Agency for Toxic Substances and Disease Registry Search  |  Index  |  Home  |  Glossary  |  Contact Us  
 
Oak Ridge Reservation: Compendium of Public Health Activities at the US Department of Energy

Historical Document

This Web site is provided by the Agency for Toxic Substances and Disease Registry (ATSDR) ONLY as an historical reference for the public health community. It is no longer being maintained and the data it contains may no longer be current and/or accurate.


1.0 INTRODUCTION

1.1 Background

The Oak Ridge Reservation is a US Department of Energy (DOE) facility that was established in Oak Ridge, Tennessee in 1942 as part of the Manhattan Project, the federal government's World War II effort to build the atomic bomb. There are three major installations at the Oak Ridge site: the Y-12 weapons plant; the X-10 complex, now known as the Oak Ridge National Laboratory; and the gaseous diffusion plant, K-25, now known as the East Tennessee Technology Park.

After World War II, the mission of the facilities broadened to include a variety of research and production projects. In recent years, however, the facilities developed in the interest of the national defense have been downsized. Presently, the missions include environmental restoration, government and industry partnerships, national security programs, research and development, technology transfer, and waste management.

1.2 Purpose

The purpose of this compendium of public health activities is to outline the past and present strategies used to address and evaluate public health issues related to chemical and radioactive substances released from the Oak Ridge Reservation. This compendium serves as a foundation document that summarizes both ongoing and completed activities that local, state, and federal health agencies have conducted to address public health issues. This document was developed to enhance communication and help ensure interaction and coordination among individual citizens, local organizations, and government agencies.

This document also provides a framework of the systematic approaches used to evaluate and address public health issues at the Oak Ridge Reservation. In order to evaluate the potential health effects on people working on the reservation or living in the area, the following questions must be answered.

  1. What is the nature and extent of the contamination?
  2. Is there an exposure pathway and what are its characteristics?
  3. What are the demographics of the exposed population?
  4. What are the public health implications?
  5. How does the health effects data in the community compare with rates in other areas?

1.3 Agencies Involved

The Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention's (CDC) National Center for Environmental Health (NCEH) and National Institute for Occupational Safety and Health (NIOSH), the Tennessee Department of Health, the Tennessee Department of Environment and Conservation (TDEC) and DOE have responded over the years to workers and communities concerned about potential exposures and reported unexplained illnesses afflicting workers and residents.

1.4 Public Health Issues

This document outlines public health activities related to the following broad public health issues at the Oak Ridge Reservation.

1.4.1 Issue 1: Worker Exposure

Employees of the Oak Ridge Reservation may have been exposed to radiological and chemical agents in the workplace. The health risks associated with low-level chronic exposure to ionizing radiation and chemical hazards are of personal interest to the Oak Ridge workforce. Additionally, as an occupationally exposed and relatively well-monitored population, this group offers a unique research opportunity to examine and understand exposure-response relationships.

1.4.2 Issue 2: Off-Site Exposure

Residents in communities surrounding the reservation may have been exposed to chemical and radiological substances released from operations at the site. Recent studies are used to characterize exposures, identify exposed populations, assess the impact on public health, and determine follow-up public health actions or studies needed to evaluate and mitigate or prevent adverse health outcomes.

1.4.3 Issue 3: Reported Illnesses

Illnesses afflicting workers and residents in communities surrounding the Oak Ridge Reservation have been reported to public health agencies.

1.4.4 Issue 4: Community Involvement

Broader representation of the community is needed in planning and implementing current and future public health activities.

2.0 ONGOING PUBLIC HEALTH ACTIVITIES

2.1 Issue 1: Worker Exposure

2.1.1 Leukemia Case-Control Study

Purpose

This multi-site case-control study will explore the relationship between external ionizing radiation and leukemia risk. Leukemia is the abnormal cell development of blood-forming organs causing excessive white blood cell development. Exactly 257 leukemia deaths have been identified at four DOE sites and the Portsmouth Naval Shipyard now that the vital status (vital status refers to the number of living versus deceased) has been updated through 1994. One of the four DOE sites included in the study is the Oak Ridge National Laboratory. Confounding exposures to internal radiation, chemicals, and electromagnetic fields will be evaluated for all cases and controls. This study is a followup to recent positive findings of leukemia and radiation in cohort studies and includes an update of vital status of Hanford and Savannah River cohorts.

Background and Agencies Involved

Exposure to ionizing radiation has been associated with excessive risk of leukemia mortality. This excess risk has been observed in persons exposed to high dose acute radiation, as well as in persons occupationally exposed to protracted low dose radiation. However, inconsistency of findings across studies continues to be a problem. Some studies of occupationally exposed persons have demonstrated a dose-response relationship between exposure to ionizing radiation (Kendall, et al., 1992; IARC, 1994; Cragle, et al., 1995). Wing, et al. (1991) observed an elevated risk of leukemia, though no apparent dose-response relationship with radiation exposure. In a combined study of three facilities in the United States, Gilbert et al. (1993) found no overall increase in leukemia risk nor any dose-response relationship. Many of these studies have suffered from limited statistical power due to the relatively small number of cases. As a result of this limited statistical power, NIOSH investigators have designed and begun this multi-site leukemia case control study.

Time Line

The expected date of completion of the Leukemia Case-Control Study is September 2001.

Status

The protocol for this study was approved in 1996. The study is currently underway, and controls have been selected from a combined roster of 94,517 eligible workers. Validation of radiation exposure records is underway, comparing electronic summary data with the original records at the sites.

2.1.2 Cohort Mortality Study of DOE Chemical Laboratory Workers

Purpose

In limited studies of chemical laboratory workers, increased risk has been found for several specific cancers and for all cancers combined. A multi-site mortality study of DOE chemical laboratory workers is feasible through use of the available data set. The Cohort Mortality Study of DOE Chemical Laboratory Workers addresses chemical and mixed exposure hazards that are applicable to workers outside the DOE complex. The workforce under study has remained quite stable and should provide valuable information on the mortality expectation of chemical laboratory workers across the United States.

Background and Agencies Involved

Chemical laboratory workers have been identified from previous studies of workers at DOE Oak Ridge facilities. Identification of the laboratory workers has been accomplished by cross matching job titles and department titles and codes from work history records by personnel at the Oak Ridge Associated University Center for Epidemiologic Research who are familiar with these cohorts. Potential exposures of workers to groups of chemicals and to ionizing radiation will be assessed, and the relationship of these exposures to mortality patterns will be investigated.

Time Line

An all-causes mortality rate for this workforce as compared to the general U.S. population is expected to be completed by December 2002.

Status

Vital status (determining the number of living versus deceased) is currently being updated through 1998 for the chemical laboratory workers. In fiscal year 2000, walk-through surveys were conducted at the Oak Ridge National Laboratory, K-25, Y-12, and Savannah River sites. Dosimetry data and work history records are being requested from site management for the exposure assessment portion of the study.

2.1.3 Multiple Myeloma Case-Control Study at K-25 Plant

Purpose

Multiple myeloma is a malignant growth of bone marrow causing bone pain and deformities that result in anemia and pulmonary and kidney complications. This case-control study of 63 multiple myeloma cases at K-25 complements a multiple myeloma study that focused on external radiation. This study addresses the question of whether multiple myeloma is related to internal or external radiation exposure, and it evaluates potential confounders with reasonable statistical power.

Background and Agencies Involved

The K-25 workforce was exposed primarily to internal radiation. Both radiation and chemical exposure will be included in the exposure assessment for all cases and controls in this study conducted by NIOSH. A multi-site case-control study, which was conducted by Dr. Steve Wing at the University of North Carolina, evaluated possible etiologic risk factors for multiple myeloma, focusing on external radiation (radiation dose from outside the body) and chemical exposures. This study of K-25 multiple myeloma cases will allow specific examination of internal radiation (radiation dose inside the body).

Time Line

The expected date of completion for the Multiple Myeloma Case-Control Study at K-25 Plant is December 2002.

Status

The vital status (determination of living versus deceased) of the K-25 cohort of workers has been updated through 1998. Controls will be matched as specified by the approved scientific study protocol. Updated information on work history and exposure is being compiled prior to analysis.

2.1.4 Construction Workers Mortality Study

Purpose

Relatively few mortality studies have been conducted among construction workers. This Construction Workers Mortality Study is an all-cause retrospective cohort mortality study of former DOE construction workers. The study provides an opportunity to further define the risks associated with asbestos fibers, silica-containing dusts, beryllium particulates, and other exposures encountered by construction workers. The study will provide useful information applicable to the present construction workforce across the DOE weapons complex.

Background and Agencies Involved

There have not been specific health studies of construction workers across the DOE weapons complex, although there have been studies of workers who were more production-oriented. This study will be an all-causes mortality study performed by researchers of the NIOSH Health-Related Energy Research Branch.

Time Line

The expected date of completion for the study is December 2001.

Status

A scientific study protocol is being developed, and a roster of construction workers with work history information is being compiled. Work on the project was suspended in Fiscal year 2000 due to scarce resources; work will resume when resources permit.

2.1.5 Beryllium Worker Medical Surveillance Program

Purpose

The Beryllium Worker Medical Surveillance Program (BWMSP) is designed to detect and diagnose chronic beryllium disease (CBD) among current and former workers exposed to beryllium throughout the DOE complex, including Oak Ridge. Early detection of CBD offers hope of reducing morbidity from this condition. In addition to understanding the size of the CBD problem, information from this program is used to improve and evaluate worker protection and control measures, to monitor trends in CBD frequency, and to strengthen work planning to minimize worker exposures. This program includes an intensive, coordinated health-risk communication effort.

Background and Agencies Involved

The program, currently focused on Y-12, is operated by the Oak Ridge Institute for Science and Education (ORISE) under contract to the DOE. The program began in 1992 when plant records were used to compile a roster of more than 3,000 living current and former beryllium workers. Between December 1993 and December 1996, more than 1,000 current and former beryllium workers were screened. In addition, those not identified on the initial roster were allowed to self-identify themselves as having worked with beryllium. Screening medical examinations provided by off-site clinics include a physical examination, a symptoms questionnaire, a chest radiograph, the beryllium lymphocyte proliferation test (Be-LPT), and a pulmonary function test. The Be-LPTs are performed by ORISE and the National Jewish Medical and Research Center. Individuals suspected of having CBD are referred to Vanderbilt University Medical Center for further diagnostic examinations.

This is an ongoing program whose scope and duration will be determined by its ability to find additional cases of CBD in this population of all current and former Oak Ridge workers, including those at the East Tennessee Technology Park (K-25) and the .

Status

To date, 25 Oak Ridge workers have been diagnosed with CBD. An additional 77 workers who do not have CBD at present have been found to be sensitized to beryllium.

This program has also been ongoing at Rocky Flats. In 1999, the BWMSP is being expanded to all 20 DOE sites that have or have had beryllium operations under the direction of ORISE.

2.1.6 Former Oak Ridge Construction Workers

Purpose

DOE's Former Worker Program is a pilot program designed to provide medical surveillance for selected former DOE workers at risk of work-related illness as a result of exposures while working at DOE facilities. One such pilot project is underway at Oak Ridge, focusing on former Oak Ridge construction workers.

Background and Agencies Involved

The Defense Authorization Act 1993, in particular 42 USC Sec. 7274i, directs the Secretary of Energy to develop a "Program to Monitor DOE Workers Exposed to Hazardous and Radioactive Substances." The Oak Ridge pilot project began in October 1996 with a Phase I needs assessment designed to identify critical groups of at-risk former construction workers. The project is led by Dr. Eula Bingham of the University of Cincinnati in cooperation with the United Brotherhood of Carpenters Health and Safety Fund, the Center to Protect Workers' Rights, and Duke University Medical Center.

Time Line

The Phase I needs assessment was completed in 1997, and the Phase II medical screening began in late 1998 and is scheduled to run through 2001.

Status

Initially, approximately 800 former construction workers were identified as potentially at high risk. The exposures that will be focused on during the medical screening include asbestos, beryllium, noise, silica, solvents, and heavy metals (e.g., cadmium and lead).

2.1.7 Former Production Workers from Oak Ridge K-25, Paducah, and Portsmouth Gaseous Diffusion Plants

Purpose

DOE's former worker program is a pilot program designed to provide medical surveillance for selected former DOE workers at risk of work-related illness as a result of exposures while working at DOE facilities. One such pilot project focusing on production workers is underway at the Oak Ridge K-25, Paducah, and Portsmouth gaseous diffusion plants.

Background and Agencies Involved

The Defense Authorization Act 1993, in particular 42 USC Sec. 7274i, directs the Secretary of Energy to develop a "Program to Monitor DOE Workers Exposed to Hazardous and Radioactive Substances." The Oak Ridge project began in October 1996 with a Phase I needs assessment designed to identify critical groups of at-risk former production workers. The project is led by Dr. Steven Markowitz of Queens College, City University of New York, and Mr. Robert Wages of the Oil, Chemical, and Atomic Workers International Union, in cooperation with the University of Massachusetts at Lowell.

Time Line

The Phase I needs assessment was completed in 1997, and the Phase II Medical Screening began in late 1998 and is scheduled to run through 2001.

Status

Initially, approximately 1,260 former production workers were identified as potentially at high risk. Exposures of concern that were identified in Phase I and that will be focused on during the Phase II medical screening include asbestos, beryllium, bladder carcinogens, chlorinated solvents, fluorine compounds, nickel, noise, silica, uranium, welding fumes, and heavy metals (e.g., cadmium, lead, and mercury).

2.1.8 Case-Control Study of Lung Cancer and External Ionizing Radiation

Purpose

Several recent epidemiologic studies have shown a dose-response relationship between lung cancer and external ionizing radiation. These studies, however, have had potentially confounding exposures to lung carcinogens. This project will investigate the association of mortality from lung cancer and exposure to external ionizing radiation among DOE workers. The study population was selected to target workers primarily exposed to external radiation and includes those involved in reactor operations. The sites identified include the Oak Ridge National Laboratory (X-10), Hanford (Area 100), Savannah River (Area 100), and the Idaho National Engineering and Environmental Laboratory.

Background and Agencies Involved

This study will be a case-control study performed by researchers of the NIOSH Health-Related Energy Research Branch.

Time Line

The expected date of completion for the study is December 2003.

Status

The protocol has received approval from the NIOSH-Human Subject Review Board and all site institutional review boards. Opening meetings have been held at all sites, and preliminary records review was initiated. Data coding for roster development has begun. Roster development and selection of cases and controls will be completed during fiscal year 2001.

2.1.9 Work Histories Evaluating New Participatory Methods

Purpose

Workers in the construction trades are exposed to a wide variety of chemical and radiological agents at DOE sites, and an effective allocation of medical surveillance resources to these workers depends upon adequate knowledge of these exposures. However, documentation of the exposure histories for these workers is complicated by the difficulty in worker recall of their complex exposure patterns over time periods which typically include a large number of short-term workplace assignments. Investigators from the Department of Environmental Health at the University of Cincinnati, supported by a NIOSH grant, are developing new methods for construction trade workers to improve recall of their occupational exposure histories which can be used to establish guidelines and formats for the maintenance of personal work histories. These improved personal histories would then be utilized to improve the efficiency and effectiveness of medical surveillance programs intended to assist those former construction workers at risk due to their occupational exposure histories.

Phase I of this project was carried out from 1995 to 1998 with the active participation of the United Brotherhood of Carpenters. This phase focused on former construction workers at the Oak Ridge site and included four major elements:

  • Identification and current location of former Oak Ridge construction workers and the administration of traditional occupational history interviews using available information
  • Assembly of available documents with information regarding exposure histories from the institutions on the site, including union pension records and other task history documentation, for various Oak Ridge construction work sites
  • Development of new techniques for aiding occupational history recall, including graphic displays of work site locations, detailed Oak Ridge work site histories, and discussion groups, followed by administration of modified occupational history interviews.
  • Comparison of the results of traditional and innovative methods of occupational exposure history recall in providing detailed exposure histories, along with an evaluation of the improvements in identifying workers with risk-associated need for cost-effective medical surveillance.

Phase II of the project is intended to utilize those methods found to be the most effective in Phase I in order to validate their usefulness at DOE sites in general. This phase, begun in 1998, is being conducted at another DOE site, and it involves a similar group of construction workers. The second phase effort will be used to establish the validity and applicability of the first phase study carried out at the Oak Ridge site. The results will be applied to the establishment of guidelines and formats for personal work histories for construction trade workers at DOE sites generally.

Background and Agencies Involved

This work is being carried out by the Department of Environmental Health at the University of Cincinnati, in collaboration with the United Brotherhood of Carpenters, with Dr. Eula Bingham as the principal investigator. The work is supported by a grant from the NIOSH Health-Related Energy Research Branch.

Time Line

The expected date of completion for this study is November of 1999.

Status

The study is currently in its second year at the DOE Hanford site, and the final report is expected in late 1999.

< Table of Contents     Next Section >

 Resources on Oak Ridge Reservation Health Effects
Education & Training Opportunities General Information Publications and Products
Fact Sheets   Questions & Answers   Presentations
         
horizontal dividing line
rectangle border
Oak Ridge Reservation
bullet Home
bullet  Public Health Activities
bullet Public Participation
bullet Community Resources
bullet ORRHES Subcommittee
bullet Contact Us
bullet Site Map
rectangle border
 Events
Calendar of Meetings
divider

Programs

State Agency Links
List of ATSDR state cooperative agreement partners. divider

 
 
 
 

This page last updated on February 16, 2005
Questions? - Call the ATSDR Information Center toll free at 1-800-CDC-INFO, or e-mail.

ATSDR Home  |  Search  |  Index  |  Glossary  |  Contact Us
About ATSDR  |  News Archive  |  ToxFAQs  |  Public Health Assessments
Privacy Policy  |  External Links Disclaimer  |  Accessibility
US Department of Health and Human Services