Appendix A: Background Documents

Panel One: Biomedical and Psychophysiological Effects

Defining the Problem

Biomedical and Psychophysiological Effects. Composed of neurobiological scientists such as psychologists with expertise on the psychophysiology of chronic stress and resulting health effects, neurobehavioral toxicologists, neuropsychologists, and psychiatric/psychological epidemiologists.

Charge

To examine what is known about the potential effects on public health of the chronic stress response that some studies have documented in communities near hazardous waste sites. Focus areas include the pattern of stress that may occur at hazardous waste sites (i.e., acute or chronic, or both); the effects of psychological stress on physiological responses to exposure; and whether neurobehavioral disorders caused by neurotoxicants, which may manifest as psychological disorders, are ever a public health phenomenon near hazardous waste sites.

Topics to be addressed by Panel One include the following:

1. What is known about the long-term health effects of chronically increased stress among individuals living near hazardous waste sites?
2. Are there certain neurobehavioral effects found in individuals living near hazardous waste sites that, if detected, could constitute sentinel health events at these sites? If they exist, can their early detection be used as an intervention screening tool?
3. What is known clinically about how to differentiate between organic behavioral disorders caused by exposure to certain neurotoxicants and purely psychologic responses to possible exposures? This discussion will consider methodological questions such as testing for stress and neurobehavioral effects as well as other issues.
4. Given what is known regarding the psychobiology of stress, are there interactions between chronic stress and exposure to neurotoxicants that could change the dose-response curve for neurotoxins?
5. What is known about those individuals who are most sensitive to this stressor (i.e., the uncertainty of possible exposures)? This includes consideration of medically, psychologically, and physiologically sensitive populations.

Overarching Issues For Discussion By All Three Panels

Overarching Issue 1: Evaluate information about susceptible populations. This may include: a) preexisting conditions (i.e., medical, psychological), b) individual variability in reactions to stress, c) cultural patterns of reaction to stress, and d) interventions targeted to vulnerable populations.

Overarching Issue 2: Examine the reports of increased incidence of psychological disorders in these communities and make recommendations regarding the direction for future strategies.

Overarching Issue 3: Address ethical concerns pertinent to dealing with the psychological responses to hazardous substances. This addresses the appropriateness of various intervention strategies.

Overarching Issue 4: Identify future directions for investigation of the biopsychosocial effects from possible exposures to hazardous waste sites.

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Panel Two: Community and Social Science Perspectives

Defining the Problem

Community and Social Science Perspectives. Composed of community and social psychologists, sociologists, anthropologists, political scientists, and community members

Charge

To review what is known about the psychosocial responses in communities living near hazardous waste sites and make recommendations regarding ways to interact with communities, outline problems in need of further investigation, and suggest possible psychosocial interventions to reduce stress.

Topics to be addressed by the second panel include:

1. Factors (both internal and external to a community) that might make some communities susceptible to the stress of living near a hazardous waste site. This discussion will include:

   Individual and community dynamics,

   • Cultural factors affecting responses,
   • Type of community (e.g., marginalized),
   • Community's response (i.e., duration of exposures, socioeconomic and demographic factors, and unique community factors).
2. The human response to uncertainty may lead to different understandings of a possible exposure to hazardous substances and its relation to psychological responses, such as learned helplessness.
3. Some of the psychosocial responses that communities have given to the stress of living near a hazardous waste site and the results from these responses.

Overarching Issues for Discussion by All Three Panels

Overarching Issue 1: Evaluate information about susceptible populations. This may include a) preexisting conditions (medical, psychological), b) individual variability in reactions to stress, c) cultural patterns of reaction to stress, and d) interventions targeted to vulnerable populations.

Overarching Issue 2: Examine the reports of increased incidence of psychological disorders in these communities and make recommendations regarding the direction for future strategies.

Overarching Issue 3: Address ethical concerns pertinent to dealing with the psychological responses to hazardous substances. This addresses the appropriateness of various intervention strategies.

Overarching issue 4: Identify future directions for investigation of the biopsychosocial effects from possible exposures to hazardous waste sites.

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Panel Three: Protecting and Promoting Psychosocial Health

Responding to the Problem

Protecting and promoting psychosocial health. Composed of clinical psychologists, psychiatrists, occupational medicine physicians, disaster relief specialists, and community members.

Charge

To develop public health strategies to prevent and control long-term, stress-related health problems in communities near hazardous waste sites.

Topics to be addressed by the third panel include:

1. Assessing the extent of the psychosocial effects and possible public health impacts in these communities to date.
2. Previous prevention and therapeutic strategies that have been used in these communities. What were the results of these interventions and what issues did they raise?
3. The most effective methods for preventing the acute stress of learning of the existence of a hazardous waste site from becoming chronic in adults and children.
4. The best methods to prevent demoralization from occurring in these communities.
5. Identification and appropriate referral of susceptible persons in these communities.
6. The best methods for increasing public and professional capacity to respond effectively to psychological issues related to hazardous waste sites.

Overarching Issues for Discussion by All Three Panels

Overarching Issue 1: Evaluate information about susceptible populations. This may include a) preexisting conditions (i.e., medical, psychological), b) individual variability in reactions to stress, c) cultural patterns of reaction to stress, and d) interventions targeted to vulnerable populations.

Overarching Issue 2: Examine the reports of increased incidence of psychological disorders in these communities and make recommendations regarding the directions for future strategies.

Overarching Issue 3: Address ethical concerns pertinent to dealing with the psychological responses to hazardous substances. This addresses the appropriateness of various intervention strategies.

Overarching issue 4: Identify future directions for investigation of the biopsychosocial effects from possible exposures to hazardous waste sites.

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