake patient referrals to
the Association of Occupational and Environmeatal Clinics (AGBC).
3. ATSDR conducted an environmental health eduC$tiOtt:$sssion for physicians at the Methodist
Medical Center in Oak Ridge, Tennessee. The medical staff .ground rounds provided the
venue for conducting this session^ yiftch focused on assapiSg local physicians and other health
care providers in diagnosing and ^Mwering patients' questions about chronic and acute
cyanide intoxication.
Background tmd Agencies jnvc&ved:
In January 1996'a:l!feckheed Maft}8 Energy Systems, Inc. employee requested assistance from
ATSDR concerllffigBccupationa^^J^spre to cyanide. On January 29, 1996, NIOSH received the
request for a he^&^^d.evaluatiQa;;.Between February and June 1996 they made four site visits
to conduct.a medical and ^uyifonmerital assessment. NIOSH released the health hazard evaluation
in July.:10$6.
In.fpl!owing up on recommendations in the NIOSH health hazard evaluation, ATSDR conducted
a'p^ician health education session at the Methodist Medical Center in Oak Ridge, in
cooperation with the ^OEC, NIOSH, and the TDH. Lome Garrettson, MD, ABMT, Medical
Director of the Georgia Poison Control Center made a presentation at the grand round entitled
"Cyajiidf /Medication: Acute and Chronic."
Time Line:
The physician education program was held in August 1996.
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4.3.9 Presentation of the Utah Leukemia and Thyroid Disease Studies Related to Fallout
From the Nevada Test Site
Purpose:
This presentation was conducted to inform the Oak Ridge Health Agreement Steering Panel
(ORHASP) and the general public of the multiple studies related to the fall out frqiifthe Nevada
Test Site, including the study of leukemia and thyroid disease. .:
Findings:
Background and Agencies Involved
The TDH sponsored Joseph L. Lyon, MD,
at
Time line:
This presentation was give at.th|pRHASF:|&f>lic meeting on February 16, 1995
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4.3.10 Governor of Tennessee's Independent Panel on the DOE Toxic Substances Control
Act (TSCA) Incinerator at the East Tennessee Technology Park
Purpose:
The independent panel was appointed to review the operations of the DOE Toxic Substances
Control Act (TSCA) incinerator at the East Tennessee Technology Park to ensure.that the TSCA
incinerator is properly and legally operated, monitored, and protective of :humafc health and the
environment. In addition, the panel was charged with addressing the.cojjeecBS and issues raised
by the public about the TSCA incinerator.
Findings:
1. The TSCA incinerator facility and operating condifiOrtS- were in harmony with its permit
and had experienced few operating violations. Th& aiitioyrti:$f waste actually burned is a
small fraction of the volume that the incinerators designed ami permitted to process
The highest measured concentrations at the..sit«nionitors 'were:a:sfcll fraction of the
permissible levels and most pollutants measured were not primarily from the TSCA
incinerator. Since the incinerator is re:gulated:afi4:JH0iytored Sii'd the permissible levels of
pollutants in the environment are deemed adequate tajpmteet public health then the
TSCA incinerator is not a major-contributor to the illnesses seen in the Oak Ridge area.
2. Transportation of hazardous Substances to and fifttfn the DOE Oak Ridge facilities is
regulated and monitaredSy the US:jDepartme|i;of Transportation and the State of
Tennessee. The reec^&pf safety forisucksbtpments has be exemplary. There have been
on 'highway accid^tS:it3Vo|y:jng wastes being shipped to the TSCA incinerator. The
transportation of hazard^ls substances to the Oak Ridge TSCA incinerator and from the
Oak Ridge::Site Involves nsfes:!«®ltwithin those accepted on a daily basis in the
transportattpri.pfother hazardous materials, such as gasoline.
3. ..;The panel found are sick workers at the East Tennessee Technology Park and
sick residents in its vkanity. The panel also found that the areal distribution of affected
!i;;; workers and members of the public conforms to no pattern and that the reported diseases
: are not uniquely specific chemicals. The panel reported that it is not known whether the
-.incidence and types of illnesses reported are above normal or a statistical aberration. The
panel f^uad no specific causes for the illnesses suffered by workers and members of the
^.public or whether they are more numerous than the norm.
4. Many of the workers and members of the public were not stratified with the availability,
quality, and extent of medical care. Complaints reported to the panel include refusal of
doctors to accept patients, availability of specialist, lack of coverage of "pre-existing
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illnesses" for continuing workers with changing contractors, lack of medical care for non-
workers, and lack of responsiveness.
Background and Agencies Involved:
In response to a series of articles in the Tennessean concerning the impact of the incinerator upon
the health of workers at K-25 and hearings held at the Tennessee State General Aspmbly on the
illnesses in Oak Ridge and the transportation of hazardous waste through the state to the TSCA
incinerator, the governor appointed the independent panel of environmental scientists, engineers,
and occupational health professionals to investigate the op|p£tOns of fhe TSCA incinerator,
currently operated under contact for Doe by Lockheed Martin Energy Systems,.The panel . #
inspected the TSCA incinerator, investigated allegations at the East TennesseejTechndlogy Park,
visited the SEG incinerator, a.id held four meeting in Oak Ridge, Tennessee.
Time Line:
The panel was appointed in May 1997 and submitted the. final repon.tirJanaary 1998.
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4.3.11 Health Assessment of the East Tennessee Region, Second Edition
Purpose:
This assessment was conducted to evaluate the health status of the population, assess the
availability and utilization of health services, and develop priories in planning to use resources.
Findings:
Please refer to report.
Background and Agencies Involved:
In response to the Institute of Medicine's 1988 report oftthfe "Future of Public Health", in 1991
the Tennessee Public Health Association encouraged eaoJtr-sgiofi'Ofthe TDH to look at the
health status of the population, evaluate the availability&nd utiiiptton of health services, and
develop priories in planning to make the best use of.resources. Iri l^ceailter 1991, the East
Tennessee Region of the TDH released the fir st: edition 00A Health Assessment of the East
Tennessee Region", which included data generally froitvl^Mjto 1990. ^The second edition
included data generally from 1990 through :1995.
Time Line:
The report was released in 1996.1; r
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4.4 Issue 4 - Community Involvement
4.4.1 Oak Ridge Health Studies Bulletin
Purpose:
The Oak Ridge Health Studies Bulletin was published to provide the public information about the
Oak Ridge Health Studies.
Findings:
Background and Agencies Involved
The TDH published the bulletin.
Time line:
The bulletin was published from ???? through ????.
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4.4.2 Technical Workshops for Phase I of Oak Ridge Health Studies
Purpose:
Findings:
Background and Agencies Involved:
Time line:
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4.4.3 Community Feedback Sessions for Phase I of Oak Ridge Health Studies
Purpose:
Findings:
Background and Agencies Involved
Time line:
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Anxf
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4.4.4 Scarboro Meetings
Purpose:
Findings:
Background and Agencies Involved
Time line:
:;;P:
¦ "
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4.4.5 Knowledge, Attitude, and Beliefs Study
Purpose:
The purpose of this study was to survey the eight-county area surrounding Oak Ridge, Tennessee
(1) to investigate public perceptions and attitudes about environmental contamination and public
health problems related to the DOE Oak Ridge Reservation; (2) to ascertain the f&plic's level of
awareness and assessment of the Oak Ridge Health Agreement Steering jtanel^ancl (3) to make
recommendations for improving public outreach programs.
Findings:
See report for complete list of findings.
Background and Agencies Involved:
The Social Science Research Institute at the University .of Tennessee ln ICnoxville, Tennessee
conducted the study from October through Novefti&$t ii.$$3 for the T£|P,: the Oak Ridge Health
Agreement Steering Panel (ORHASP), and t&eLocai Oversight Cooynittee (LOC).
Time line: 17
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4.4.6 Community Diagnosis Status Report—Anderson County
Purpose:
This community diagnosis was conducted to analyze the health status of the community, evaluate
the health resources, services, and systems of care within the community, assess attitudes toward
community health services and issues, identify priorities, establish goals, and detq$pne the course
of action to improve the health status, and establish a baseline for measuring injpfovements over
time.
Findings:
Please see the report.
Background and Agencies Involved:
The Anderson County Health Council, in cooperation with the East Teri&essee Regional Office of
the TDH, identified Anderson County as a pilot twhty Ibr the comrrtMity diagnosis process. This
process included conducing a community survey^ revfewiflg various 4^ta sets, and evaluating
resources in the community to identify areas of concern tlMt could affect the health of Anderson
County citizens
Time Line:
The report was released in 1997;
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