OAK RIDGE RESERVATION (USDOE)
OAK RIDGE, ANDERSON COUNTY, TENNESSEE
VII. CHILDREN'S HEALTH CONSIDERATIONS
ATSDR recognizes that infants and children can be more sensitive to environmental
exposure than adults in communities faced with contamination of their water,
soil, air, or food. This sensitivity is a result of the following factors: (1)
children are more likely to be exposed to certain media (for example, soil or
surface water) because they play and eat outdoors; (2) children are shorter
than adults, which means that they can breathe dust, soil, and vapors close
to the ground; and (3) children are smaller; therefore, childhood exposure results
in higher doses of chemical exposure per body weight. Children can sustain permanent
damage if these factors lead to toxic exposure during critical growth stages.
As part of the ATSDR Child Health Initiative, ATSDR is committed to evaluating
the special interests of children at sites such as the ORR.
Children living near the ORR are exposed to small amounts of uranium in the
air they breathe, in the food they eat, and in the water they play in. However,
no cases have been reported where exposure to uranium is known to have caused
health effects in children (ATSDR 1999a). It is possible that if children were
exposed to very high amounts of uranium, they might have damage to their kidneys,
similar to what is seen in adults. However, the levels of uranium in the environment
surrounding ORR are too low to cause these kinds of health effects.
Studies of developmental effects in the offspring of uranium miners and millers
have not reported any chemical or radiological effects on the development of
humans. Very high doses of uranium in drinking water (far above any plausible
human exposure) can affect the development of the fetus in laboratory animals
(one study reported birth defects and another reported an increase in fetal
deaths). However, health scientists do not believe that uranium can cause these
problems in pregnant women who take in normal amounts of uranium from food and
water, or women who breathe the air around a hazardous waste site that contains
uranium (ATSDR 1999a). Therefore, based on the estimated uranium exposure to
people living near the Y-12 plant, ATSDR does not expect adverse health effects
to a fetus from Y-12 uranium releases.
Having thoroughly evaluated past public health activities and available current
environmental information, ATSDR has reached the following conclusions:
ATSDR concludes that off-site exposures to uranium released from the
Y-12 plant is not a health hazard. Past and current off-site exposures
to uranium are not at levels expected to cause adverse health effects for
either adults or children living near the Y-12 plant, including the city of
Oak Ridge and the Scarboro community. ATSDR has categorized the Y-12 uranium
releases as posing no apparent public health hazard from exposure to
uranium. That categorization means that people could be or were exposed, but
the level of exposure is not expected to result in adverse health effects
(definitions of ATSDR's public health categories are included in the glossary
in Appendix A).
Using the results of the Task 6 report, ATSDR evaluated past uranium
exposures (1944 to 1995) to communities near the Y-12 plant. Despite the
fact that the evaluation had several conservative aspects, its conclusion
was that exposure to uranium through both the inhalation and ingestion pathways
would result in doses below levels expected to cause adverse radiation and
chemical health effects. Therefore, past exposure to uranium poses no apparent
public health hazard.
The total past radiation dose from exposure to uranium via air, surface water,
and soil pathways was estimated to be 155 mrem over 70 years, which is well
below (32 times less than) the radiogenic cancer comparison value of 5,000 mrem
over 70 years. The approximate radiation dose of 2.2 mrem for the first year
dose is well below (45 times less than) the ATSDR MRL of 100 mrem/year for ionizing
radiation (see Figure 12).
Yearly estimated past air concentrations of uranium ranged from 2.1 ×
10-8 to 6.0 × 10-5 mg/m3, which are
less than 1% of the intermediate-duration inhalation MRL of 8 × 10-3
mg/m3 for insoluble forms of uranium (see Figure 9).
Yearly estimated past doses from exposure to uranium via all soil and
surface water exposure pathways ranged from 2.7 × 10-5
to 1.3 × 10-2 mg/kg/day. Those doses are less than the
dose (5 × 10-2 mg/kg/day) at which health effects (renal
toxicity) have been observed in rabbits, the mammalian species most sensitive
to uranium kidney toxicity (see Figure 8).
Using available environmental data, ATSDR evaluated current uranium exposures
(1995 to 2002) to residents living near the Y-12 plant. Exposure to uranium
through both the inhalation and ingestion pathways would result in doses well
below levels known to cause radiation and chemical health effects. Therefore,
current exposure to uranium poses no apparent public health hazard.
The current radiation dose from exposure to uranium through ingestion of
soil and vegetables and inhalation of air is 0.216 mrem, which is well below
(more than 23,000 times less than) the radiogenic cancer comparison value of
5,000 mrem over 70 years. The approximated radiation dose of 0.003 mrem for
the first-year dose is also well below (33,000 times less than) the ATSDR MRL
of 100 mrem/year for ionizing radiation (see Figure 12).
Average current uranium air concentrations were 5.4 × 10-11
mg/m3 in Scarboro and 1.4 × 10-10 mg/m3
in the city of Oak Ridge, well below (more than a million times less than)
the ATSDR intermediate-duration MRL of 8 × 10-3 mg/m3
for insoluble forms of uranium (see Figure 9).
The estimated uranium doses from ingestion of Scarboro soil (1.4 ×
10-5 mg/kg/day for a 6-year-old child) and vegetables grown in
Scarboro (3.9 × 10-5 mg/kg/day from Plot 46), as well as
both doses combined (5.3 × 10-5 mg/kg/day), are well below
(more than 37 times less than) the intermediate-duration oral MRL of 2.0
× 10-3 mg/kg/day (see Figure 8).
The total uranium mean concentrations in surface water from Scarboro ditches
(0.197 µg/L) and from off-site areas of Lower East Fork Poplar Creek
(12.8 µg/L) are well below ATSDR's health-based comparison value,
the EMEG, of 20 µg/L.
Having evaluated past public health activities and the available environmental
information, ATSDR recommends that the community be informed that ATSDR has
evaluated uranium releases from the Y-12 plant on the Oak Ridge Reservation
and has concluded that there is no apparent public health hazard associated
with past and current releases. ATSDR will work with the Oak Ridge Reservation
Health Effects Subcommittee to determine the best way to communicate the results
of the evaluation to the people in the community.
X. PUBLIC HEALTH ACTION PLAN
The public health action plan for the Oak Ridge Reservation (ORR) contains
a description of actions taken at the site and those to be taken at the site
following the completion of this public health assessment. The purpose of the
public health action plan is to ensure that this public health assessment not
only identifies potential and ongoing public health hazards, but also provides
a plan of action designed to mitigate and prevent adverse human health effects
resulting from exposure to harmful substances in the environment. The following
public health actions at the ORR are completed, ongoing, or planned:
In 1991, the Tennessee Department of Health (TDOH) began a two-phase research
project to determine whether environmental releases from ORR harmed people
who lived nearby. Phase I focused on assessing the feasibility of doing historical
dose reconstruction and identifying contaminants that were most likely to
have effects on public health. Phase II efforts included full dose reconstruction
analyses of iodine 131, mercury, polychlorinated biphenyls (PCBs), and radionuclides,
as well as a more detailed health effects screening analysis for releases
of uranium and other toxic substances (a summary can be found in the Oak
Ridge Dose Reconstruction Project Summary Report, Volume 7). Phase II
was completed in January 2000.
In 1992, the U.S. Department of Energy (DOE) conducted a Background Soil
Characterization Project in the area around Oak Ridge (DOE 1993).
In 1993, ATSDR evaluated public health issues related to past and present
releases into the creek from the Y-12 plant in a health consultation, Y-12
Weapons Plant Chemical Releases Into East Fork Poplar Creek (ATSDR 1993).
In 1996, ATSDR evaluated the current public health issues related to the past
and present releases into the Lower Watts Bar Reservoir from the ORR in a
Health Consultation on the Lower Watts Bar Reservoir (ATSDR 1996).
In 1997, the Centers for Disease Control and Prevention (CDC), the National
Center for Environmental Health (NCEH), TDOH, and the Scarboro Community Environmental
Justice Council conducted a study to determine whether rates of pediatric respiratory
illnesses were higher in Scarboro than elsewhere in the United States, and whether
exposure to various factors increased residents' risk for health problems (CDC
et al. 1998).
In 1998, the Environmental Sciences Institute at Florida Agricultural
and Mechanical University (FAMU), along with its contractual partners at the
Environmental Radioactivity Measurement Facility at Florida State University,
and the Bureau of Laboratories of the Florida Department of Environmental Protections,
as well as DOE subcontractors in the Neutron Activation Analysis Group at Oak
Ridge National Laboratory and the Jacobs Engineering Environmental Management
Team, sampled soil, sediment, and surface water from Scarboro to address community
concerns about environmental monitoring in the neighborhood (FAMU 1998).
In 2001, the U.S. Environmental Protection Agency (EPA) collected samples
of soil, sediment, and surface water from the Scarboro community to address
community concerns and verify the results of the 1998 sampling conducted by
FAMU (EPA 2003).
ATSDR will continue to evaluate contaminants and pathways of concern
to the community surrounding the reservation. In addition to this evaluation
of uranium from the Y-12 plant, ATSDR is evaluating uranium and fluorides from
the K-25 facility, iodine 131, mercury, White Oak Creek releases in the 1950s,
PCBs, the TSCA incinerator, and groundwater. ATSDR will also screen data from
1990 to the present to determine whether additional contaminants of concern
need to be addressed.
In 1986, DOE installed a continuous air monitoring station (Station
46) in the Scarboro community to provide quarterly and annual air measurements
of uranium 234, uranium 235, and uranium 238 (ChemRisk 1999). The station is
being operated by the Oak Ridge National Laboratory as part of the DOE ORR air
In 1999, the Oak Ridge Reservation Health Effects Subcommittee (ORRHES)
was created under the guidelines and rules of the Federal Advisory Committee
Act to provide a forum for communication and collaboration between citizens
and the agencies that are evaluating public health issues and conducting public
health activities at the ORR. The ORRHES serves as a citizen advisory group
to CDC and ATSDR and provides recommendations on matters related to public health
activities and research at the reservation. It also provides an opportunity
for citizens to collaborate with agency staff members, to learn more about the
public health assessment process and other public health activities, and to
help prioritize public health issues and community concerns to be evaluated
In 2004, ATSDR will conduct additional community involvement activities,
such as health education, to provide the public with the results of the public
health assessment on uranium releases from the Y-12 Plant. Past releases were
not a public health hazard to people living near the reservation, and current
releases are not a public health hazard to people living near the reservation.
XI. PREPARERS OF REPORT
Jack E. Hanley, M.P.H.
Environmental Health Scientist
Division of Health Assessment and Consultation
Agency for Toxic Substances and Disease Registry
Paul A. Charp, Ph.D.
Senior Health Physicist
Division of Health Assessment and Consultation
Agency for Toxic Substances and Disease Registry
Mark Evans, Ph.D.
Division of Health Assessment and Consultation
Agency for Toxic Substances and Disease Registry
Michelle Arbogast, M.S.
Eastern Research Group
Agency for Toxic Substances and Disease Registry (ATSDR). 1993a. ATSDR record
of activity for telephone communication with a representative from the Tennessee
Department of Environment and Conservation. January 26, 1993.
Agency for Toxic Substances and Disease Registry (ATSDR). 1993b. Health consultation
for U.S. DOE Oak Ridge Reservation: Y-12 Weapons Plant Chemical Releases Into
East Fork Poplar Creek, Oak Ridge, Tennessee. April 5, 1993.
Agency for Toxic Substances and Disease Registry (ATSDR). 1996. Health consultation
for U.S. DOE Oak Ridge Reservation: proposed mercury clean-up level for the
East Fork Poplar Creek floodplain soil, Oak Ridge, Anderson County, Tennessee.
Atlanta: U.S. Department of Health and Human Services.
Agency for Toxic Substances and Disease Registry, National Center for Environmental
Health, National Institute for Occupational Safety and Health, Tennessee Department
of Health, Tennessee Department of Environment and Conservation, U.S. Department
of Energy. 2000. Compendium of public health activities at the U.S. Department
of Energy. Atlanta: U.S. Department of Health and Human Services. Available
from URL: http://www.atsdr.cdc.gov/HAC/oakridge/phact/c_toc.html.
Carden D, Joseph T. 1998. Aerial radiological surveys of the Scarboro community.
U.S. DOE, Oak Ridge Operations.
Cardis E, Gilbert ES, Carpenter L, Howe G, Kato I, Armstrong BK, Beral V, Cowper
G, Douglas A, Fix J, et al. 1995. Effects of low doses and low dose rates of
external ionizing radiation: cancer mortality among nuclear industry workers
in three countries. Radiation research 142:117-32.
Centers for Disease Control and Prevention (CDC), National Center for Environmental
Health, the Tennessee Department of Health, and the Scarboro Community Environmental
Justice Council. 1998. An analysis of respiratory illnesses among children in
the Scarboro community. Atlanta: U.S. Department of Health and Human Services.
ChemRisk. 1993a. Oak Ridge health studies, phase 1 report. volume II part
a dose reconstruction feasibility study. tasks 1 & 2: a summary of
historical activities on the Oak Ridge Reservation with emphasis on information
concerning off-site emissions of hazardous materials. Oak Ridge: Oak Ridge Health
Agreement Steering Panel and Tennessee Department of Health.
ChemRisk. 1993b. Oak Ridge health studies, phase 1 report. volume II part
b dose reconstruction feasibility study. tasks 3 & 4: identification
of important environmental pathways for materials released from Oak Ridge Reservation.
Oak Ridge: Oak Ridge Health Agreement Steering Panel and Tennessee Department
ChemRisk. 1993c. Oak Ridge health studies, phase 1 report. volume II part
c dose reconstruction feasibility study. Task 5: A summary of information
concerning historical locations and activities of populations potentially affected
by releases from the Oak Ridge Reservation. Oak Ridge: Tennessee Department
of Health and the Oak Ridge Health Agreement Steering Panel.
ChemRisk. 1999. Uranium releases from the Oak Ridge Reservationa review
of the quality of historical effluent monitoring data and a screening evaluation
of potential off-site exposures, task 6. Report of the Oak Ridge Dose reconstruction,
volume 5. Oak Ridge: Tennessee Department of Health.
Florida Agricultural and Mechanical University (FAMU). 1998. Scarboro Community
Friday JC, Turner RL. 2001. Scarboro community assessment report. Joint Center
for Political and Economic Studies. August 2001.
GAO see U.S. General Accounting Office
Harrison JD, Leggett RW, Nosske D, Paquet F, Phipps AW, Taylor DM, Metivier
H. 2001. Reliability of the ICRP's dose coefficients for members of the public,
ii. uncertainties in the absorption of ingested radionuclides and the effect
on dose estimates. New York: International Commission on Radiological Protection.
Radiat Prot Dosim 95(4)295-308.
International Commission on Radiological Protection (ICRP). 1990. Age-dependent
doses to members of the public from intake of radionuclides: Part 1. ICRP Publication
56. New York: Pergamon Press.
International Commission on Radiological Protection (ICRP). 1991. 1990 recommendations
of the International Commission on Radiological Protection. ICRP Publication
60. New York: Pergamon Press.
Joint Center for Political and Economic Studies. Environmental and health summaries
for the Scarboro community. An analysis of respiratory illness among children
in the Scarboro community. Number 4. Oak Ridge.
Kendall GM, Muirhead CR, MacGibbon BH, O'Hagan JA, Conquest AJ, Goodill AA,
Butland BK, Fell TP, Jackson DA, Webb MA. 1992. Mortality and occupational exposure
to radiation: first analysis of the National Registry for Radiation Workers
Leggett RW. 2001. Reliability of the ICRP's dose coefficient for members of
the public. 1. sources of uncertainty in the biokinetic models. International
Commission on Radiological Protection. Radiat. Prot. Dosim. 95(3):199-213.
Los Alamos National Laboratory. 2000. Uranium uptake study, Nambe, New Mexico:
Source document. Los Alamos, New Mexico. LA-13614-MS.
Maurer RJ. 1989. An Aerial Radiological Survey of the Oak Ridge Reservation
and Surrounding Area. Washington, DC. Report No. EGG-10617-1123. EG&G/EM.
National Council on Radiation Protection and Measurements (NCRP). 1999. Recommended
screening limits for contaminated surface soil and review of factors relevant
to site-specific studies. Report 129. Bethesda, Maryland: National Council on
Radiation Protection and Measurements.
National Council on Radiation Protection and Measurements (NCRP). 2001. Evaluation
of the linear-nonthreshold dose-response model for ionizing radiation. NCRP
Report 136. Bethesda, Maryland: National Council on Radiation Protection and
National Research Council (NRC). 1988. Health risks of radon and other internally
deposited alpha emitters. Washington, DC: National Research Council.
Oak Ridge Comprehensive Plan. 1988. Comprehensive plan including 1988 update.
Available from the Oak Ridge Reading Room, Oak Ridge Public Library, Oak Ridge
Oak Ridge Health Agreement Steering Panel (ORHASP). 1999. Releases of contaminants
from Oak Ridge facilities and risks to public health. Final report of the ORHASP.
Prichard HM. 1998. Scarboro community sampling results: implications for task
6 environmental projections and assumptions. Knoxville: Auxier & Associates.
November 9, 1998.
Roman E, Doyle P, Maconochie N, Davies G, Smith PG, Beral V. 1999. Cancer in
children of nuclear industry employees: report on children aged under 25 years
from nuclear industry family study. BMJ. 318(7196):1443-50.
SAIC 2002. Land use technical report. Science Applications International Corporation.
Storms R, Rector D. 1997. Radiological survey of Clinch River public parks
and recreational areas from Melton Hill Dam to Kingston. TDEC/ORO3/20/97.
Stranden E. 1985. Sources of exposure to technological enhanced natural radiation.
Science of the Total Environment. 45:27-45.
Teasley N. 1995. Deer Hunt Radiation Monitoring Guidelines. ORNL Chemical and
Analytical Science Division. January 17, 1995.
Tennessee Department of Health (TDOH). 2000. Contaminant releases and public
health risks: results of the Oak Ridge health agreement studies. July 2000.
U.S. Census Bureau. 2000. Census of population and housing: summary tape file.
Washington DC: U.S. Department of Commerce.
U.S. Department of Energy (DOE). 1989. Oak Ridge Reservation environmental
report for 1988. vol. 1: narrative, summary, and conclusions. Oak Ridge, Tennessee:
U.S. Department of Energy, Office of Scientific and Technical Information.
U.S. Department of Energy (DOE). 1993. Final report on the background soil
characterization project at the Oak Ridge Reservation, Oak Ridge, Tennessee.
Volume 1- Results of field sampling program. DOE/OR/01-1175/V1. October 1993.
U.S. Department of Energy (DOE). 1995a. Record of decision for Lower East Fork
Poplar Creek, Oak Ridge, Tennessee. U.S. Department of Energy, Office of Environmental
Management. July 1995.
U.S. Department of Energy (DOE). 1995b. Oak Ridge Reservation annual site report
for 1994. environmental, safety, and health compliance and environmental management
staffs of the Oak Ridge Y-12 plant, Oak Ridge National Laboratory, and Oak Ridge
K-25 site. October 1995.
U.S. Department of Energy (DOE). 2001. Overview of CERCLA actions at off-site
locations. Environmental Management Program fact sheet. September 2001.
U.S. Department of Energy (DOE). 2002a. 2002 Remediation Effectiveness Report
for the U.S. Department of Energy Oak Ridge Reservation, Oak Ridge, Tennessee.
Prepared by SAIC. March 2002.
U.S. Department of Energy (DOE). 2002b. Record of decision for phase I interim
source control actions in the Upper East Fork Poplar Creek Characterization
Area, Oak Ridge, Tennessee. U.S. Department of Energy, Office of Environmental
Management. May 2002.
U.S. Department of Energy (DOE). 2002c. Oak Ridge Reservation Annual Site Environmental Report for 2002. September 2003. Available from URL: http://www.ornl.gov/Env_Rpt/ .
U.S. Department of Energy (DOE). 2003. Boneyard/Burnyard Waste Site Cleanup.
Environmental Management Program fact sheet. April 2003.
U.S. Environmental Protection Agency (EPA). 1988. Limiting values of radionuclide
intake and air concentration and dose conversion factors for inhalation, submersion,
and ingestion. Federal Guidance Report No. 11. Washington, DC: U.S. Environmental
U.S. Environmental Protection Agency (EPA). 1989. Toxicological review of uranium,
soluble salts. Integrated Risk Information System. Washington, DC. October 1,
1989. Available from URL: http://www.epa.gov/iris/subst/0421.htm .
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in air, water, and soil. Federal Guidance Report No. 12. Washington, DC.
U.S. Environmental Protection Agency (EPA). National Primary Drinking Water
Regulations, Part II: Radionuclides; Final Rule. Federal Register, 65 (236):
76712-15; Government Printing Office, Washington, DC; December 7, 2000.
U.S. Environmental Protection Agency (EPA). 2002a. Tennessee NPL/NPL caliber
cleanup site summaries. U.S. DOE Oak Ridge Reservation, Oak Ridge, Anderson
County, Tennessee. Available from URL: http://www.epa.gov/region4/waste/npl/npltn/oakridtn.htm
(last updated 10/15/02; accessed 10/16/2002).
U.S. Environmental Protection Agency (EPA). 2003. September 2001 sampling report
for the Scarboro community, Oak Ridge, Tennessee. Athens, Georgia. April 2003.
U.S. Environmental Protection Agency (EPA), Region III. 2003. October 2003
Update. Updated Risk Based Concentration Table Cover Memo. October 15, 2003.
Available from the following URL: http://www.epa.gov/reg3hwmd/risk/cov1003.htm .
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Domenici, U.S Senate. June 2000 radiation standards: scientific basis inconclusive,
and EPA and NRC disagreement continues. GAO/RCED-00-152.
APPENDIX A: ATSDR GLOSSARY OF ENVIRONMENTAL HEALTH TERMS
The Agency for Toxic Substances and Disease Registry (ATSDR) is a federal public
health agency with headquarters in Atlanta, Georgia, and 10 regional offices
in the United States. ATSDR's mission is to serve the public by using the best
science, taking responsive public health actions, and providing trusted health
information to prevent harmful exposures and diseases related to toxic substances.
ATSDR is not a regulatory agency, unlike the U.S. Environmental Protection Agency
(EPA), which is the federal agency that develops and enforces environmental
laws to protect the environment and human health.
This glossary defines words used by ATSDR in communications with the public.
It is not a complete dictionary of environmental health terms. If you have questions
or comments, call ATSDR's toll-free telephone number, 1-888-42-ATSDR (1-888-422-8737).
The process of taking in. For a person or animal, absorption is
the process through which a substance gets into the body through the eyes,
skin, stomach, intestines, or lungs.
The number of radioactive nuclear transformations occurring in a material
per unit time. The term for activity per unit mass is specific activity.
Occurring over a short time [compare with chronic].
Contact with a substance that occurs once or for only a short time (up
to 14 days) [compare with intermediate-duration exposure and chronic
Adverse health effect:
A change in body function or cell structure that might lead to disease
or health problems.
Surrounding (for example, ambient air).
Analytic epidemiologic study:
A study that evaluates the association between exposure to hazardous substances
and disease by testing scientific hypotheses.
An average or expected amount of a substance or radioactive material in
a specific environment, or typical amounts of substances that occur naturally
in an environment.
The amount of radiation to which a member of the general population is
exposed from natural sources, such as terrestrial radiation from naturally
occurring radionuclides in the soil, cosmic radiation originating from
outer space, and naturally occurring radionuclides deposited in the human
Plants and animals in an environment. Some of these plants and animals
might be sources of food, clothing, or medicines for people.
The total amount of a substance in the body. Some substances build up in
the body because they are stored in fat or bone or because they leave the
body very slowly.
Any one of a group of diseases that occurs when cells in the body become
abnormal and grow or multiply out of control.
A theoretical risk of for getting cancer if exposed to a substance every
day for 70 years (a lifetime exposure). The true risk might be lower.
A substance that causes cancer.
A study that compares exposures of people who have a disease or condition
(cases) with people who do not have the disease or condition (controls). Exposures
that are more common among the cases may be considered as possible risk factors
for the disease.
Central nervous system:
The part of the nervous system that consists of the brain and the spinal
[See Comprehensive Environmental Response, Compensation, and Liability
Act of 1980.]
Occurring over a long time (more than 1 year) [compare with acute].
Contact with a substance that occurs over a long time (more than 1 year)
[compare with acute exposure and intermediate-duration exposure].
Committed Effective Dose Equivalent (CEDE):
The sum of the products of the weighting factors applicable to each of
the body organs or tissues that are irradiated and the committed dose equivalent
to the organs or tissues. The committed effective dose equivalent is
used in radiation safety because it implicitly includes the relative carcinogenic
sensitivity of the various tissues. The unit of dose for the CEDE is the rem
(or, in SI units, the sievert1 sievert equals 100 rem.)
Comparison value (CV):
Calculated concentration of a substance in air, water, food, or soil that
is unlikely to cause harmful (adverse) health effects in exposed people. The
CV is used as a screening level during the public health assessment process.
Substances found in amounts greater than their CVs might be selected for further
evaluation in the public health assessment process.
Completed exposure pathway:
[See exposure pathway.]
Comprehensive Environmental Response, Compensation, and Liability Act
of 1980 (CERCLA):
CERCLA, also known as Superfund, is the federal law that
concerns the removal or cleanup of hazardous substances in the environment
and at hazardous waste sites. ATSDR, which was created by CERCLA, is
responsible for assessing health issues and supporting public health activities
related to hazardous waste sites or other environmental releases of hazardous
The amount of a substance present in a certain amount of soil, water, air,
food, blood, hair, urine, breath, or any other medium.
A substance that is either present in an environment where it does not
belong or is present at levels that might cause harmful (adverse) health effects.
A unit of radioactivity. One curie equals that quantity of radioactive
material in which there are 3.7 × 1010 nuclear transformations
per second. The activity of 1 gram of radium is approximately 1 Ci; the activity
of 1.46 million grams of natural uranium is approximately 1 Ci.
Decay product/daughter product/progeny:
A new nuclide formed as a result of radioactive decay: from the radioactive
transformation of a radionuclide, either directly or as the result of successive
transformations in a radioactive series. A decay product can be either
radioactive or stable.
Depleted uranium (DU):
Uranium having a percentage of U 235 smaller than the 0.7% found in natural
uranium. It is obtained as a byproduct of U 235 enrichment.
Referring to the skin. For example, dermal absorption means passing
through the skin.
Contact with (touching) the skin [see route of exposure].
The study of the amount and distribution of a disease in a specified population
by person, place, and time.
The lowest concentration of a chemical that can reliably be distinguished
from a zero concentration.
A system of ongoing registration of all cases of a particular disease or
health condition in a defined population.
The United States Department of Energy.
Dose (for chemicals that are not radioactive):
The amount of a substance to which a person is exposed over some time period.
Dose is a measurement of exposure. Dose is often expressed as
milligrams (a measure of quantity) per kilogram (a measure of body weight)
per day (a measure of time) when people eat or drink contaminated water, food,
or soil. In general, the greater the dose, the greater the likelihood
of an effect. An "exposure dose" is how much of a substance is encountered
in the environment. An "absorbed dose" is the amount of a substance that actually
gets into the body through the eyes, skin, stomach, intestines, or lungs.
Dose (for radioactive chemicals):
The radiation dose is the amount of energy from radiation that is
actually absorbed by the body. This is not the same as measurements of the
amount of radiation in the environment.
The relationship between the amount of exposure [dose] to a substance
and the resulting changes in body function or health (response).
Environmental Media Evaluation Guide, a media-specific comparison value
that is used to select contaminants of concern. Levels below the EMEG are
not expected to cause adverse noncarcinogenic health effects.
Uranium in which the abundance of the U 235 isotope is increased above
Soil, water, air, biota (plants and animals), or any other parts
of the environment that can contain contaminants.
Environmental media and transport mechanism:
Environmental media include water, air, soil, and biota (plants
and animals). Transport mechanisms move contaminants from the source
to points where human exposure can occur. The environmental media and transport
mechanism is the second part of an exposure pathway.
The United States Environmental Protection Agency.
The ongoing, systematic collection, analysis, and interpretation of health
data. This activity also involves timely dissemination of the data and use
for public health programs.
The study of the distribution and determinants of disease or health status
in a population; the study of the occurrence and causes of health effects
In a radioactive series, the state that prevails when the ratios between
the activities of two or more successive members of the series remain constant.
Contact with a substance by swallowing, breathing, or touching the skin
or eyes. Exposure can be short-term [see acute exposure], of
intermediate duration [see intermediate-duration exposure], or long-term
[see chronic exposure].
The process of finding out how people come into contact with a hazardous
substance, how often and for how long they are in contact with the substance,
and how much of the substance they are in contact with.
A method of estimating the amount of people's past exposure to hazardous
substances. Computer and approximation methods are used when past information
is limited, not available, or missing.
The collection and analysis of site-specific information and biological
tests (when appropriate) to determine whether people have been exposed to
The route a substance takes from its source (where it began) to its end
point (where it ends), and how people can come into contact with (or get exposed
to) it. An exposure pathway has five parts: a source of contamination
(such as an abandoned business); an environmental media and transport mechanism
(such as movement through groundwater); a point of exposure
(such as a private well); a route of exposure (eating, drinking, breathing,
or touching), and a receptor population (people potentially or actually
exposed). When all five parts are present, the exposure pathway is
termed a completed exposure pathway.
A system of ongoing follow up of people who have had documented environmental
A study by EPA to determine the best way to clean up environmental contamination.
A number of factors are considered, including health risk, costs, and what
methods will work well.
Training sessions for physicians and other health care providers about
Water beneath the earth's surface in the spaces between soil particles
and between rock surfaces [compare with surface water].
The time it takes for half the original amount of a substance to disappear.
In the environment, the half-life is the time it takes for half the
original amount of a substance to disappear when it is changed to another
chemical by bacteria, fungi, sunlight, or other chemical processes. In the
human body, the half-life is the time it takes for half the original
amount of the substance to disappear either by being changed to another substance
or by leaving the body. In the case of radioactive material, the half-life
is the amount of time necessary for one half the initial number of radioactive
atoms to change or transform into other atoms (normally not radioactive).
After two half-lives, 25% of the original number of radioactive atoms
A source of potential harm from past, current, or future exposures.
Potentially harmful substances that have been released or discarded into
A review of available information or collection of new data to respond
to a specific health question or request for information about a potential
environmental hazard. Health consultations are focused on a specific
exposure issue. They are therefore more limited than public health assessments,
which review the exposure potential of each pathway and chemical [compare
with public health assessment].
Programs designed with a community to help it know about health risks and
how to reduce these risks.
The collection and evaluation of information about the health of community
residents. This information is used to describe or count the occurrence of
a disease, symptom, or clinical measure and to estimate the possible association
between the occurrence and exposure to hazardous substances.
Health statistics review:
The analysis of existing health information (i.e., from death certificates,
birth defects registries, and cancer registries) to determine if there is
excess disease in a specific population, geographic area, and time period.
A health statistics review is a descriptive epidemiologic study.
Indeterminate public health hazard:
The category used in ATSDR's public health assessment documents when a
professional judgment about the level of health hazard cannot be made because
information critical to such a decision is lacking.
The number of new cases of disease in a defined population over a specific
time period [contrast with prevalence].
The act of swallowing something through eating, drinking, or mouthing objects.
A hazardous substance can enter the body this way [see route of exposure].
The act of breathing. A hazardous substance can enter the body this way
[see route of exposure].
Contact with a substance that occurs for more than 14 days and less than
a year [compare with acute exposure and chronic exposure].
Any radiation capable of knocking electrons out of atoms and producing
ions. Examples: alpha, beta, gamma and x rays, and neutrons.
Nuclides having the same number of protons in their nuclei, and hence the
same atomic number, but differing in the number of neutrons, and therefore
in the mass number. Identical chemical properties exist in isotopes
of a particular element. The term should not be used as a synonym for "nuclide,"
because "isotopes" refers specifically to different nuclei of the same element.
Lowest-observed-adverse-effect level (LOAEL):
The lowest tested dose of a substance that has been reported to cause harmful
(adverse) health effects in people or animals.
The conversion or breakdown of a substance from one form to another by
a living organism.
Milligrams per kilogram.
Milligrams per cubic meter: a measure of the concentration of a chemical
in a known volume (a cubic meter) of air, soil, or water.
Moving from one location to another.
Minimal risk level (MRL):
An ATSDR estimate of daily human exposure to a hazardous substance at or
below which that substance is unlikely to pose a measurable risk of harmful
(adverse), noncancerous effects. MRLs are calculated for a route of
exposure (inhalation or oral) over a specified time period (acute, intermediate,
or chronic). MRLs should not be used as predictors of harmful (adverse)
health effects [see reference dose].
Death. Usually the cause (a specific disease, condition, or injury) is
A substance that causes mutations (genetic damage).
A change (damage) to the DNA, genes, or chromosomes of living organisms.
National Priorities List for Uncontrolled Hazardous Waste Sites (National
Priorities List or NPL):
EPA's list of the most serious uncontrolled or abandoned hazardous
waste sites in the United States. The NPL is updated on a regular basis.
No apparent public health hazard:
A category used in ATSDR's public health assessments for sites where human
exposure to contaminated media might be occurring, might have occurred in
the past, or might occur in the future, but is not expected to cause any harmful
No-observed-adverse-effect level (NOAEL):
The highest tested dose of a substance that has been reported to have no
harmful (adverse) health effects on people or animals.
No public health hazard:
A category used in ATSDR's public health assessment documents for sites
where people have never and will never come into contact with harmful amounts
of site-related substances.
[See National Priorities List for Uncontrolled Hazardous Waste Sites.]
A radionuclide which, upon disintegration, yields a new nuclide, either
directly or as a later member of a radioactive series.
A volume of a substance that moves from its source to places farther away
from the source. Plumes can be described by the volume of air or water
they occupy and the direction in which they move. For example, a plume
can be a column of smoke from a chimney or a substance moving with groundwater.
Point of exposure:
The place where someone can come into contact with a substance present
in the environment [see exposure pathway].
A group or number of people living within a specified area or sharing similar
characteristics (such as occupation or age).
Parts per billion.
Parts per million.
The number of existing disease cases in a defined population during a specific
time period [contrast with incidence].
Actions that reduce exposure or other risks, keep people from getting sick,
or keep disease from getting worse.
Public comment period:
An opportunity for the public to comment on agency findings or proposed
activities contained in draft reports or documents. The public comment period
is a limited time period during which comments will be accepted.
Public health action plan:
A list of steps to protect public health.
Public health advisory:
A statement made by ATSDR to EPA or a state regulatory agency that a release
of hazardous substances poses an immediate threat to human health. The advisory
includes recommended measures to reduce exposure and reduce the threat to
Public health assessment (PHA):
An ATSDR document that examines hazardous substances, health outcomes,
and community concerns at a hazardous waste site to determine whether people
could be harmed by coming into contact with those substances. The PHA also
lists actions that need to be taken to protect public health [compare with
Public health hazard:
A category used in ATSDR's public health assessments for sites that pose
a public health hazard because of long-term exposures (greater than 1 year)
to sufficiently high levels of hazardous substances or radionuclides
that could result in harmful health effects.
Public health hazard categories:
Statements about whether people could be harmed by conditions present at
the site in the past, present, or future. One or more hazard categories might
be appropriate for each site. The five public health hazard categories
are no public health hazard, no apparent public health hazard, indeterminate
public health hazard, public health hazard, and urgent public health
Public health statement:
The first chapter of an ATSDR toxicological profile. The public
health statement is a summary written in words that are easy to understand.
It explains how people might be exposed to a specific substance and describes
the known health effects of that substance.
A public forum with community members for communication about a site.
Quality factor (radiation weighting factor):
The linear-energy-transfer-dependent factor by which absorbed doses are
multiplied to obtain (for radiation protection purposes) a quantity that expresses
- on a common scale for all ionizing radiation - the approximate biological
effectiveness of the absorbed dose.
The unit of absorbed dose equal to 100 ergs per gram, or 0.01 joules per
kilogram (0.01 gray) in any medium [see dose].
The emission and propagation of energy through space or through a material
medium in the form of waves (e.g., the emission and propagation of electromagnetic
waves, or of sound and elastic waves). The term "radiation" (or "radiant energy"),
when unqualified, usually refers to electromagnetic radiation. Such
radiation commonly is classified according to frequency, as microwaves,
infrared, visible (light), ultraviolet, and x and gamma rays and, by extension,
corpuscular emission, such as alpha and beta radiation, neutrons, or
rays of mixed or unknown type, such as cosmic radiation.
Material containing radioactive atoms.
Spontaneous nuclear transformations that result in the formation of new
elements. These transformations are accomplished by emission of alpha or beta
particles from the nucleus or by the capture of an orbital electron. Each
of these reactions may or may not be accompanied by a gamma photon.
An unstable or radioactive isotope (form) of an element that can change
into another element by giving off radiation.
Any radioactive isotope (form) of any element.
Risk-based Concentration, a contaminant concentration that is not expected
to cause adverse health effects over long-term exposure.
[See Resource Conservation and Recovery Act (1976, 1984).]
People who could come into contact with hazardous substances [see exposure
Reference dose (RfD):
An EPA estimate, with uncertainty or safety factors built in, of the daily
lifetime dose of a substance that is unlikely to cause harm in humans.
A unit of dose equivalent that is used in the regulatory, administrative,
and engineering design aspects of radiation safety practice. The dose equivalent
in rem is numerically equal to the absorbed dose in rad multiplied
by the quality factor (1 rem is equal to 0.01 sievert).
The CERCLA process of determining the type and extent of hazardous material
contamination at a site.
Resource Conservation and Recovery Act (1976, 1984) (RCRA):
This act regulates management and disposal of hazardous wastes currently
generated, treated, stored, disposed of, or distributed.
[See reference dose.]
The probability that something will cause injury or harm.
Route of exposure:
The way people come into contact with a hazardous substance. Three routes
of exposure are breathing [inhalation], eating or drinking [ingestion],
and contact with the skin [dermal contact].
[See uncertainty factor.]
A portion or piece of a whole; a selected subset of a population or subset
of whatever is being studied. For example, in a study of people the sample
is a number of people chosen from a larger population [see population].
An environmental sample (for example, a small amount of soil or water)
might be collected to measure contamination in the environment at a specific
The SI unit of any of the quantities expressed as dose equivalent. The
dose equivalent in sieverts is equal to the absorbed dose, in gray, multiplied
by the quality factor (1 sievert equals 100 rem).
A liquid capable of dissolving or dispersing another substance (for example,
acetone or mineral spirits).
Source of contamination:
The place where a hazardous substance comes from, such as a landfill, waste
pond, incinerator, storage tank, or drum. A source of contamination
is the first part of an exposure pathway.
People who might be more sensitive or susceptible to exposure to hazardous
substances because of factors such as age, occupation, sex, or behaviors (for
example, cigarette smoking). Children, pregnant women, and older people are
often considered special populations.
Radioactivity per unit mass of material containing a radionuclide, expressed,
for example, as Ci/gram or Bq/gram.
A person, group, or community who has an interest in activities at a hazardous
A branch of mathematics that deals with collecting, reviewing, summarizing,
and interpreting data or information. Statistics are used to determine whether
differences between study groups are meaningful.
Water on the surface of the earth, such as in lakes, rivers, streams, ponds,
and springs [compare with groundwater].
[see epidemiologic surveillance]
A systematic collection of information or data. A survey can be
conducted to collect information from a group of people or from the environment.
Surveys of a group of people can be conducted by telephone, by mail,
or in person. Some surveys are done by interviewing a group of people.
An ATSDR document that examines, summarizes, and interprets information
about a hazardous substance to determine harmful levels of exposure and associated
health effects. A toxicological profile also identifies significant
gaps in knowledge on the substance and describes areas where further research
The study of the harmful effects of substances on humans or animals.
A mathematical adjustment for reasons of safety when knowledge is incompletefor
example, a factor used in the calculation of doses that are not harmful (adverse)
to people. These factors are applied to the lowest-observed-adverse-effect-level
(LOAEL) or the no-observed-adverse-effect-level (NOAEL) to derive a minimal
risk level (MRL). Uncertainty factors are used to account for variations
in people's sensitivity, for differences between animals and humans, and for
differences between a LOAEL and a NOAEL. Scientists use uncertainty factors
when they have some, but not all, the information from animal or human studies
to decide whether an exposure will cause harm to people [also sometimes called
a safety factor].
1 disintegration per second = 2.7 ×10-11 Ci
3.7 ×1010 disintegrations per second = 3.7 ×
1 J/kg = 100 rad
100 erg/g = 0.01 Gy
*International Units, designated (SI)
Urgent public health hazard:
A category used in ATSDR's public health assessments for sites where short-term
exposures (less than 1 year) to hazardous substances or conditions could result
in harmful health effects that require rapid intervention.
APPENDIX B: SUMMARY OF OTHER PUBLIC HEALTH ACTIVITIES
Summary of ATSDR Activities
Exposure Investigations, Health Consultations, and Other Scientific Evaluations.
ATSDR health scientists have addressed current public health issues and community
health concerns related to two areas affected by Oak Ridge Reservation (ORR)
operationsthe East Fork Poplar Creek (EFPC) area and the Watts Bar Reservoir
Following are summaries of other ATSDR public health activities involving EFPC:
Health Consultation on Proposed Mercury Cleanup Levels, January 1996.
In response to a request from community members and the city of Oak Ridge,
ATSDR evaluated the public health impact of the U.S. Department of Energy's
(DOE's) cleanup levels of 180 milligrams per kilogram (mg/kg) and 400 mg/kg
of mercury in the EFPC floodplain soil. ATSDR concluded that the cleanup levels
of 180 mg/kg and 400 mg/kg of mercury in the soil of the EFPC floodplain would
be protective of public health and pose no health threat to adults or children.
ATSDR Science Panel Meeting on the Bioavailability of Mercury in Soil,
August 1995. The purpose of the science panel was to identify methods
and strategies that would enable health assessors to develop data-supported,
site-specific estimates of the bioavailability of inorganic mercury and other
metals (arsenic and lead) from soils. The panel consisted of private consultants
and academicians internationally known for their metal bioavailability research
along with experts from ATSDR, the Centers for Disease Control and Prevention
(CDC), the U.S. Environmental Protection Agency (EPA), and the National Institute
for Environmental Health Science. ATSDR used information obtained from the
panel meeting to evaluate the EFPC cleanup level. ATSDR also used the findings
to characterize and evaluate soil containing mercury at other waste sites.
Three technical papers and an ATSDR overview paper on the findings of the
panel meeting were published in the International Journal of Risk Analysis
in 1997 (Volume 17:5).
Following are summaries of other ATSDR public health activities involving Watts
Community and Physician Education, September 1996. To follow up on
the recommendations in the ATSDR Lower Watts Bar Reservoir Health Consultation,
ATSDR developed community and physician education programs on polychlorinated
biphenyls (PCBs) in the Watts Bar Reservoir. Daniel Hryhorczuk, MD, MPH, ABMT,
of the Great Lakes Center, University of Illinois at Chicago, made presentations
on the health risk associated with PCBs in fish at a community health education
meeting in Spring City, TN on September 11, 1996. In addition, a physician
and health professional education meeting for health care providers in the
vicinity of the Lower Watts Bar Reservoir was held at the Methodist Medical
Center in Oak Ridge on September 12, 1996. ATSDR, in collaboration with local
citizens, organizations, and state officials, developed an instructive brochure
on the Tennessee Department of Environment and Conservation's (TDEC's) fish
consumption advisories for the Watts Bar Reservoir.
Watts Bar Reservoir Exposure Investigation. In following up on the
findings of previous studies and investigations of the Watts Bar Reservoir,
including Feasibility of Epidemiologic Studies by the Tennessee Department
of Health (TDOH), ATSDR conducted the exposure investigation with cooperation
from the TDOH and the Roane County Health Department. The 1996 exposure investigation
was conducted to measure actual PCB 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. ATSDR published the following three major findings:
The exposure investigation participants' serum PCB levels and blood
mercury levels are very similar to levels found in the general population.
Only 5 of the 116 people tested (4%) had PCB levels that were higher than
20 micrograms per liter (µg/L) or parts per billion (ppb), which is
considered to be an elevated level of total PCBs. Of the five participants
who exceeded 20 µg/L, four had levels of 20-30 µg/L. Only one
participant had a serum PCB level of 103.8 µg/L, which is higher than
the general population distribution.
Only one participant in the exposure investigation had a total blood mercury
level higher than 10 µg/L, which is considered to be elevated. The
remaining participants had mercury blood levels that ranged up to 10 µg/L,
as might be expected to be found in the general population.
Clinical Laboratory Analysis. In June 1992, an Oak Ridge physician reported
to the TDOH and the Oak Ridge Health Agreement Steering Panel (ORHASP) that
approximately 60 of his patients may have been exposed, either occupationally
or from the environment, to several heavy metals. The physician felt that these
exposures had resulted in a number of adverse health outcomes (for example,
increased incidence of cancer, chronic fatigue syndrome, neurological diseases,
autoimmune disease, and bone marrow damage). In 1992 and 1993, ATSDR and CDC's
National Center for Environmental Health (NCEH) facilitated clinical laboratory
support by the NCEH Environmental Health Laboratory for patients referred by
an Oak Ridge physician to the Howard Frumkin, M.D., Dr.PH., Emory University
School of Public Health.
Because of patient-to-physician and physician-to-physician confidentiality,
results of the clinical analysis have not been released to public health agencies.
However, Dr. Frumkin recommended (in an April 26, 1995 letter to the Commissioner
of TDOH) that one should "not evaluate the patients seen at Emory as if
they were a cohort for whom group statistics would be meaningful. This was a
self-selected group of patients, most with difficult to answer medical questions
(hence their trips to Emory), and cannot in any way be taken to typify the population
at Oak Ridge. For that reason, I have consistently urged Dr. Reid, each of the
patients, and officials of the CDC and the Tennessee Health Department, not
to attempt group analyses of these patients."
Review of Clinical Information on Persons Living In or Near Oak Ridge.
In addition to the above Clinical Laboratory Analysis, an ATSDR physician reviewed
the clinical data and medical histories provide by the Oak Ridge physician on
45 of his patients. The purpose of this review was to evaluate clinical information
on persons tested for heavy metals and to determine whether exposure to metals
was related to these patients' illnesses. ATSDR concluded that this case series
did not provide sufficient evidence to associate low levels of metals with these
diseases. The TDOH came to the same conclusion. ATSDR sent a copy of its review
to the Oak Ridge physician in September 1992.
Health education. Another essential part of the public health assessment
process is designing and implementing activities that promote health and provide
information about hazardous substances in the environment.
Health Professional Education on Cyanide. A physician education program
was conducted in 1996, to provide information regarding the health impacts
of possible cyanide intoxication. 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 (formerly the K-25 facility).
ATSDR provided the local physicians with copies of the ATSDR Case Studies
in Environmental Medicine publication "Cyanide Toxicity," the National Institute
for Occupational Safety and Health (NIOSH) final health hazard evaluation,
and the ATSDR public health statement for cyanide. Further, ATSDR instituted
a system through which local physicians could make patient referrals to the
Association of Occupational and Environmental Clinics (AOEC). Finally, ATSDR
conducted an environmental health education session for physicians at the
Methodist Medical Center in Oak Ridge, Tennessee. The medical staff grand
rounds provided the venue for conducting this session. The workshop focused
on providing local physicians and other health care providers with information
to help them diagnose chronic and acute cyanide intoxication and to answer
Workshops on Epidemiology. At the request of members of the Oak Ridge
Reservation Health Effects Subcommittee (ORRHES), ATSDR held two workshops
on epidemiology for the subcommittee. The first epidemiology workshop was
presented at the June 2001 ORRHES meeting. Ms. Sherri Berger and Dr. Lucy
Peipins of ATSDR's Division of Health Studies provided an overview of the
science of epidemiology. The second epidemiology workshop was presented at
the December 2001 ORRHES meeting and was designed to help subcommittee members
develop the skills needed to review and evaluate scientific reports. In addition,
at the August 28, 2001, meeting of the Public Health Assessment Work Group
(PHAWG), Dr. Peipins guided the work group and community members through a
systematic scientific approach as they critiqued a report by J. Mangano, "Cancer
Mortality Near Oak Ridge, Tennessee" (Int. J. of Health Services, V. 24 #3,
1994, p. 521). Based on the PHAWG critique, the ORRHES made the following
conclusions and recommendation to ATSDR.
The Mangano paper is not an adequate, science-based explanation of any alleged
anomalies in cancer mortality rates of the off-site public.
The Mangano paper fails to establish that radiation exposure from the ORR
are the cause of any such alleged anomalies of cancer mortality rates in the
The ORRHES recommends to the ATSDR that the Mangano paper be excluded from
consideration in the ORR public health assessment process.
Health Education Needs Assessment. Throughout the public health assessment
process, ATSDR staff members have gathered concerns from people in the communities
around the ORR. Through a cooperative agreement with ATSDR, AOEC began a community
health education needs assessment in 2000 to aid in developing a community
health education action plan. George Washington University and MCP Hahnemann
University are conducting the assessment for the AOEC. The needs assessment
will help in planning, implementing, and evaluating the health education program
for the site. It will also help health educators identify key people, cultural
norms, attitudes, beliefs, behaviors, and practices in the community, which
is information that will aid in developing effective health education activities.
Information on the needs assessment was presented at several ORRHES meetings.
Coordination with other parties. Since 1992 and continuing to the present,
ATSDR has consulted regularly with representatives of other parties involved
with the ORR. Specifically, ATSDR has coordinated efforts with TDOH, TDEC, NCEH,
NIOSH, and DOE. This effort led to the establishment of the Public Health Working
Group in 1999, which led to the establishment of ORRHES. In addition, ATSDR
provided some assistance to TDOH in its study of past public health issues.
ATSDR has also obtained and interpreted studies prepared by academic institutions,
consulting firms, community groups, and other parties.
Establishment of the ORR Public Health Working Group and the ORRHES.
In 1998, in collaboration with the DOE Office of Health Studies, ATSDR and CDC
embarked on a process of developing credible, coherent, and coordinated agendas
of public health activities and health studies for each DOE site. In February
1999, ATSDR was given the responsibility to lead the interagency group's efforts
to improve communication at ORR. In cooperation with other agencies, ATSDR established
the ORR Public Health Working Group to gather input from local organizations
and individuals regarding the creation of a public health forum. After careful
consideration of the input gathered from community members, ATSDR and CDC determined
that the most appropriate way to meet the needs of the community would be to
establish the ORRHES.
Site visits. To better understand site-specific exposure conditions,
ATSDR scientists have conducted site visits to the ORR and visited surrounding
areas numerous times since 1992. The site visits included guided tours of the
ORR operation areas, as well as tours of the local communities to identify how
community members might come into contact with environmental contamination.
Summary of U.S. Department of Health and Human Services Activities
U.S. Department of Health and Human Services' Evaluation of Data in The
Tennessean Article. In a November 2,1998 letter, the Honorable William H.
Frist, M.D., United States Senator requested Donna E. Shalala, Secretary of
the Department of Health and Human Services (DHHS), have the CDC, ATSDR, and
the National Institutes of Health (NIH) evaluate the data on which the The
Tennessean article describes reports of a pattern of illnesses among residents
living near nuclear plants, including the DOE ORR.
In particular, Senator Frist requested the following:
Assess the quality and usefulness of the data on which the report is
Examine the data for any patterns of illness and assess whether there
is sufficient data to establish a relationship to the nuclear plants.
Summarize the current DHHS studies that are currently underway at the
Estimate how the key questions raised by the newspaper articles could
be addressed in a potential study.
Describe any existing programs at the three agencies that may help address
the medical needs of people living near nuclear plants.
In a February 22, 1999, Donna E. Shalala, Secretary of DHHS, responded to Senator
Frist's request. The DHHS evaluated the The Tennessean article and responded
to the Senator Frist's five specific issues. DHHS concluded the following:
The data in The Tennessean article were not compiled from an epidemiologic
study and thus have many limitations. It is impossible to calculate rates
for the reported illnesses or to determine whether rates of the illnesses
were abnormal. It is also difficult to relate excess illnesses to specific
nuclear plants because primary exposures differ among the plants.
Epidemiologically, it is neither acceptable to tabulate data collected in
an unstandardized manner, nor to assess illnesses and symptom based on limited
diagnostic information. Thus, it is not possible to determine if data in this
report represent a new or unusual occurrence of symptoms in this population.
DHHS has a significant number of ongoing studies that seek to analyze environmental
exposure at each of the 11 sites rather than focusing on general medical evaluations
of the populations near the sites. However, clinical data from the Fernald Medical
Monitoring Program and the Scarboro, Tennessee survey focus on respiratory illnesses
in children and, although quite limited, are most relevant to the issues raised
by the report.
Sound data using standardized information is essential in order to establish
increased prevalence of a disease and linkage to the nuclear plants.
First, the occurrence of a single, definable illness would have to be assessed.
Second, studies including structured population surveys would need to be developed
for general health and illness data in well-defined population groups near the
nuclear sites. The finding would then be compared to results form other well-defined
populations living elsewhere.
Third, any attempt to determine a causal relationship between disease or illness
rates in these populations and exposures to hazards would be difficult since
historic exposures are difficult to identify and measure.
CDC, ATSDR, and NIH are working with DOE to plan appropriate public health
follow-up activities to address the concerns of communities and workers regarding
the nuclear weapons complexes. Embarking on such a comprehensive program will
require considerable resource, planning, and evaluation. Please note that CDC,
ATSDR, and NIH do not provide direct primary medical services to communities.
However, where possible, CDC, ATSDR, and NIH will continue to support community
leaders and existing medical care systems to address public health concerns
of communities that are near nuclear plants.
Summary of TDOH Activities
Pilot Survey. In the fall of 1983, TDOH developed an interim soil mercury
level for use in environmental management decisions. CDC reviewed the methodology
for the interim mercury level in soil and recommended that a pilot survey be
conducted to determine whether populations with the highest risk for mercury
exposure had elevated body burdens of mercury. In June and July 1984, a pilot
survey was conducted to document human body levels of inorganic mercury for
residents of Oak Ridge with the highest potential for mercury exposure from
contaminated soil and fish. The survey also examined whether exposure to mercury-contaminated
soil and fish constituted an immediate health risk to the Oak Ridge population.
The results of the pilot survey, released in October 1985, suggested that residents
and workers in Oak Ridge, Tennessee, are not likely to be at increased risk
for having significantly high mercury levels. Mercury concentrations in hair
and urine samples were below levels associated with known health effects.
Health Statistics Review. In June 1992, an Oak Ridge physician reported
to TDOH and ORHASP that he believed approximately 60 of his patients had experienced
occupational and environmental exposures to several heavy metals. The physician
felt that these exposures had resulted in increased cancer, immunosuppression,
chronic fatigue syndrome, neurologic diseases, autoimmune disease, bone marrow
damage, and hypercoagulable state including early myocardial infarctions and
stroke. In 1992, the TDOH conducted a health statistics review to compare cancer
incidence rates for the period of 1988 to 1990 for counties surrounding the
ORR to rates from the rest of the state. Findings of the review are in a TDOH
memorandum dated October 19, 1992, from Mary Layne Van Cleave to Dr. Mary Yarbrough.
The memorandum details an Oak Ridge physician's concerns about the health status
in the Oak Ridge area. Also available from the TDOH are the minutes and handouts
from a presentation given by Ms. Van Cleave at the ORHASP meeting on December
Health Statistics Review. In 1994 local residents reported that there
were many community members with amyotrophic lateral sclerosis (ALS) and multiple
sclerosis (MS). The TDOH in consultation with Peru Thapa, MD, MPH, from the
Vanderbilt University School of Medicine conducted a health statistics review
of mortality rates for amyotrophic lateral sclerosis (ALS), multiple sclerosis
(MS), and other selected health outcomes.
TDOH found that because ALS and MS are not reportable diseases, it is impossible
to calculate reliable incidence rates. Mortality rates for the period of 1980
to 1992 were reviewed for the 10 counties surrounding the ORR and compared with
mortality rates for the state of Tennessee. The following results were reported
by the TDOH at the ORHASP public meeting on August 18, 1994.
There were no significant differences in ALS mortality in any of the
counties in comparison to the rest of the state.
For Anderson County, the rate of age-adjusted deaths from chronic
obstructive pulmonary disease (COPD) was significantly higher than rates in
the rest of the state, but rates for total deaths, deaths from stroke, deaths
from congenital anomalies, and deaths from heart disease were significantly
lower for the period from 1979 to 1988. There were no significant differences
in the rates of deaths due to cancer, for all sites, in comparison to rates
in the rest of state. Rates of deaths from uterine and ovarian cancer were significantly
higher than the rates in the rest of the state. The rate of deaths from liver
cancer was significantly lower in comparison to the rest of the state.
For Roane County, the rates of total deaths and deaths from heart
disease were significantly lower than the rates in the rest of the state for
the period from 1979 to 1988. Although the total cancer death rate was significantly
lower than the rate in the rest of the state, the rate of deaths from lung cancer
was significantly higher than the rate in the rest of the state. Rates of deaths
from colon cancer, female breast cancer, and prostate cancer were also significantly
lower than the rates in the rest of the state.
For Knox County, the rates for total deaths and deaths from heart
disease were significantly lower than the rates in the rest of the state. There
was no significant difference in the total cancer death rate in comparison to
the rest of the state.
There were no significant exceedances for any cause of mortality studied
in Knox, Loudon, Rhea, and Union counties in comparison to the rest of the state.
Rates of total deaths were significantly higher in Campbell, Claiborne,
and Morgan counties in comparison to the rest of the state.
Cancer mortality was significantly higher in Campbell County in comparison
to the rest of the state. The excess in number of deaths from cancer appeared
to be attributed to the earlier part of the time period (1980 to 1985); the
rate of deaths from cancer was not higher in Campbell County in comparison to
the rest of the state for the time periods from 1986 to 1988 and 1989 to 1992.
Cancer mortality was significantly higher in Meigs County in comparison
to the rest of the state from 1980 to 1982. This excess in cancer deaths did
not persist from 1983 to 1992.
Knowledge, Attitude, and Beliefs Study. A study, coordinated by TDOH,
was conducted in an eight-county area surrounding Oak Ridge, Tennessee. The
purpose of the study was to (1) investigate public perceptions and attitudes
about environmental contamination and public health problems related to the
ORR, (2) ascertain the public's level of awareness and assessment of the ORHASP,
and (3) make recommendations for improving public outreach programs. The report
was released in August 1994. Following is a summary of the findings.
A majority of the respondents regard their local environmental quality
as better than the national environmental quality. Most rate the quality of
the air and their drinking water as good or excellent. Almost half rate the
local groundwater as good or excellent.
A majority of the respondents think that activities at the ORR created
some health problems for people living nearby and most think that activities
at ORR created health problems for people who work at the site. Most feel that
researchers should examine the actual occurrence of disease among Oak Ridge
residents. Twenty-fine percent know of a specific local environmental condition
that they believe has adversely affected public health, but many of these appear
to be unrelated to ORR. Less than 0.1% have personally experienced a health
problem that they attribute to the ORR.
About 25% have heard of the Oak Ridge Health Study and newspapers
are the primary source of information about the study. Roughly 33% rate the
performance of the study as good or excellent and 40% think the study will improve
public health. Also, 25% feel that communication about the study has been good
Health Assessment. A health assessment of the East Tennessee region
was conducted by TDOH's East Tennessee Region to evaluate the health status
of the population, assess the availability and utilization of health services,
and develop priorities in planning to use resources. In December 1991, the East
Tennessee Region released the first edition of A Health Assessment of the
East Tennessee Region, which included data generally from 1986 to 1990.
The second edition, released in 1996, included data generally from 1990 through
1995. A copy of the document is available from the TDOH East Tennessee Region.
Presentation. Dr. Joseph Lyon of the University of Utah gave a presentation
to inform the ORHASP and the public of the multiple studies related to the fallout
from the Nevada Test Site, including the study of leukemia and thyroid disease.
The presentation was sponsored by TDOH and held on February 16, 1995, at the
ORHASP public meeting.
Summary of Joint Center for Political and Economic Studies Activities
Scarboro Community Assessment Report. In 1999, the Joint Center for
Political and Economic Studies conducted a survey of the Scarboro community
to identify environmental and health concerns of the residents. The surveyors
attempted to elicit responses from the whole community and achieved an 82% response
rate. Additionally, with support from DOE Oak Ridge Operations, the Joint Center
has been working with the community since 1998 to help residents articulate
their environmental, health, economic, and social needs. Because Scarboro is
a small community, the community assessment provided new information about the
community that is not available through sources such as the U.S. Census Bureau.
It also identified Scarboro's strengths and weaknesses and illustrated the relative
unimportance of environmental health issues to other community concernsenvironmental
and health issues are not a priority for most Scarboro residents; rather the
community is more concerned about crime and security, children, and economic
development. The Joint Center recommended more active community involvement
in city and community planning (Friday and Turner 2001).