Oak Ridge Reservation: Public Health Assessment Work Group

Public Health Assessment Work Group

April 19, 2004 - Meeting Minutes

Attendance

ORRHES Members attending:
Bob Craig (Work Group Chair), Kowetha Davidson (Subgroup Chair), George Gartseff, David Johnson, James Lewis, Anthony Malinauskas, Pete Malmquist, and LC Manley

Public Members and others attending:
Tim Joseph (DOE), John Merkle, Judy Pussell (phone), Lynne Roberson (phone), and Danny Sanders

ATSDR Staff attending (all staff attended via telephone except Bill Taylor):
Loretta Bush, Subha Chandar, Jack Hanley, Marilyn Horton, Theresa NeSmith, Terrie Sterling, Bill Taylor, and Dee Williamson

ERG Contractor:
Liz Bertelsen (phone)

Purpose

The purpose of the meeting was to discuss ATSDR's Cancer Incidence Assessment.

Update on ATSDR's Cancer Incidence Assessment

Presenter: Dee Williamson, ATSDR

Dee Williamson provided the PHAWG with an update of her assessment. She completed the draft document and sent a copy to the Tennessee Cancer Registry for comment. Ms. Williamson wanted to ensure that she followed the state's rules and regulations. The state provided a few comments; Ms. Williamson made these changes and sent the document to her management for review. She explained that ATSDR management would need two or three weeks to review the document. Once she receives the document from her management, she will make any necessary changes and then present the report to the PHAWG. While the report is in review, Ms. Williamson will prepare a fact sheet for the Cancer Incidence Assessment. The fact sheet will summarize the 1) activities performed for the assessment, 2) reasons why ATSDR conducted the assessment, and 3) conclusions that ATSDR can develop based on the results. Ms. Williamson indicated that ATSDR would use these points to develop its communication strategy for the assessment.

Bill Taylor reminded Dee Williamson to discuss how ATSDR could use the analysis, and also explain its limitations. Dr. Taylor said that Susan Kaplan had also asked if Ms. Williamson could separate the data for rare cancers.

Dee Williamson continued that it is imperative for everyone to know that ATSDR will not be able to determine the causation of these cancers. She can discuss general risk factors associated with specific types of cancers, but she cannot say what caused the cancers. Also, Ms. Williamson reminded the PHAWG that she could not determine if exposures from the Oak Ridge Reservation caused any of the cancers. She added that this message had to be clear when ATSDR presents its results to the public.

Dee Williamson explained that she had difficulty obtaining demographic data. She was able to locate data for the eight counties, but she was not able to locate demographic data for the "area of interest," which consisted of 49 census tracts that were previously identified.

Dee Williamson addressed the question from Susan Kaplan regarding rare cancers. In a previous presentation, Ms. Williamson explained that she would not evaluate "other" cancers or "all combined" cancer categories. For her to conduct these analyses for rare cancers, the state would need to provide an explanation for its "other" category. If she analyzed the "other" category in its entirety, the results would have no statistical meaning. Ms. Williamson said she would have the state define the "other" category. If this category included particular cancers, then Ms. Williamson may be able to conduct analyses on the specific cancers. However, because the category currently encompasses a group of unknown cancers, she cannot conduct any analyses at this time.

Discussion

James Lewis asked Dee Williamson if the Ad Hoc Work Group would look at the report before the PHAWG. Bob Craig replied that the report would go to the Ad Hoc Work Group and then to the PHAWG. Ms. Williamson noted that the report would be available for the next ORRHES meeting in June 2004.

John Merkle asked for an explanation about the Ad Hoc Work Group. He wanted to participate and provide input on the mathematical procedures that Dee Williamson used to analyze the data. Bob Craig said that he would add Mr. Merkle to the Ad Hoc Work Group.

Pete Malmquist asked Dee Williamson if the state refused to give her the requested demographic data. Ms. Williamson replied that the state was willing to help her, but it did not have the necessary information. She had trouble locating demographic data at the county level and said that it was "going to be impossible" to obtain demographic data at the census tract level. Ms. Williamson added that the Web site for the census data was not "user-friendly" and that she was unable to extract data for the 49 census tracts. Dr. Malmquist asked Ms. Williamson to explain in her report that the PHAWG requested analyses for the 49 census tracts, and also provide reasons why she could not complete the request. She replied that she had not included this information, but that she would add it into her report.

Danny Sanders asked for an explanation about the 49 census tracts. Dee Williamson explained that she was referring to 49 different census tracts around the Oak Ridge Reservation that lie within the eight different counties. She said that the data were from 1990 to 1996. She added that the state felt that the data were only 80% complete; Ms. Williamson told the state to expect questions concerning this issue.

James Lewis noted that he had read reports that used these types of data and asked if Tennessee used a different format than other states. Dee Williamson responded that the census Web site is not easy to use. She assumed that New York and other states had more advanced cancer registries and statistical programs to manage the data. She had to find the data herself and because the state of Tennessee does not have these types of advanced systems, she was unable to obtain the data for the census tracts. Mr. Lewis thought that this should be explained; Ms. Williamson agreed.

Bill Taylor thought that Susan Kaplan asked if the "other" category could be separated by cancer type. Dee Williamson did not know the answer to Ms. Kaplan's question, but she would e-mail the state cancer registry for clarification. She added that her analyses included an evaluation of about 20 different cancer types, but she did not know what the state combined into the "other" category.

James Lewis asked Dee Williamson if the state was invited to her presentation. Ms. Williamson said that they could invite the state. She noted that the state could not provide answers to questions related to the statistical analyses, but the state could respond to questions about the registry data, the data provided to ATSDR, and other questions of this nature. Bob Craig agreed that they should invite the state. Ms. Williamson said she could have the report ready for the June 8, 2004, ORRHES meeting.

Kowetha Davidson suggested reviewing Toni Bounds's presentation to evaluate the information that was already received from the state. Bob Craig recommended that Bill Taylor re-send the presentation so meeting attendees can familiarize themselves with the subject matter.

Pete Malmquist was less concerned about ORRHES members knowing the information than he was concerned that the general public understood it. He wanted the state to attend the meeting to answer questions from the public, including questions about data collection methods. Dee Williamson commented that she put her name as a contact on the fact sheet, but had notified the state to be prepared for questions.

Bob Craig reiterated that the state should be invited to the meeting, but if the state was unable to attend they could refer to Toni Bounds's presentation. Dee Williamson asked if they had a copy of the actual presentation or a summary. Jack Hanley replied that Ms. Bounds's presentation was included in detailed ORRHES meeting minutes. Mr. Hanley added that Bill Taylor would send these minutes to everyone. Jack Hanley asked Dee Williamson what the cutoff was for not performing analyses if there were only a few cases of a particular cancer. Ms. Williamson responded that they needed five or more cancer cases to conduct analyses. According to Ms. Williamson, each table in the report contains the same number of cancers, but she indicated in each table if there were less than five cases of a particular cancer. Mr. Hanley asked if thyroid cancer was on this list. Ms. Williamson said that thyroid cancer was not on the list, but she wondered if it was included in the "other" category. Bob Craig asked if this meant that the state did not track thyroid cancer. Mr. Hanley said this indicated that the state did not track thyroid cancer or that thyroid cancer was not tracked individually. Ms. Williamson added that she evaluated 19 or 20 different cancers, but she did not know why thyroid cancer was not on the list. She was going to investigate further.

Bob Craig said that the purpose of this meeting was to prepare Dee Williamson for the types of questions she would receive from the public. Ms. Williamson explained that she included a question and answer section in the report. She noted that the PHAWG and Ad Hoc Work Group might want to modify this section according to questions that they know people want answered.

Bob Craig asked when Dee Williamson would present her report and findings to the Ad Hoc Work Group and the PHAWG. Ms. Williamson stated that her management needed two or three weeks to review the document. Dr. Craig said that there were PHAWG meetings scheduled for May 3 and 17, 2004. He asked if she could present her report on May 17, 2004. Ms. Williamson responded that she would be out of town. Dr. Craig said that they could reschedule the PHAWG meeting. Ms. Williamson asked if they should schedule the meeting after ATSDR management completed its review of the report. Dr. Craig agreed, and noted that the Ad Hoc Work Group would need to review the report before the PHAWG.

James Lewis commented that most questions from the general public were associated with cancer issues. He asked about details for presenting the information to the public. He wanted to know about the timing, the plan for presenting the report, if there would be advertising, and if ATSDR would use fanfare. Dee Williamson replied that ATSDR would use a hybrid of these communication methods. She added that there would be a fact sheet to summarize the findings. Ms. Williamson noted that she has contacted media representatives in the area and can provide fact sheets to these media sources to disseminate the information to the public. Ms. Williamson cautioned that she wanted to provide the information, but did not want to cause unnecessary alarm in the community. She thought they needed to find a "middle ground." Mr. Lewis questioned if this was a "management issue." John Merkle replied that a strategy for presentation depends partly on the conclusions. He said that there is always the possibility that the findings are too small to indicate anything except a random occurrence. He added that they do not want a "big fanfare" if the results are inconclusive. Ms. Williamson suggested making these decisions after reviewing the report.

Bob Craig mentioned that regardless of the findings, they needed to convey to the public that these data could not be correlated to conditions on the ORR. Dee Williamson reminded the group that she evaluated about 20 different cancers separately in males and females for eight different counties. She conducted over 300 analyses and just based on the number of analyses, some of the numbers will be higher and some will be lower.

Pete Malmquist requested that the PHAWG receive the report prior to the Ad Hoc Work Group meeting. He asked if Loretta Bush could attend this meeting to help with communication strategies. Ms. Bush responded that she would attend the meeting. Bill Taylor said that he would send out the report and then Dee Williamson would schedule the meeting.

Loretta Bush commented that the Community Involvement Branch, the Division of Health Education and Promotion, and Dee Williamson met recently to discuss a communication strategy plan. She thought that ATSDR was on target for communicating the results of this assessment.

Kowetha Davidson asked Dee Williamson about the parameters that were not obtainable. Ms. Williamson responded that she went to the U.S. Census Bureau's Web site and could download information by different parameters. She was searching for age, race, and gender within the eight different counties. However, she was unable to locate this information for the 49 different census tracts. Even at the county level, Ms. Williamson had difficulty obtaining the information and downloading the available information into a useful format.

New Business

Danny Sanders explained that he submitted an addendum to questions previously given to ATSDR. He and his sister (Judy Pussell) had composed the questions and would like ATSDR to provide answers to each question.

James Lewis asked about a possible report conducted in Scarboro by DOE and the Joint Center for Political and Economic Studies. He said that this report evaluated data at the census tract level for a number of different cancers. Mr. Lewis had a table from the report, but asked if there was any follow up to locate the report. Jack Hanley replied that he spoke with Tim Joseph and that Dr. Joseph was unable to find a report that accompanied Mr. Lewis's table. Dr. Joseph added that he asked a number of people, but that no one knew the origination of the table.

Danny Sanders asked how a person could obtain census data for the 1940s. Dee Williamson thought this information was available on the U.S. Census Bureau's Web site, but she would investigate further.

Judy Pursell asked about locating data for areas during specific time periods to find information about former occupants. Dee Williamson said that the census is conducted every 10 years and that it is standardized to the specific census population. Bob Craig did not think that Happy Valley was around in 1940 or 1950, which was "unfortunate" in this situation. Dr. Craig added that DOE was the best source of information for Danny Sanders and Ms. Pursell; he thought if any data existed, DOE would have the data.

Danny Sanders asked about the other encampments. Tim Joseph replied that there were two other encampments in addition to Happy Valley. He could not remember the names of the two encampments, but said that DOE had detailed photographs of the area. Dr. Joseph added that Happy Valley was the largest of the three encampments.

Jack Hanley asked if there was a population estimate for that area. Judy Pussell read from a report by R.P. Prince entitled The Happy Valley Settlement of the K-25 Plant: Dates of Initial Construction, Occupancy, and Removal of Buildings; she read that the area had an estimated "peak occupancy of 8,700." However, Ms. Pussell did not think the author had any supporting documentation for this estimate. Pete Malmquist asked if the population estimate referred to Happy Valley only. Ms. Pussell thought that the entire area was called "Happy Valley." She also mentioned the Fort Bacon and Davis labor camp, which later became known as the "Wheat Colony." She added that all these camps later became collectively known as "Happy Valley."

Bob Craig asked about the proximity of the S-50 plant to Happy Valley. Tim Joseph said that the plant was very close and that the photographs detail much of the area at that time.

John Merkle asked what the encampments used for water and waste disposal. Jack Hanley replied that the community reportedly received its water from Grassy Creek.

Danny Sanders reiterated that he submitted their questions to ATSDR and hoped their questions would be addressed.

Bob Craig adjourned the meeting at 6:10 pm.