Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options

Oak Ridge Reservation

ORRHES Meeting Minutes
April 13, 2004


ORRHES Web Site Redesign Review

Ms. Susan Robinson, Team Lead
Health Communication Team
Division of Health Education and Promotion
Agency for Toxic Substances and Disease Registry

Ms. Robinson introduced herself and indicated that the ORRHES has been asking for quite awhile to have the web site redesigned. The team has been quite busy working on some documents for the subcommittee on which she would like some feedback. After distributing copies of her presentation, Ms. Robinson explained that the first idea was that the current ORRHES web site, which is focused on the subcommittee's needs, will become a community web site for the ORR about the health activities in the area. Therefore, the new site will be designed to meet the needs of multiple audiences. Ms. Robinson reminded the group that at the last ORRHES meeting, she presented a sample communication education plan and how that was going to be informed by the community assessments. In presenting that plan, staff said that they could take some action now to begin improving the information delivered around the different health studies. Thus, the web site redesign is one of the actions that staff was discussing at that meeting. Ms. Robinson stated that the ORRHES might recognize the list of audience members from the sample plan. She reiterated that the plan was not a completed plan, but it was something with which they could begin to organize the communication.

In that plan the multiple audiences included:

  • ORRHES Members


  • Interested Community Members


    • Technical and non-technical
    • Within specific PHA area—outside of the PHA area
  • Interested Groups


    • Civic and environmental groups
    • Government agencies
    • Public health councils
    • Elected officials
    • Hospitals, private practitioners (Medical personnel are especially encouraged to submit specifics regarding what they would like to see on the website.)
    • Schools (added)


  • Media
    • Oak Ridge, Regional media

Ms. Robinson shared a flow chart of the standard process for developing a web site. She explained that in the top, left-hand box was the first step, which is documenting the information needs. The team has received a great deal of input from the ORRHES which they have inputted into the web site's prime user scenarios. Then, the work that Dr. Sterling's group is doing with the community assessment will obtain more information about potential users of the site. Once all of that information is obtained, then the team will develop a creative brief. Ms. Robinson indicated that she had a draft of the creative brief with her, which she would share with the group later during her presentation. A creative brief assists developers with keeping on strategy to develop a product, which in this case is the Web site. She indicated that she would walk through that draft creative brief later, and she was looking forward to the group's feedback on it.

Because a web site is an interactive medium, the team had to develop what is called "user scenarios." Individual scenarios are developed for different types of users. A scenario helps the developer to understand what information the user wants and what they might do with the information that they receive from the web site. For example, some people might want to download the information and give it to people, so those users would want the information on the web site to be in a format that they can use and carry with them. After the team knows what the users like and what they want to do with the information, then the developers have to inventory the content to make sure it meets the needs that have been identified. The content will then be matched up with the information that has been received on different users.

Next, the team will revise the web site structure, develop a prototype or a "mock up" of the new web site, and launch it. Ms. Robinson stated that she had not done the "mock up" yet, but all of the steps up to the "mock up" had been done. Although she did not have the mock up completed, she had done some pages just to give the group a feel for how it might look. Once the prototype is completed, she plans to send the ORRHES an e-mail, so that they can review the new version. She asked those in the group who were very interested in the Internet to let her know, because it would be nice if they could work with the team in the interim. Finally, the Web site is revised, based on feedback and then it is launched. The team is planning to launch the new web site in June.

With regard to content development, a web site is developed like an onion is peeled. First, the major activities are done and then one keeps peeling. Not everything will be completed when the web site first comes up, but things will continually be added. Ms. Robinson then walked the group through the creative brief. She invited the group to present their comments to her as she walked them through the sections, rather than wait until the end of her presentation. She added that they could also e-mail changes or additions to her or to Ms. Horton. First came the audiences, which she already mentioned. Next came the goals and objectives of the web site, which were as follows:

  • Assist the ORR community in understanding the findings of the PHAs;
  • Build capacity within the ORR community to respond to issues related to release of PHAs;
  • Increase interest and participation by ORRHES members and interested individuals in providing input on PHAs; and
  • Collect the address the community's needs and concerns related to PHAs and their health.

Ms. Robinson stressed that she really wanted the group's input into the goals and objectives for the web site. She said that all of the goals and objectives suggested features that the ORRHES might want on the web site. The last objective suggested that they might want an open-ended comment box. For example, a PHA could be put up, and they could ask for comments on it.

Just as important as creating something is thinking about what is going to get in the way of creating it. Obstacles to the web site include:

  • Community members may not have access to the web site. There are a lot of technical details to consider, such as low bandwidth access.
  • Community members may not trust the information
  • Depth and complexity of the information presented will pose readability and usability challenges because of the web medium. It is not like a printed newspaper, and obviously having a printed PHA is much easier than trying to deal with it on the Web.
  • Internal CDC/ATSDR standards may constrain design to meet the needs of users. She stated that she would discuss the template that they were going to use. It is a much more powerful template that the CDC has developed, but it will constrain some of things that the ORRHES wants to do.
  • Clearance at CDC/ATSDR may slow down the creation of needed content.
  • Clearance and posting process barriers may slow timely updates.
  • Funding for external support for web enhancements may be limited.

The key promise is what helps developers stay on target with the web site development. The ORRHES Web site's key promise is as follows:

"By using this web site, I will have a better understanding of ATSDR's public health activities in the areas surrounding the ORR. This includes public health processes and what different findings from assessments and other studies mean. I will be able to answer my own questions and the questions of others regarding what is known about the health effects from the Oak Ridge site."

Ms. Robinson explained that the next part of the creative brief was the support statements or the reasons why the key promise would outweigh the obstacles and why what is being promised or promoted is beneficial:

  • The Oak Ridge web site will be a one-stop source for public health information regarding the areas surrounding the ORR.
  • The Oak Ridge web site will provide a collection of resources and tools that will help ORRHES members, residents, and other interested groups to understand, evaluate, and respond to ATSDR's public health activities.
  • The Oak Ridge web site will provide ORRHES members and Oak Ridge residents with up-to-date information disseminated in a timely manner.

Ms. Robinson pointed out that she thought she had addressed usability, which addressed Ms. Kaplan's concern. The next section is the tone of the web site, which also addressed Ms. Kaplan's concern about usability. Tone describes what the web site will feel like.

"The tone [of the Oak Ridge Web site] will be informative, sensitive to community concerns, accessible, and capable of keeping users' interest. The text will present a public health ‘voice' that provides reliable (objective) information that is, at the same time, inviting and user-friendly. The links will be in plain language, easy-to-navigate, and accessible to multiple audiences (e.g., lay or professional)."

Ms. Robinson said they would add a statement about usability into this section. She then shared what is called the "Openings." The team needed to look at openings for when the web site might be used, because that might assist the team in thinking about what should be presented to the users first. So, this is thinking about the mental model of how they are approaching the web site information. The openings answer the question of what the potential users might be looking for when they come to the ORRHES Web site. Some openings are:

  • When looking for general information about ORR public health activities, including PHAs, community needs assessments, NCEH, ATSDR, and ORRHES activities.
  • When looking for specific information about a contaminant of concern or other issue related to public activities in the ORR area.
  • When specifically looking for information about ORRHES, including background information (i.e, purpose and functions, minutes of the past meetings, scheduled future meetings).
  • When looking for health educational resources to share with interested parties related to public health activities in the ORR area.

Ms. Robinson continued to explain that the last issue was creative considerations, by which the web site has to abide. Some of these are:

  • The use the CDC/ATSDR standards and guidelines for publishing material on the Internet, including fonts, photographs, and graphics.
  • CDC meta-tagging standards need to be used as time allows. This will address the indexing questions.
  • Coordinate with the Office of Communication for review and approvals.

Ms. Robinson then explained how user scenarios were developed. She also thanked Wilma López who worked hard on the user scenarios that she was going to present. Essentially, the way one develops a user scenario is to analyze how people might use the site and identify the potential user groups, which are listed in the creative brief. Then one uses data to create a user scenario. The team essentially analyzed the web site issues expressed by the community members that Mr. Hanley has compiled. They also analyzed some of the materials in the HAZDAT Database that are used at other sites, so that they could understand the demand for information from other Superfund or Federal sites. Then the team also happened to have, in house, a DELPHI Panel Report on what health care professionals want in a web site related to toxic substances. So, the team used that knowledge to create some of the profiles for health care professionals. Some additional data gathering would be good as the team continues to develop the site, including some interviews with ORRHES team members that represent the top users. For example, Ms. Kaplan would be a good one to interview with regard to what an ORRHES member would be looking for, and Dr. Malmquist would be a good representative of physicians. She suggested that if anyone in the room wanted to be a champion for a particular user group, they should talk to her.

Other data sources include focus group results from the needs assessment that will be conducted, and looking at the community concerns database reports. The team first had to think about the general information needs that would be similar across all of the audiences and how that content would be used, what content that we had to meet those needs, and where that data might be obtained. First she shared the team's "blue sky" page, which listed the team's thoughts about everything that could go on the web site. Then she shared several user scenarios.

The first was a community member: Sandra is a high school teacher who has been living in the ORR for about ten years. She saw an article in the newspaper about the ATSDR public health activities in the area, and she wants to find out what the contaminants of concern are in her area and her adverse health effects. She thinks that she might want to prepare a current affairs discussion topic on that for her students. So, she Google's® the terms ATSDR and Oak Ridge. She notices the link to the ORRHES web site, clicks on it, and she reads a brief history of the public health activities at the site and notices that there is an update on all activities on the site, which is one of the suggested features of the new site. Because she wants details on all activities, she clicks on that. She receives a fact sheet on all the PHAs, plus links to more information discussing the contaminants of concern and the timeline for the PHA. She selects Y-12 because it is in her area. The Y-12 pages include links to a summary, a map of the area, fact sheets, health education materials, and frequently asked questions (FAQs). She downloads the full PHA to read later.

Next, Ms. Robinson showed the group a "mock up" of what the site might look like. She emphasized that this look was not finalized, but it would give them a sense of how it might look. The team plans to use the new architecture in which the CDC has invested so heavily. The new architecture attempts to put content on the first page that people will come to, and so the first page could include, on the left-hand side, a picture, and then some text to draw people into the site. The architecture also has features with which to lump together the different types of information one might have on a particular topic, such as fact sheets, Q and As, reports and presentations. On right hand side are some menu selections. Current usability studies show that one should put the menu bar on right side because of the scrolling. That way, the user's eye does not have to travel across the page. So, the new site has a menu bar on the right side. The topic content for this new site would include: Home, Public Health Activities, Public Participation, perhaps a section for community resources, and then the ORRHES would have its own link and page.

In the aspects area on the new architecture, is an area for events. That is where the calendar would go. Ms. Robinson indicated that she had sent an e-mail to the IT department informing them that the ORRHES would like to keep the calendar that is currently on the site, but that function is not built out yet. Then there would be links to other programs that might think are allied with the ORRHES efforts. As an example, Ms. Robinson had included the DOE High School program, since she had met Dr. Joseph at the last meeting. Links to other Federal or state agencies would also go in that area.

Based on a philosophy related to the different literacy of the audiences, as the user goes down the page, the information will become more complex. For example, on CDC's web site, in the SARS section, one would see the basic information first, and then the clinical and more technical information would be found at the bottom of the page. The team can program this section called "selected resources" to highlight the things that the ORRHES thinks are the most relevant at any given time. For example, the section could include things like: Update on All Activities for Spring 2004, FAQs, Information for Health Professionals, Exposure Fact Sheets. These can be mixed and matched with the most requested items. The Web site also includes space for:

  • Education and training information such as case studies, environmental medicine, taking exposure history
  • News and press releases
  • Repeat of resources

Ms. Robinson shared what the PHA overview page might look like. This page would give some content right up front and then it could have a section for the PHAs, with a link to each assessment. She demonstrated what would occur when someone went to the page, using a Y-12 PHA mock up. Information on the PHA would include links to all of the resources available for that PHA, beginning with the most simple and ending with the most technical. So, the section would lead the user from FAQs, short briefings, and the summary to the full report and presentations, and then to the training resources related to Y-12, and finally the news and press for Y-12. This architecture had been usability tested with consumers, and it works.

Discussion Points:

  • Mr. Lewis liked the concept of concerns, because most of the public looks to see if their concerns have been heard. If there is a complete listing of their concerns, and they read them, then they have some confidence that even if they do not understand the technical requirements, at least their concerns have been addressed. He thought at was an excellent idea. Ms. Robinson responded that what was interesting about that collection is that addressing concerns is another thing altogether. She was not sure that they would want to put the raw comments up. She needed to ask that question. However, they needed to be extremely careful of privacy. Nonetheless, it could be an extremely nice mechanism in that regard.


  • Dr. Malinauskas added one more obstacle, which was the educational diversity of the intended audience. It needs to be kept simple. If the site is too technical, it is not going to be read by anybody. Ms. Robinson agreed that it was important to note because they could actually have a strategy to try to address that obstacle.


  • Ms. Kaplan said she was having a problem with the key promise, because if someone is going to have understanding of something, then that implies that someone is going to read it and understand it. However, the web site should also be useable, and one of the problems with the current web site is that it is not useable. Ms. Robinson suggested that perhaps they should amend the key promise to include a statement that says that the web site will be easy to use. She indicated that they would work on the wordsmithing later.


  • Mr. Lewis suggested that the web site be user-friendly for the type of audiences that Dr. Malinauskasa discussed. Ms. Robinson agreed that there should be something for everybody, no matter who they are. She said they would make that revision and send out another draft.


  • Mr. Box said he had a feeling that the average computer user in the ORR nine-county area is really not familiar with this web site. He thought that the ORRHES needed to announce the new web site in the newspapers and advertise in other ways, so that the community would know it exists. Ms. Robinson suggested that they add that as an obstacle: ORR community members may not know about the web site. Mr. Box clarified that their audience should include not only ORR but also the entire nine-county area. Ms. Robinson agreed that people in the nine-county area might not know about the web site. She said it sounded like he was also recommending that the team put together a promotion plan. Mr. Box responded that it did not have to be a major effort, but it should be something that peaks their interest, something that would appear in the newspapers of the area to let people know that the web site is available and that they can find out more information about health effect efforts in the ORR area.


  • Ms. Robinson explained that when a web site is first launched, often there is what is called a "soft launch," because the site will have glitches that will have to be corrected. So, the team would probably not promote the site widely until after it was up and running well for awhile.


  • Mr. Lewis thought that people were interested in health issues and concerns and not necessarily exposures. Ms. Robinson responded that they would figure out how to fit into the programming the idea that health issues are key for lay people.


  • Dr. Peter Malmquist noted that in the support statements, the team includes the broad, general statement that the web site would be a "one-stop source for public health information regarding the areas surrounding the ORR." It cannot really say that because what people are looking for is public health related to the ORR Superfund site and not public health per se, as a broad category. If the ORRHES is going to say they are going to be a "one-stop source for public health," then is the site going to include information about diabetes and other public health issues? Ms. Robinson indicated that meant related to the ORR. Dr. Malmquist suggested that should be specifically stated, that the Web site was regarding the area surrounding ORR. They are concerned with the nine-county area, and there are different areas of concerns in public health that this web site will not address. If one looks at prior concerns in most of the outlying counties, they are not related to the possible contamination from Oak Ridge. Ms. Robinson agreed with Dr. Malmquist and indicated that the team would reword that point.


  • Ms. Robinson indicated that all the language would be corrected based on the group's feedback. She added that Mr. Lewis's comment needed to be added to the openings, which was: When looking for information about health issues, that is a key one.


  • Mr. David Johnson commented that he was not hearing partnerships as they relate to the medical field. Even though the site focuses on the ORR area, there are still other illnesses and diseases that impact the ORR community specifically, such as diabetes, obesity, et cetera. He suggested that the team look "outside of the box" to include some of those other ORR community concerns. Ms. Robinson asked if his suggestion was to consider a section of links to other health issues information, perhaps linking to the National Library of Medicine and so forth. Mr. Johnson responded that was exactly what he was talking about. Ms. Robinson thought they might already have that in their detailed user profiles, where the team thinks people are going to look for general health information.


  • Dr. Malinauskas commented that he had a concern about "awareness of the web site." He knew that there was intent to make the public media aware of the site, but he did not think that would be sufficient unless they propose to use the site as the lead headline of their newspapers, and that was not going to happen. He thought that they needed to look for a more saturated approach. For example, presentations to local civic organizations, chambers of commerce, rotary clubs, Lions, Kiwanis, putting posters in appropriate libraries, putting announcements in post offices. The community should be saturated with fan awareness of this web site. Ms. Robinson responded that he was referring to a promotion plan that would saturate the community with awareness of the web site. She asked the group if they understood that the web site would be launched first, without being promoted. The promotion plan would be implemented after the bugs were worked out of the site.


  • Dr. Craig thought that the chambers of commerce and local real estate organizations would love to have this information, so that they could guide people to it for information if they have concerns about the area.


  • Ms. Kaplan asked if the ORR Web site show up in Google® Ms. Robinson explained that different search engines use different algorithms for how the results are returned, especially commercial search engines. For example, in Yahoo®, someone can purchase their way up the food chain in search results. Google® uses quite a complex formula related to how many people are linking to a site. It is difficult to move a site's position in Google®, unless it is just a popular site. That is why people like it, because they know it is not being manipulated. That said, if some search terms are typed in, the ORRHES site does pop up very quickly.


  • Mr. Box reiterated that the area needed to be saturated with the web site information. There is a large number of people in the area who would like to know something, but who are not really doing a search. However, if they are made aware of the site, they will go there directly. If the web site is publicized, it will reach a much larger number of people who have concerns, but who will not know how to use search engines to find the web site. Ms. Robinson responded that she thought he was saying that they might need to think through helping people find the web site, so that they will know where it is. If they cannot manipulate the search engines, then they should think about having an easy-to-read URL and think about other ways to get people to the site or getting other people to link to the site.


  • Mr. Hill explained that when he wanted information, he simply goes to Google® or Yahoo® and types some terms in to the search window. Although he does not understand how the search engines work exactly, he does understand that they cannot manipulate them like they would like to. However, he did not hear, in Ms. Robinson's presentation using the actual terms. Everyone said "nine counties," but they did not name the counties. The group talked about ORR but did not name ORNL, K-25, ETTP, Y-12, et cetera. He wondered if he was out of state doing a search on Kingston, Roane County, located close to Oak Ridge National Laboratory, if he puts those words into the search engine, if it would find the web site. Ms. Robinson replied that she was hearing his concern, and they could put metadata in the pages in that assists with that. The way a web page works is just like a text file, and inside some brackets are things that do not show up when the browser pulls it up. So, the team could put a lot of those terms in, and that would help the search engines find it. There are some technical ways that the team can improve the search results. Ultimately, they sometimes cannot change the position, but she was hearing that this was a chief concern. Also, she asked if the group would help the team with a creative way of ensuring that they list these things, such as the counties, in the creative brief. If no one sees the team talking about something, they need to bring that issue up.


  • Dr. Craig thought that it would help with Google® if they could get up to 50 or 60 web sites that are linked to the ORR web site. He thought that it would pop up quite quickly. He also suggested that links could be created easily by sending out e-mails with the new site's URL to the chambers of commerce, to UT Battelle, to Y-12, to all the counties, to the City of Oak Ridge. He thought that they would all love to link to the ORRHES site. Ms. Robinson agreed. She also thought that putting the metadata into the page would help some, too. Dr. Craig pointed out that Google® has gotten wise to that. Ms. Robinson knew that, and said that it was one of the reasons that everyone liked Google® so much. It could not be easily manipulated.


  • Ms. Robinson summarized that one of the main concerns was that people had to be able to find the site and they should be able to find it through the search engines. She added that the team would be working on getting the web site up first, and then they would work on making it easier to find.


  • Mr. Hill suggested that somewhere up front, the site should have links to the three sites, the DOE Oak Ridge Operations, and then DOE Headquarters, because those open up a lot of things that area not related to what the ORRHES is doing, but people would be interested in those efforts. Dr. Craig reiterated the need to have a myriad of links, and the ORRHES should offer to exchange links. Ms. Robinson asked if those DOE links were currently on the ORRHES site. Dr. Craig was not sure, but they did need to add cities, civic groups, and the chambers of commerce.


  • Ms. Robinson asked the group to please send any ideas to her. She added that anything that is currently on the site would not be lost and would be integrated into the new site.


  • Dr. Malinauskas thought that it would be quite helpful if, in parentheses, they would put the number of pages involved in any reports that are on the site, because he would hate to try to download a full report and find out later that it is 205 pages. Dr. Craig suggested that even just the number of megabytes would be helpful.


  • Ms. Janet Michelle suggested that if they wanted a member of the community group to make comments, she would be happy to be that community representative. She is a member of the Community Coalition for a Healthy Environment.


  • Ms. Kaplan commented that she spent the weekend using the old ORRHES site when preparing her earlier comments, and so she felt close to the site as it currently exists. As it exists, if an ORRHES member wants to go in and do a search on a particular subject, and they want to go through all of the ORRHES meeting minutes and the Work Group minutes, the only thing that is searchable are the ORRHES meeting minutes. They can go in and there is a version choice. If they pull up the .PDF version, then there is a find feature. Someone could search it, but could not copy sections. She spent all weekend typing the timeline. It was a waste of her time from that standpoint. The other thing they get is a list of hits. The page on their own hit and the page that prints out do not match. She will write down her specific comments and send them to the team, but she reiterated that people should be able to get a printed search product. Also, it would be nice to have a map that was searchable by area or by county, so that people could click on it for information on the possible contaminants to which they might have been exposed. The link should also explain the possible health risks and what is known about the impact of the contaminants on their bodies. Ms. Robinson responded that some of these issues have been worked on with the cdc.gov site for years, but others, like the map, should be doable.


  • Mr. Lewis suggested that the map might even go down to the community level, because the ORRHES has heard, from certain people who live in the Happy Valley area, that they have issues related to their health. It would be nice if people in the individual communities could look for their particular concerns. He pointed out that he was advocating for the major communities and not every single block.


  • Ms. Robinson suggested that the team have a working session with the ORRHES members who are interested in organizing information in that way. Then the team could look at how to pull the documents in that way. Then, if it was a matter of resources, it may be something that the ORRHES could assist with, but that is doable.


  • Mr. Lewis thanked Ms. Robinson for her excellent presentation. He added that the ORRHES is a part of it and he wanted that noted. He thought that would be very helpful.

Hearing no further comments, Ms. Susan thanked the subcommittee for their time, and she asked that anyone who had any further comments, questions, or suggestions to please contact either her or Ms. Horton.

Introductory Presentation of Past Releases of Mercury from the Y-12 Plant

Mr. Bill Taylor
ATSDR Oak Ridge Field Office

Mr. Bill Taylor's presentation covered the following:

  • Mercury Presentations at ORRHES ("Big Picture")
  • Data Sources for the Y-12 Mercury Releases PHA
  • Mercury Exposure Pathways
  • Mercury Concentrations in Environmental Media

Mr. Taylor explained that mercury is one of the nine PHAs that the ATSDR is producing for Y-12, and like many of the PHAs, this PHA is divided into past and current exposures. The past exposures are for the years 1950 through 1990. Presented would be 1990 to the present. The reason for this division is because ATSDR is relying on the Oak Ridge Dose Reconstruction Project for past information, and is relying primarily on those reports for the analysis of past exposures.

Directing the group's attention to page 2, the middle row, looking from the left to the right, Mr. Taylor explained that he was, first of all, considering the data sources that ATSDR is utilizing for this PHA. From the releases of mercury from Y-12, ATSDR developed and estimated concentrations of mercury in the environmental media, which includes air, water, soil, biota, and fish. From that, the human doses are calculated. Also considered are the health implications of those human doses, along with health outcome data available. Finally, conclusions and recommendations are reached and a public health action plan is developed for the public health assessment. All of this is accomplished along with community concerns that have been collected.

With respect to the mercury releases up to the point of environmental media and concentrations, Mr. Taylor said it was important to note that what starts at the left in the process, impacts each step of the process. So, what is learned about the mercury concentrations in environmental media will have an impact at the very end of the process. Therefore, it is important to know what the strengths and the weaknesses are on this data at this stage. The data sources being considered for this project are:

  • The Oak Ridge Dose Reconstruction Task 2 Report, from 1999.


  • Comments by technical reviewers on the Oak Ridge Dose Reconstruction Task 2 Report. These are technical reviewers that ATSDR contracted, who gave the ATSDR comments. Those comments have been compiled into a report, and that report was distributed to the PHAWG late last year. He instructed the ORRHES that if anyone was interested in receiving a copy of that, they could contact him. The five technical reviewers were hired to study the Oak Ridge Dose Reconstruction Task 2 Report and to give us their professional opinions of what they saw, according to standard questions provided to them to address.


  • Questions, comments, and concerns from ORRHES and the public, which include:


    • Received one unpublished scientific paper containing environmental data
    • Concerns about waste pits and burial sites
    • Concerns about unauthorized releases
    • Concerns for contamination in specific soils and groundwater that has not been tested
    • Concerns about the full effects of the complicated terrain in the ORR area

As ATSDR receives more concerns, they will be incorporated into the report as well. Mr. Taylor emphasized that if anyone in the group knew of anything that was not on the above list, ATSDR is interested in seeing it.

At the beginning of the process, ATSDR wanted to consider how much mercury came into the plant and how much mercury ATSDR knows went out of the plant. Mr. Taylor shared a condensed table from the Dose Reconstruction Task 2 Report. The numbers in the table were generated in a study done in 1983 that was not specifically for the dose reconstruction, but was reproduced on the Dose Reconstruction Task 2 Report. The amount of mercury vouchered to Y-12, in pounds of mercury, is estimated to have been over 24 million pounds. Of that total, the amount that was accounted for that went into production and was resold at a later time was over 22 million pounds, and the difference was approximately 2 million pounds. What is known about those 2 million pounds? Looking at the releases, they have estimated the amount lost to the air, soil, and water is approximately 733 thousand pounds, which leaves a difference of 1.2 million pounds of mercury that is not accounted for.

With regard to the importance of these numbers, Mr. Taylor said that first, the unaccounted amount of mercury is the amount that is going into the air, water, and soil. Also, the amount that is really unknown is more than half again larger. This is an amount that is difficult to deal with because where it went is unknown. There is some speculation that is discussed in the report that says that this may have been an accounting error, that it was part of the way that they counted mercury coming into the plant. The people they interviewed estimated that this might have accounted for approximately half of this number. Even so, that leaves an amount half again the size of what is known is unaccounted for. Those numbers provide some uncertainty about the pathways being considered, particularly the air and water pathways. The numbers do not particularly impact the soil and the fish pathways because those were estimated based on actual measurements in the environment rather than modeled amounts that were released from the site.

Primary exposure pathways include: Surface water, air, soil and sediment, and fish. Secondary exposure pathways are: Fruits and vegetables and milk and meat. These are secondary in the sense that they are derived from concentrations in mercury that were estimated in the surface water, air, and soil. After they decided what these might have been in the past years, they also modeled how they could have affected the concentrations of mercury in the fruits, vegetables, milk, and meat. The additional exposure pathways that the ATSDR is going to be considering as a part of this public health assessment were chosen based on the concerns of the technical reviewers, members of ORRHES, or members of the public in meetings Mr. Taylor has attended over the past year. These additional exposure pathways include:

  • Inhalation of mercury tracked into homes on shoes, primarily from soils, but possibly even from workers bringing it home on their boots.
  • Contaminated soils transported from East Fork Poplar Creek to gardens. ATSDR knows that there were some soils and sediments that have been moved around from East Fork Poplar Creek.
  • Ingestion of or skin contact to mercury of children digging in soils below the surface level.
  • Air dispersion or mercury from East Fork Poplar Creek in the K-25 cooling towers.

Additional exposure pathways will be considered as the come to ATSDR's attention. Mr. Taylor then discussed, in more detail, the four primary environmental media types and discussed what ATSDR knows about how mercury concentrations were developed by the people who developed the Oak Ridge Dose Reconstruction Task 2 Report. He explained that the reference populations for water include:

  • Scarboro Community (Mile 14)
  • Robertsville School Students (Mile 12)
  • East Fork Poplar Creek floodplain farm family (Mile 10)

The types of exposures ATSDR is considering are incidental ingestion of the water and skin contact. Those are the primary ways in which people would come in contact with the surface water. The locations that were considered of interest for Mercury concentrations in the water that the dose reconstructionists looked at for these specific communities were at mile 14, mile 12 and mile 10, along East Fork Poplar Creek. Those locations correspond to the nearest parts of East Fork Poplar Creek to those particular communities. The data ATSDR currently has for water include spot samples from 1955 through 1961 from the East Fork Poplar Creek, near Y-12 and at the opposite end of East Fork Poplar Creek, near Poplar Creek. This data is very useful because it is direct data that can be used to estimate what the concentrations were in the water in the past. They provide a measure of the total change in mercury in the water over the full length of the East Fork Poplar Creek. The assumptions that went in to the modeling were that:

  1. Changes in mercury concentration in EFPC between Y-12 and Poplar Creek are due to:


    • Surface water runoff to EFPC
    • Loss of mercury from water to sediment and air
    • Discharges to EFPC from OR waste water treatment facility (beginning in 1958)


  2. Amount of surface water runoff along and into EFPC was estimated in the study by the Tennessee Valley Authority, in 1985. Using this information, along with annual precipitation data, the Task 2 dose reconstructionists were able to determine the factors that provided dilution of water to the creek over its entire length.


  3. Loss of mercury to sediment and air that was considered to be linear along the length of the creek, which means that the rate of loss does not vary. This loss was calculated by the Task 2 dose reconstructionists as the difference between the changes in the water mercury concentration from Y-12 to Poplar Creek and the effect from dilution. This was a basic description of the model that was used to estimate what the mercury concentrations were at the three locations along the creek that corresponded to the receptor populations.

    The results of their calculations were:

  • Surface water mercury concentrations at receptor locations (for each year, from 1950 to 1961) were calculated from:


    • The measured concentrations at Y-12,
    • Reduced by a dilution factor (from the drainage basin) and
    • The fractional loss to sediment and air as estimated by a calculation subtracting out the effect of dilution.

Through this model, dose reconstructionists were able to provide the estimates of the water mercury concentrations that did not rely entirely on releases to the water. The strengths of their results are:

  • The model is reasonable


  • Numerous data were used that correspond to the 1950s and the early 1960s, as well as precipitation data for the years of interest


  • The value selected for loss to sediment and air, which is 70% along the fullest extent of East Fork Poplar Creek; this value was supported by a separate study

The weaknesses of the data include:

  • In the early years, the model broke down. What happened was, when they took into consideration dilution, the resulting concentration was greater in the creek than was predicted and was not allowing for any reduction due to precipitation or fallout of mercury into the sediment or volatilization to the air.


  • The uncertainty in the amount that was lost to sediment and air was a very large number. This basically says that that along the full length of the creek, somewhere between 40% and 100% of the mercury went into the sediment and the air. That is a large amount of uncertainty.


  • The assumption that the linear loss of mercury to sediment and air is problematic, because it is known that mercury and sediment was not deposited linearly along the bed of the creek. ATSDR has examples, particularly near two of the receptor populations of Scarboro and the Robertsville School, where mercury in the sediment was actually quite high. The relationship between mercury fallout in the sediment and the water concentrations is not entirely clear.

Mr. Taylor explained that there were three different models and a series of different reference populations for air, including:

  • Wolf Valley, where mercury concentrations in air were estimated from releases from the Y-12 plant, using an air dispersion model.


  • At the Scarboro community, with releases from the Y-12 plant and a model based on uranium data


  • Releases of mercury from volatilization from the creek water from EFPC, which would have affected Scarboro, Robertsville School, two different locations in Oak Ridge that were modeled, and EFPC Floodplain farm family.

These were three different models that they used for different reasons, to calculate mercury concentrations in air. The first model, with Wolf Valley, was the simplest model. Mr. Taylor referred the group to the first of the figures. The diagram shows, graphically, what source terms are. Mr. Taylor pointed out the numbered items in the diagram are the stacks, vents, and window fans on the Y-12 buildings. For each of these locations, it calculated for each of the years how much mercury came out of these locations and into the air. When all of these locations were combined, the total was the amount of mercury that went into the air from the Y-12 for any particular year.

Each of these was plugged into the EPA dispersion model that was then used to calculate mercury concentrations in air at the Wolf Valley location. The dispersion model was appropriate for this task because the model that was used is for relatively flat locations, and Wolf Valley is down wind in the valley direction from Y-12. There were 114 point source terms at Y-12. These are the points on the diagram, and they included the stacks, window fans, and vents. The total uncertainty estimated by Task 2 for these air concentrations, was +/- 44% percent of the concentrations. The method and the results are likely very reasonable for this calculation.

The second model for air was in the Scarboro Community, and because the air would be going up and over Pine Ridge, the flat-air dispersion model was not appropriate to use. So, they went to a model that is referred to as the "Chi-over-Q" method. Chi is a Greek letter that looks like a capital X. The Chi-over-Q method assumed that mercury behaved like uranium. ATSDR had data from 1986 to 1995 that indicated how much uranium concentrations were in Scarboro during this ten-year period and what uranium releases from Y-12 occurred during the same ten-year period. From those data, a ratio of these quantities can be calculated, and if one believes that mercury behaves like uranium, one can use releases of mercury from Y-12, which was known during the 1950s and the 1960s. So, the estimate the mercury concentrations in Scarboro were based on this ratio of uranium data. The value of Chi-over-Q, which is uranium concentrations over uranium releases from Y-12, is calculated from twenty pairs of data where the uranium releases were relatively low compared to the 1950s and 1960s. The weaknesses of this particular model are:

  • There is no direct evidence that mercury behaves like uranium.
  • There is no evidence that the relation holds for much higher release levels of mercury.

Thus, it questionable whether this uranium model is a good choice for estimating mercury concentrations in Scarboro. But, this model was the choice of Task 2, as the best way to go with this problem.

Mr. Taylor explained that the third model was air mercury concentrations in communities affected from mercury volatilization from EFPC water. It was estimated that amounts of mercury going over Pine Ridge from direct releases from Y-12 did not account for the amount of mercury that they were finding in tree samples, in the cores of trees. In looking over the studies of the trees, they estimated that a source of mercury was directly out of the water of the creek itself. They modeled this and for this purpose, they estimated 403 theoretical segments of EFPC.

Mr. Taylor referred the group to the second diagram on his handout, which was a visualization of what the creek looks like when it is divided into segments. Each of these is segments is no longer than 100 meters, and each of the segments provides a source term of the amount of mercury going out of water and into the air. From that point, the same model the EPA dispersion model was used to estimate the amount of mercury concentration in air at the receptor locations. So, it was a dispersion model using the creek itself as the source term for mercury going into the air.

The amount of mercury going into the air was estimated based on the distance of each of the segments from Y-12 and the rate of volatilization from the water. The rate of volatilization was estimated in a couple of specific studies that were conducted on Reality Lake in EFPC and in the laboratory. The numbers they arrived at were somewhere between 1% and 30% of the mercury in the water would volatilize, which the central number being 5%. This figure was applied to the mass of mercury in each of the theoretical segments along the EFPC. Again, the amount of mercury mass was assumed to be linear with distance from Y-12. The receptor populations and locations along EFPC were the same as for water exposures. The data sources were:

Environmental Pathway

EFPC Farm Family

Robertsville School

Scarboro Community

Soil

SAIC RI

SAIC RI

ORAU

Sediment

SAIC RI

SAIC RI

SAIC RI

Studies looked at the soils and sediment from the SAIC remedial investigation study, and soils from Scarboro and an ORAU study. The SAIC Remedial Investigation study included:

  • 159 transects of EFPC, which are theoretical lines that cross through the creek, where samples were actually taken.
  • The core samples taken were in units of 0-16, 16-32, and 32-48 inches. These were homogenized, so that there were three sets of data for each of the core samples.

Task 2 calculated fish concentrations in a couple of different ways for different receptor populations and locations, including:

  • Scarboro residents (fish from EFPC)
  • EFPC floodplain farm family (fish from EFPC)
  • Anglers at EFPC
  • Anglers at Poplar Creek/Clinch River
  • Anglers at Watts Bar Reservoir

Past fish mercury concentrations were calculated from sediment mercury concentrations. They found that there was a good match when an analysis was done among the data that they had in the 1970s and 1980s for the amount of mercury in sediment and the amount of mercury in bluegill and largemouth bass. With a linear regression analysis to match the concentrations in the sediment and in certain fish species, they were able to apply this correlation to the sediment samples that they took to look at historic years. Those 6 core samples were taken from the EFPC, Poplar Creek, Clinch River, and the Tennessee River. Core samples were dated using both mercury and cesium-137 stratification. This model demonstrates that there were many core samples done as a part of this study to look at the amount of mercury in the soils and the sediment along EFPC. In order to date them, there was a specific, special study called the Vertical Integration Study, where 18-inch cores were divided up into 1-inch segments. It was estimated from the study of these five core samples how the soil concentrations varied along the depth of the core. This particular distribution of mercury through the depth was normalized and applied across the board to the samples where the amounts were homogenized to estimate the amounts of mercury at different levels and therefore for different years throughout the EFPC flood plain. The samples that were selected in the floodplain for the three receptor populations were then selected as those samples that were closest to those mile markers.

The SAIC study was an elaborate study, and much real data were used. ATSDR is using it directly to estimate how much mercury was in the soils and the sediment from, 1950 through 1990. One of the weaknesses of this model is that if there were significant amounts of mercury that fell below sixteen inches, which was the core sample that was used to make the estimates, then the amount of mercury for that particular year could have been underestimated:

  • Regression equations were a good use of recent data from the 1970s and 1980s.


  • Cesium dating increased the reliability of the sediment dating


  • There were too few core samples (6) used for the entire surface water from Y-12 all the way down to Watts Bar Dam:


    • There was only one each in EFPC and Poplar Creek. This is quite difficult to accept given that we know that the sediment concentrations through EFPC vary a great deal
    • The high variation in sediment mercury is not accounted for in the model. There is one estimate at the Y-12 end and EFPC, and another estimate at the Poplar Creek end of EFPC. Those two core estimates of mercury concentrations for the 1950s and 1960s are based on averages of those two cores alone.

Mr. Taylor explained that SAIC sediment data was not used, and at the lower end of EFPC they assumed 20% of New Hope Pond. There was no core sample taken. There was a surface sediment sample that was compared with the surface sample at New Hope Pond, at the Y-12 end, and the difference in the mercury concentrations in that sediment at the surface showed the difference to be 20% (1985 data). In other words, the mercury at the low end of the creek was 20% lower. Therefore, one has to assume that for all of the years, the concentrations and sediment at the low end of EFPC were all 20% of the amount at the Y-12 end of EFPC. This is also quite a stretch because it is based on few data. The EFPC and Poplar Creek sediment mercury concentrations exceeded those in 1980s data. These were the data that were used for the linear regression analysis. They began to extrapolate the linear regression for the sediment samples that were higher in mercury concentration. They put aside their model altogether and assumed maximum mercury concentration from fish based on a study that was done in the Great Lakes.

Again, correlation was based on data where the sediment mercury concentrations were relatively low in the 1980s compared to the 1950s. Once the sediment samples for the 1950s were estimated from their core samples and found to be in excess of the linear regression model, they put the linear regression model aside, took default values of maximum mercury concentrations in fish from the Great Lakes study. This was another point that was criticized by ATSDR's technical reviewers for a couple of reasons. First, the rejection of the linear regression was not fully justified. Second, even though the Great Lakes study included the same fish species and sizes of fish that are found in EFPC, the amount of mercury in the sediment in the Great Lakes study was half of that maximum that was found in certain areas of the EFPC. So, it appears that the maximum value in fish from the Great Lakes study may not be a good default value for the maximum concentration from mercury in fish from EFPC.

In summary, Mr. Taylor presented the following conclusions:

For surface water, accounting for runoff supports the variation in the dilution of the water at different locations. This comes from the TVA study and it is real, measured data. Averaging of losses of mercury to the sediment and air may underestimate mercury concentrations at receptor locations due to local variations in the amounts of mercury in the water. It is known that mercury fell out in the creek in greater concentrations in some areas than in others, and it was not linear along the length of the creek.

For air, the dispersion model for Wolf Valley was a good choice and was reasonable. The assumption that mercury behaves like uranium in the Scarboro area was unsupported by any data. It may be a good model, but there are no data to support or refute it, which is a problem. Mercury volatilization from EFPC was probably a reasonable model.

For soil and sediment, many of the core data used and the model were good. Few soil samples were taken in Scarboro. There were 57 soil samples taken from Scarboro in the ORAU study that was used for this determination, and it was not explained how historic soil concentrations in Scarboro were calculated.

For Fish, linear regression of sediment and fish mercury concentrations was a good model. A great deal of data went into this analysis that compared sediment and fish. There were too few sediment cores used to estimate fish mercury concentrations. Averaging over large expanses of the creek or the rivers ignored the high sediment mercury concentrations in some areas of the creek. Default values for the lower end of EFPC were reasonable, but were highly uncertain because they were based on one sample measurement. The use of default fish mercury concentrations in place of linear regression, when sediment mercury concentrations were high, was not well justified.

Discussion Points:

  • Dr. Malinauskas asked why the difference and the sum were not equal. The difference was given as 2,056,056. The sum was given as 2,025,056. Mr. Taylor responded that he thought that was a typographical error. Dr. Malinauskas pointed out that if that was so, then the amount actually not accounted for was more than indicated. Mr. Taylor replied that the sum should read 2,056,056. It was pointed out that it was the difference that was incorrect, not the sum.


  • Mr. Manley asked if he understood Mr. Taylor to say that the mercury level in Scarboro was high. Mr. Taylor responded that in the area of East Fork Poplar Creek, corresponding nearest to Scarboro. Mr. Manley stated that Scarboro is not near the floodplain. So, when sampling soil in Scarboro, one finds that it is actually as low as it is anywhere in the city. Mr. Taylor explained that in this calculation, ATSDR is looking at water concentrations in the creek. The estimates of the water concentration in the creek were looking at how much of the mercury fell out into the sediment. So, the fact that there were large amounts of mercury in the sediment in that area of the creek that is closest to East Fork Poplar Creek meant that the precipitation and settling of the mercury was not linear along the creek. That was part of the calculation used to estimate the water concentration in the creek. This is a weakness of the model assuming that this lost of sediment was linear, when it was not linear.


  • Mr. Box asked what the concentration was in the sediment along Mile 2. Mr. Taylor indicated that he did not have that information with him. Mr. Box said the reason he was asking was because if it was fairly linear, one would expect it to be quite low down there, but if there was a fair amount there, one would think that portions of the mercury were being swept on into Watts Bar Lake. Mr. Taylor agreed and emphasized that for this calculation, Task 2 did not look into Watts Bar Lake. They were assuming that by the time one got to Poplar Creek, at the end of East Fork Poplar Creek, that the water concentration had diminished by 70% or so. That was the figure they used to calculate water concentrations.


  • Dr. Davidson asked if the mercury and/or uranium were vapor. Mr. Taylor responded that it was a vapor. Mr. Taylor indicated that uranium is particulate. That is only one of the main differences between uranium and mercury. Uranium is heavier and is a particulate, whereas the mercury is in vapor form. These were the assumptions that were made based on the data they had about the releases to the environment. The question is: How much like uranium is mercury in its physical behavior? There was a discussion on the Task 2 report that indicated that uranium was released more often from the low stacks on the tops of the buildings than mercury. Mercury was released more often from windows at a lower elevation. So, it might be thought that more uranium got over ridge than mercury. On the other hand, mercury is a vapor and lighter and might have gone further. So, maybe more mercury than uranium got over the ridge. But maybe because uranium is a particulate, it would have fallen out in the Scarboro area more quickly because it is heavier, and so the mercury as a vapor would have gone further. In the end, Task 2 said the differences between their physical behaviors were not expected to amount to much difference. Unfortunately, there is no evidence provided for that. Therefore, he thought that the take home message was that the data themselves do not answer this question. It is a gray area. It is the best model that they decided they had available to use, and those are the weaknesses with which to consider the appropriateness and the value of this data.


  • Mr. Lewis asked if that issue had been raised before. Mr. Taylor responded that he understood that during the development of the Task 2 Report, there were many discussions about this issue, and he was told that much arguing went on under the ORRHES banner, ORHESS being the committee that ran the Dose Reconstruction meetings. It was certainly a concern that came up in ATSDR's technical reviewer comments, and they were very skeptical of this approach. ATSDR has also heard from individuals who feel the same way. However, these are the data they have to work with.


  • Based on the controversy, Mr. Lewis asked if the report was published anyway. Mr. Taylor responded that the report was published anyway.


  • Dr. Craig stated that the body of water is now called New Hope Pond, and there was mercury coming down there. They took it out in the mid-eighties and replaced the whole pond. Mr. Taylor pointed out that this study was done when they called it Reality Lake.


  • Mr. Box asked if there was any correlation related to the gold mining industry with regard to mercury concentrations in the water and sediment. Mr. Taylor asked if there was gold mining in this area. Mr. Box did not think there had been. Mr. Taylor explained to the rest of the group that mercury was used to pan for gold in surface waters, and it is one of the reasons why many of the creeks and streams in Central and Northern California are contaminated with mercury. Mr. Box's question was: Is there a correlation between amounts of mercury in those creeks that were used during the gold rush days, in areas where people mined for gold, and the data that ATSDR has for mercury in the soils, sediment, and the water. Mr. Taylor did not know. He has not seen any specific studies where that correlation was examined for EFPC or for the waters in the ORR area.


  • Mr. Box indicated that they are having that problem in Brazil currently, and there is a lot of mercury going downstream. Mr. Taylor agreed that there were mercury problems in many places.


  • Mr. Manley asked if there was a difference in the vapor pressure from mercury in the air versus mercury in the creek. Mr. Taylor did not know the exact difference in the vapor pressure. He knew that it was not a consideration in this study, because they took actual measurements from mercury in the vapor directly over the water to make the estimate. Mr. Manley commented that there had to be a good difference in the vapor pressure due to the temperature of the water being cooler than the air. Mr. Taylor agreed. He stated that the vapor pressure in the water would be lower than vapor pressure in the air because the water is cooler than the air.


  • Mr. Malinauskas asked if Mr. Taylor was talking about elemental mercury and not organic mercury. Mr. Taylor affirmed that was correct.


  • Mr. Lewis asked what Mr. Taylor's conclusion was regarding the soils and sediment measurements. Mr. Taylor replied that they have pretty good measurements of mercury concentrations in soils and sediment because there are real data and good models.


  • Mr. Hanley asked why they did not use other cores. Mr. Taylor responded that he did not know. That is a really good question since there was so much data from the SAIC study, and they had already dated those core samples for use in estimating the soil and the sediment mercury concentrations.


  • Mr. Lewis asked if there was anybody in the public who may understand the information just presented and who could clarify it. Mr. Taylor mentioned that he had some questions such as this one that he was proposing to the people who conducted the Task 2 study, and he is hoping to gather some responses back from them.


  • Dr. Davidson stated that the questions that are raised during this meeting will be in the meeting minutes, and they can be addressed at a later date. Mr. Taylor explained that part of the problem is ATSDR is moving ahead on this PHA because they need to do that, and they are obtaining answers wherever they can find them. Those questions have been asked. There are a lot of questions that come up when one studies this material, and it is a huge amount of material. Over all, they did an excellent job, but there are some questions and issues that the data simply do not answer. That is not going to change, but it is important to understand what they mean and what the significance of the data is.


  • Dr. Craig thought that the numbers should have been 20% at the lower end of what they were in New Hope Pond. So, it is 1/5 as much mercury as opposed to 20% more. Dr. Taylor clarified that he meant to say 20% of the value of the mercury concentration at the Y-12 end.


  • Dr. Craig stated that as he understood it, by defaulting to that, it was more conservative. Mr. Taylor stated that he did not know that, but what he would like to do is run the linear regression based on the actual sediment concentration and see how those fish concentrations would compare. The thing that concerned Mr. Taylor particularly was that the maximum mercury concentration in the sediment in the Great Lakes study were approximately one-half the maximum mercury concentration in the sediment in the vertical integration study. So, it may or may not be more conservative. Mr. Taylor's final words were that the data that ATSDR has may not answer all of the questions, but it is important to know what the strengths and weaknesses are. He indicated that he would be taking this work further when he looks at human doses in his next presentation.

Public Comment Period

Dr. Kowetha Davidson, Chair
Oak Ridge Reservation Health Effects Subcommittee (ORRHES)

Dr. Davidson announced the start of the second public comment period and asked if anyone would like to speak.

Discussion Points:

  • Dr. Gordon Blaylock asked Mr. Taylor what form of mercury that was released to water and what form was measured in the water. Mr. Taylor responded that the Task 2 team assumed that the mercury in the surface water was inorganic. Dr. Blaylock asked if it was methyl mercury. Mr. Taylor replied that the form of the mercury really was not considered until they got the evaluation of the doses. So, there were some broad assumptions that all of the mercury that went into the air was elemental mercury, all of the mercury in the fish was methyl mercury, and all of the mercury in all the other media was inorganic. Dr. Blaylock asked how much of the mercury was assumed to be methyl mercury. Mr. Taylor indicated that it was assumed to be 100% methyl mercury in the fish. With regard to transformation of the inorganic or organic mercury into methyl mercury, Mr. Taylor thought that there was some speculation of how that could have occurred, but it did not go specifically into the calculations that they made. I think the discussion was that it is done through bacteria and so forth.


  • Dr. Blaylock agreed that was a general assumption. He pointed out that Mr. Taylor talked about deposition of mercury in sediment, and it was not consistent, and with a flood in EFPC, usually, the water comes out. It lifts the surface sediment, and takes it downstream and deposits it in area where, when it slows down, there is a deposition. Mr Taylor stated that his thinking about that is that when the water levels come up again, that is another source of mercury feeding into the water. Dr. Blaylock replied that is providing there has not been more deposition on top. Usually that is the top layer of sediment. The mercury vapor coming out of the stacks is usually vapor, but it comes out and very quickly attaches to any particulate around it. So, it would be pretty much like other contaminants on particulates. Mr. Taylor responded that he did not recall that Task 2 described that. They just said that it was a vapor. Dr. Blaylock agreed that it was a vapor, but usually it comes out for a short distance, and then it will attach immediately to any particulate around it. He said that New Hope Pond was a pond above Lake Reality on EFPC, and it received depositions of everything from Y-12, coming out of the water. That was closed in the 1980s.


  • Dr. Craig agreed that it was closed in the mid-eighties. They took out a lot of the sediment and buried it. Dr. Blaylock indicated that they took out all of the sediment and took it up on the hill. Then they built Lake Reality down below it, with the EFPC coming around it.


  • Mr. Taylor asked if they ever both functioned at the same time. Dr. Blaylock and Dr. Craig both stated that they had never functioned at the same time. Dr. Blaylock added that now the water does not go through Lack Reality because they found that the fish in Lake Reality would get more mercury than if they were not there, if they went downstream.


  • Mr. Taylor asked if there were any newer studies where they could estimate a maximum value of mercury in fish. Dr. Blaylock responded that there was quite a bit of fish data. He thought that the maximum value that one would find now is approximately .5 parts per million. Also, regarding the core samples, he asked Mr. Taylor to tell him again how many core samples were taken. Mr. Taylor replied that there were 159 transects of the creek, and each transect would have had approximately 6 or 20 different samples, depending on the length of the transect.


  • Dr. Blaylock reiterated that they would only took 16 inches and 32 inches, and homogenized that. That was not an accurate way of doing it. They should have taken many more core samples, and instead they only had five that were sectioned. Of course, the first one would have come out in varied layers, and it was the dark layers in the sediment that would usually contain the mercury, and they were only about an inch thick. Mr. Taylor stated that what they did was a vertical integration study, where they looked at each inch. They figured out what that distribution looked like, applied that to the average value, and that was the homogenized value of the majority of the data. Dr. Blaylock asked how many core samples they had to base that on. Mr. Taylor thought that in the vertical integration study, they had five or six. Dr. Blaylock asked how many core samples were taken all together. Mr. Taylor did not know that number.


  • Dr. Blaylock did not think that number was very good. He did not think that would stand up. He added that everyone knows that in many areas where they said that the concentration for mercury in the cores were around 200 parts per million, they would find over 1,000 parts per million. Mr. Taylor asked Dr. Blaylock if he was saying that the vertical integration study did not have enough samples or give a representative picture of the average distribution of mercury over the years. Dr. Blaylock affirmed that this was what he was saying. Regarding the fish samples, mercury in fish is usually methyl mercury. He asked what the mercury was assumed to be in the sediment. Mr. Taylor responded that they had assumed it to be inorganic mercury. They did not specify the type.


  • Dr. Blaylock asked if there were sulfides. Mr. Taylor indicated they were sulfides and chlorides, maybe oxides. Dr. Blaylock thought that the correlation there was lucky as far as getting concentration in the fish and in the sediment. If one went downstream, there is very little mercury in the sediment, whereas other locations have a great deal. One can find that the fish along those areas have just as high mercury as one does in the areas where it is quite high.


  • Mr. Taylor pointed out that one thing he did not know was how many of the samples were actually used in doing that correlation. A lot of data that were listed in a table over several pages, but it did not specify which data were used in the correlation. Dr. Blaylock commented that there are many samples of mercury in fish in EFPC, a large number. He wondered why they did not use that. Mr. Taylor explained that there were no fish samples taken before the early 1970s. Dr. Blaylock argued that there were plenty of samples taken before that, even for mercury. Mr. Taylor responded that they were not indicated in the task 2 report. He did not have that data. Dr. Blaylock stated that he would locate them and send him that information. There were two Masters studies on Y-12. There is some data before then. Most of the data was after the 1970s, and one could extrapolate down with the mercury and fish in other ways than just the correlation.


  • Regarding the Great Lake studies, Dr. Blaylock indicated that he would never use that because there could be 10 parts per million in the sediment and 100 parts per million of mercury in the sediment in other locations, and have more mercury in fish where you have 10 parts per million because of a high methylization rate.


  • Dr. Blaylock asked if the TVA took a lot of core samples. Mr. Taylor affirmed that they did.


  • Mr. Blaylock asked if they also took water samples. Mr. Taylor indicated that they did.


  • Dr. Bob Craig thought that Dr. Blaylock had just identified an excellent data source, which is the Environmental Science Division Library. They should have the Masters and PhD dissertations. Dr. Blaylock responded that he did not think they were in there. Dr. Craig pointed out that "Stan" saved everything. Dr. Blaylock indicated that "Stan" was not involved in this. This was Y-12. They knew the mercury was coming out in fairly high levels, in the 1970s, and of course, at that time that was classified. Dr. Craig suggested that they look over at the Development Division at Y-12. Dr. Blaylock stated that he did not know how much data was there, but he would see if he still had those theses.


  • Dr. Davidson asked if anyone else from the public would like to address the ORRHES. With no more members of the public coming forward, she opened the floor for more questions for Mr. Taylor.


  • Ms. Adkins asked if a possible reason for the variations in dilution along the way down the stream be the underground sinkholes, caverns, canals, and so forth. Mr. Taylor replied that Task 2 considered dilution looking at runoff surface water into the creek. They did not consider loses of water from the creek into sinkholes or other underground locations.


  • Ms. Adkins asked if it would be possible for the ATSDR to check this time for those things. Mr. Taylor thought they could raise the question, but he was not sure that there were any places where the creek itself drains. He said he would have to ask someone who knew more about it.


  • Ms. Adkins indicated that her question tied into one of her earlier questions regarding inferring things. She asked if it would make sense to do soil and water testing at sites where people actually have high mercury levels and live by springs that are bringing water in from the EFPC area. Mr. Taylor thought that the ATSDR would need to know more information about that. He did not think that the work he has been looking at indicates that there are locations where mercury is high from EFPC beyond Watts Bar Dam. The waterways that have been looked at carefully and that are part of the Task 2 report include only the surface waters from the Y-12 on down to Watts Bar Dam.


  • Ms. Adkins asked if the ORRHES and the ATSDR has all the information that they need to make the decisions they are about to make without actually looking at things that the Task 2 people did not look at for one reason or another. Mr. Taylor responded that perhaps they did not, and he did refer in his talk very briefly to some areas that he will look at more closely. However, it is a question of whether he can find any information.


  • Mr. Lewis noted that on slide three, the health outcome data and health implications, it appears to be a part of his effort. He asked ATSDR what they were going to look at, how it was going to be done, and if that data would be factored into ATSDR's conclusions. Mr. Taylor explained that the only health outcome data that he currently has that relates to mercury is information that individuals have brought to him. These people have told him that they have high levels of mercury in their bodies. This is personal information that people have shared with him. He was familiar with many of the studies that have been done around the ORR, and what data are available, although he did not think he was familiar with everything. He is not aware of any organized data sources such as registries that would give any information at all about mercury exposures. That effort has not been completed, but he did not know any health outcome data, other than personal reports, that are going to help with this assessment.

Work Group Reports, Discussion, and Recommendations

Ad Hoc: Cancer Incidence Review Document

Dr. Pete Malmquist
Oak Ridge Reservation Health Effects Subcommittee (ORRHES)

Dr. Malmquist explained that Dee Williamson had received all of the numbers from the states, has crunched them, and had sent the results back to the State of Tennessee for their review. She hoped to get the results from the state sometime in the next week, after which it has to go through an internal review at ATSDR, in Atlanta. Then it will be brought to the ORRHES. She planned to be at the PHAWG meeting the next Monday evening, not with figure results, but to talk about what will be in the report and how it is set up. Then, all of the results should be in for the June ORRHES meeting. The results will have to be put up for a public comment period as well. So, that may be done prior to the June meeting.

Dr. Malmquist then moved that the ORRHES recommend that ATSDR have a community strategy in place prior to the release of any results, and further that prior to the release of the strategy or data that the ad hoc group review both the strategy and results.

Discussion Points:

  • Dr. Craig asked for clarification with regard to what the "ad hoc" group was. Dr. Malmquist explained that the group that the PHAWG chairman of the PHAWG had appointed. Dr. Malmquist indicated that he was the chairman of that group.


  • Mr. Lewis thought that the ATSDR had a communications strategy and logic already in place for issuing any document or any meeting presentation. He wondered if he asking that them to at least bring it to the group for review prior to going out. If so, that process is supposed to already be in place. Dr. Malmquist stated that he did not know whether it was in place, but with 26 cancers across 8 counties and combining them, the ORR is going to have some high numbers, because the state is an average. The ad hoc group feels that it would like an explanation of all that prior to the results being known. He thought that with this issue, the ORRHES should be proactive. They have to be able to explain what the numbers are, what the position is, what was done, and how it was done prior to these results becoming public.


  • Dr. Craig seconded the motion.


  • Dr. Davidson stated that what Dr. Malmquist was asking for was for the ORRHES to deal specifically with the issue of the Cancer Incidence Review. For the vote she clarified that Dr. Malmquist was asking that ATSDR put a community strategy in place prior to the release of the results and that the results be reviewed by the ad hoc committee and the PHAWG before the release. Dr. Malmquist affirmed that was the motion.


  • Mr. Lewis asked how that was going to be presented to the community, and if that was going to be part of the strategy. Dr. Malmquist affirmed that the release would be part of the strategy.


  • Dr. Davidson indicated that the other issue was that after review by the ad hoc committee and then the PHAWG, the results would then be brought to the ORRHES, and it would be released to the public via the ORRHES. Dr. Malmquist affirmed that was the correct process.


  • Ms. Mosby asked who was releasing this report. Dr. Davidson responded that the ATSDR would be releasing the report. He then called for the vote.

Motion

Dr. Malmquist moved that the ORRHES recommend that the ATSDR have a community strategy in place prior to the release of the Health Statistics Review results. Dr. Malmquist further moved that the Cancer Incidence Review's strategy and data be reviewed by the ad hoc committee, the PHAWG, and the ORRHES prior to its release to the public. Dr. Craig seconded. The motion carried unanimously. 12 in favor, 0 opposed, 0 abstentions.

Public Health Assessment Work Group Report

Dr. Robert Craig, Chair
Public Health Assessment Work Group Report (PHAWG)

Dr. Craig directed everyone to the PHAWG report in their packets. The PHAWG has met twice since the ORRHES's last meeting, and both meetings were targeted meetings. The first meeting, which took place on February 17, 2004, was to consider comments submitted for the Initial Release version of the White Oak Creek Radionuclide Releases Public Health Assessment (WOC PHA). The second meeting took place on March 15, 2004, with John Wilhelmi, a chemical engineer with ERG, under contract to ATSDR. He will be the Principal Scientist conducting the Toxic Substances Control Act (TSCA) Incinerator PHA and was invited to the PHAWG to present his initial approach and data sources. The only recommendation made was the one that was considered during the teleconference. That recommendation was submitted and passed at that meeting, and the WOC PHA comments be forwarded to the ORRHES and to ATSDR.

Discussion Points:

  • Dr. Davidson stated that she has asked that the ATSDR ensure that John Wilhelmi's presentation that was given to the PHAWG be distributed to the members of ORRHES who were not at that meeting, so that they would know where the ORRHES is in the process of the TSCA Incinerator. Dr. Craig responded that he would distribute those to the entire ORRHES if they have not already received them.


  • Dr. Davidson asked that any subcommittee members who had any questions about the incinerator, or who had any existing data regarding the TSCA incinerator that John Wilhelmi might not know about, to get that information to Mr. Bill Taylor. Mr. Taylor added that all of the PHAWG meeting minutes are distributed to all of the ORRHES members.

Agenda Work Group

Dr. Davidson indicated that Ms. Sonnenburg was not present for the Agenda Work Group, but they will continue to work with Ms. Horton in formulating the Agenda for the next meeting in June.

Guidelines and Procedures Work Group

Ms. Karen Galloway, Chair
Guidelines and Procedures Work Group

Ms. Galloway indicated that the Guidelines and Procedures Work Group did not meet because they did not have a task, but she guessed that was about to change. Ms. Davidson agreed that was about to change because they now had a task before the next ORRHES meeting.

Communications and Outreach Work Group

Mr. James Lewis, Chair
Communications and Outreach Work Group

Mr. Lewis indicated that the COWG did not have any formal meetings. He complimented Ms. Susan Robinson on what he considered an excellent presentation. He thought that would work toward creating a method of doing good outreach, and he thought that the entire subcommittee ought to continue to apply input there.

Additionally, he thought that the subcommittee would be remiss if they did not mention that they have lost a member of ATSDR who, in his opinion has done "a heck of a job" with outreach. Her name is Ms. Melissa Fish, and for this group not to acknowledge her loss, based on all that she has done, would be quite sad. Because she was the type of person that she was, and because she was so close to many people in the community, he and others hoped that she would have the opportunity, perhaps during her exit interview, to discuss some of the ORRHES's activities in which she has been involved. Mr. Lewis further recommended that that discussion be with someone in senior management at ATSDR, like Dr. Falk. Mr. Lewis indicated that he did not know how the ATSDR conducted its exit interviews, but he hoped that when individuals who have worked in the community and who are familiar with that process had the opportunity to share their experiences with ATSDR, so that the agency would begin to have a better feel for what it takes to "package their science." Ms. Fish reached out to the community to do that and she should have the opportunity to share her experiences and what she has accomplished. He asked that anyone who disagreed with him to raise their hands.

He also thought that Mr. Taylor did an excellent job on this effort in talking with Ms. Robinson. He has provided a nice template that the ORRHES ought to consider adopting for all contaminants of concern. He thought that they should approve it and create the template, so that it could be put on the web site. He thought it was quite user-friendly. He suggested that the items he discussed be followed up as action items

Discussion Points:

  • Mr. Hill asked if he could make two suggestions before the subcommittee lost their quorum, given that he had two tasks for the ATSDR. One of them he heard from Susan that morning, that when she was not at a meeting, there was information handed out at the meeting that she did not receive. He asked to make it a task that when an ORRHES member is not present or somebody has to leave early, that they ensure those persons are provided with any literature or information that was handed out when they were not present. The second task was when the ORRHES makes a recommendation and the ATSDR decides not to fulfill that recommendation, that the ORRHES be notified, either by e-mail or somehow, prior to the next meeting. Certainly, they are only recommendations, and ATSDR can do whatever they want to with them. However, he asked that whenever they did anything other than what the ORRHES asked them to do, that the ORRHES be notified as soon as possible, so that people would not walk into a meeting and find out that something did not happen.


  • Dr. Davidson stated that at this point, the ORRHES had to make a decision, because there was one more work group presentation scheduled, and several members had to leave, and so the subcommittee was going to lose its quorum. It was noted that they had already lost their quorum.


  • Ms. Horton explained that technically they could not even have a meeting without a quorum. They could go ahead and continue with information sharing, but there could be no voting or no further recommendations

Having lost their quorum, the ORRHES meeting was officially adjourned.

Post-Meeting Information Sharing Session

Overview

Ms. Horton asked Ms. Robinson if she would continue to take notes, but noted that officially, the meeting had ended. Ms. Robinson agreed to do so.

Discussion Points:

  • Ms. Libby Howse suggested that the DHEP update be deferred until the next ORRHES meeting. They would then have more to share and could share it during an official meeting. Dr. Davidson stated that at the request of ATSDR, the ORRHES would defer the DHEP report until the next subcommittee meeting on June 8, 2004. She asked Mr. Pereira to go give his Project Management Status Update, and then they would defer their end of the meeting general announcements and go over the list of action items before they left, so that they would have a record of all of those items.

Project Management Status Update

Mr. Pereira announced that since the last meeting he has become a grandfather twice more. He then explained that staff had advised Dr. Falk directly about submitting nomination packages for the people who are currently on the subcommittee. He knows, traditionally, that they are really cracking down on allowing members to be renewed. What staff is going to do is take the existing body and recommend a one-year extension, which would put them until December 31, 2005. If the ORRHES is not finished with its business by then, which he hoped they would be, they can ask for an extension of up to six months. That has already been granted. However, part one has to happen first. They have a grant of the original request to December 31, 2005. If that does not happen, Plan B is that the ORRHES will be able to go until approximately June 2005.

With the existing body, no renewal is required. The ORRHES could still go until June 2005 as they currently sit. After June 2005 the ORRHES, would basically be finished if they do not renew. The ATSDR will still travel to Oak Ridge, and the group could still meet to discuss everything that they have been doing to this point, whatever is not finished, except there will be no ORRHES. That would be the only difference. Obviously, ATSDR wants to support the December 2005 date, with a possible six-month extension on top of that, if needed. Dr. Falk will be updated at all times regarding where the group is, where it is going, and what Committee Management says about what the ORRHES can and cannot do. Dr. Falk will specifically review the packet request and the documentation that is being put forward.

During the week following this meeting, the staff members will be discussing Melissa Fish's vacancy and deciding on the best strategy to fill that void. Mr. Pereira stated that he was also going to introduce Ms. Loretta Bush, but that was done earlier in the meeting. Regarding funding, if they did not get a cut in funding, and if they maintain some sense of frugal spending, they should be okay with the ORRHES as it is currently operating. He did not see any major glitches, unless something arose upon which the subcommittee wanted to spend a lot of money.

Regarding the Iodine and Groundwater PHAs, staff plans on having a discussion on that, with a pre-discussion on both of those with the PHAWG no later than August 2004. There will be some documentation on both of those PHAs on or before August 2004, certainly with the PHAWG.

Discussion Points:

  • On behalf of Ms. Kaplan, Ms. Galloway, and others, Mr. Lewis said he thought that someone who had some facilitation skills needed to assist Ms. Galloway with the next Guidelines and Procedures meeting. He thought that some valuable input would come out of that meeting, but he thought that it should definitely be facilitated, so that everyone could lay their cards on the table and then get to work rebuilding mutual trust and making the ORRHES even stronger. He hoped that the agency could work with the ORRHES to become more cohesive and get the mutual trust back. He believed there were some terrific ideas, and he thought that the group would be able to come to consensus on some of those. For example, there has been talk about reducing the duplication. One suggestion has been to combine the NAWG and the COWG. He thought perhaps the CIB and DHEP could come together. If they get together working on communications and health education, then there would be less conflict in the ORRHES. He also thought the issue that the ORRHES brought up about identifying whether the ATSDR was following up on action items was one that needed to be addressed. If they could not get recommendations accepted, then they needed to know what was happening to all of the action items.
  • As a COWG member, Mr. Lewis has heard many people from the lay side say that they do not feel comfortable. There is this concept with ATSDR of a "need to know" with regard to technical information. It may be that sometimes the technicocrats decide that something is too technical for lay people, and so information is withheld. Mr. Lewis thought that the both the ATSDR and the ORRHES needed to be willing to share information with the public and present it to them the best that they could. These arguments have occurred before, and he thought that there was enough on the table that if they laid them out and offer a "lessons learned," all of this could be cleaned up and the subcommittee could move forward. He hoped that the ATSDR would consider endorsing that stance, so everyone could get the maximum out of this process.

  • Regarding the work groups, Mr. Pereira stated that they were going to discuss that in Atlanta, in terms of what ATSDR thinks as an agency. He asked them to keep in mind that work groups are formed, and dissolved, and created at the behest of the Chair and ORRHES as a whole, and the agency certainly can make recommendations as to what they think is an approach to consider. Mr. Pereira did think the NAWG and the COWG had been on wider parallel lines in the past, and he thought that those parallel lines are getting closer and closer together. Perhaps it is time to consider combining those two work groups. Regarding the action item issue, he stated that Ms. Loretta Bush will not let one stone go unturned, or one piece of paper not be addressed in terms of doing her job. She is one of the best in the business, and one of the best that he has ever worked with since he has been with ATSDR. So, he has full confidence in the community involvement activities that she does or assists with in concert with the ORRHES and DHEP, in the development of any strategy that this group puts forth.


  • Mr. Lewis commented that Ms. Melissa Fish and Mr. Bill Taylor did an excellent job of working together. They do more of a community outreach in getting the needs of these people heard and identified, and he thought that their skill sets need to be used sometimes in guiding this effort, even in these meetings. Although Ms. Fish is gone, Mr. Taylor has done at lot with commanding respect. There is a difference between holding a position and commanding respect. Because someone is on the ground, they may have earned more respect, but that also holds true for himself, as a chair of a work group and other chairs. If the group can utilize that and bring mutual trust back, and use those people in appropriate ways, he thought that the group could be brought closer together so that they could move through this, because the group might not always understand the technical requirements.


  • Dr. Davidson commented that she would put on the next meeting's agenda the issue of what to do about the COWG and NAWG. She indicated that Ms. Horton would go over the action items for this meeting so that those would be on record.

Action Items

Ms. Marilyn Horton, DFO
Oak Ridge Reservation Health Effects Subcommittee (ORRHES)

Ms. Horton stated that the meeting resulted in the following action items:

  • Change the EPA's "clean-up level" in the three brief PHA documents to read, "the upper bound of risk range."
  • Mr. Pereira and Mr. Richards will meet to discuss the EPA's Monday night meeting for June 7, 2004.
  • Mr. Pereira and Mr. Richards will meet and clearly define meeting objectives and set a clear agenda for the Monday night forum.
  • ATSDR will follow up with Ms. Galloway regarding Ms. Adkins' question on whole body counts and the minimum protective level for whole body counts. Staff will be in touch with Ms. Galloway and her supervisor.
  • Ms. Horton will work with Ms. Michelle on obtaining the article she found on low dose chronic exposure to radiation. She will get that to Mr. Taylor, and then Ms. Horton will forward it out to the group.
  • Staff will be updating the Web site Creative Brief.
  • Ms. Michelle will be added to the COWG group, to review the Web Site.
  • We'll distribute the Task 2 Report technical review that was distributed at previous PHAWG meetings. That will be distributed to all ORRHES members who did not receive those in the PHAWG minutes.
  • Mr. Bill Taylor will double-check the soil and sediment data on the sample below sixteen inches for mercury. (Slide 14 of his presentation)
  • ATSDR will send follow-up information to people who are absent from ORRHES meetings, including any handouts and/or presentations.
  • ATSDR will notify ORRHES prior to a meeting, if they do not plan to follow an entire ORRHES recommendation.
  • A discussion with regard to the possibility of combining the NAWG and COWG will be added to the next meeting agenda.
  • Ms. Dee Williamson will present her information on the Cancer Incidence Review.

Discussion Points:

  • Ms. Horton asked Dr. Charp if he checked on the Cesium-137. Dr. Charp indicated that rounding it off to the nearest hundred, it is about 6,600 days.


  • Mr. Lewis reiterated that he and others had a discussion about the facilitation of the upcoming meeting. They talked about how they were going to facilitate that, who was going to facilitate it, and he thought they were going to have a discussion with Dr. Davidson. Some ideas that he had were that perhaps a joint facilitation between EPA and ATSDR. He also suggested that they select a facilitator with whom everyone could feel comfortable. Ms. Horton indicated that item would be added to the list, and that Mr. Pereira and Mr. Richard could follow up on that issue and would take that into consideration. Mr. Lewis added that he thought that they had talked about facilitation, because Ms. Kaplan had that as part of her comments. He thought that the input needed to come from the ORRHES with regard to members sharing ideas on who might be appropriate facilitators.


  • Ms. Horton asked if the facilitation was part of Ms. Kaplan's motion. Mr. Lewis indicated that he did not think it had been part of her motion, but the group agreed to send the recommendation to Ms. Galloway, and he thought that part of what the group was talking about was rolling that into her group for discussion. He thought that part of the issue had been that a good facilitator needed to be present during sensitive meetings. He was going to suggest certain facilitation skills, and so he wanted to ensure that the suggestion was reflected in the minutes, if it had not been captured earlier.


  • Ms. Horton announced that the next ORRHES meeting was scheduled for June 8, 2004, in Oak Ridge, with the EPA and ATSDR evening forum the night before, on June 7, 2004.

With that, the information session was adjourned.

<< Back

 
Contact Us:
  • Agency for Toxic Substances and Disease Registry
    4770 Buford Hwy NE
    Atlanta, GA 30341
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
    Contact CDC-INFO
  • New Hours of Operation
    8am-8pm ET/Monday-Friday
    Closed Holidays
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Agency for Toxic Substances and Disease Registry, 4770 Buford Hwy NE, Atlanta, GA 30341
Contact CDC: 800-232-4636 / TTY: 888-232-6348

A-Z Index

  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #