Savannah River Site Health Effects Subcommittee (SRSHES) Meeting

Final Meeting Minutes
June 06, 2002

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Dr. Sandy Rock, Project Consultant to the American College of Preventive Medicine (ACPM), described a capacity-building program to conduct environmental health education activities related to iodine-131 (I-131). ACPM is a national medical specialty society for physicians committed to disease prevention and health promotion and is one of 25 medical specialties recognized by the American Board of Medical Specialties. ACPM represents more than 2,000 physicians who are Board-certified in preventive medicine and other specialties.

ACPM physicians are uniquely qualified in public health and clinical preventive medicine; provide leadership in communities or health settings to bridge the gap between the two disciplines; and are needed to provide services that reduce disease, disability and death in populations. ACPM physicians posses a range of competencies, including biostatistics; epidemiology; environmental and occupational health; planning, administration and evaluation of health services; social and behavioral aspects of health and disease; clinical preventive medicine; and informatics.

ACPM has had an environmental health agreement with ATSDR since 1999 to increase awareness among physicians and other health care providers of health threats posed by exposure to hazardous environmental substances. Under this activity, ACPM also improves the capacity of physicians to apply tools of population-based medicine and prevention to environmental health problems. ATSDR contracted ACPM to conduct the I-131 capacity-building program due to its demonstrated track record in this area. ACPM assisted with the development of ATSDR’s I-131 Case Study in Environmental Medicine; presented an I-131 poster and conducted an I-131 session at national meetings; and participates on the National Cancer Institute (NCI) I-131 list server.

ACPM strengths in conducting I-131 education are based on its experience in I-131 issues and environmental health; status as a national medical society; expertise of participating members; capacity to offer continuing medical education (CME) credits; partnership with the American College of Medical Toxicology; and collaboration with a knowledgeable consultant. The goals of the ATSDR/ACPM five-year agreement for the I-131 education project are to establish a central source of credible and science-based data; facilitate exchange of information, lessons learned and tools among affected sites; and develop and disseminate educational information to specific target audiences.

The target audiences for the project include clinicians, public health practitioners, community-based groups, educational institutions, and the general public at the SRS, Hanford and Oak Ridge sites. ACPM has proposed the following activities to conduct the project: develop an I-131 web-based resource center, establish a communication network among sites, conduct telephone surveys, form project advisory committees, disseminate the ATSDR case study, hold I-131 sessions at ACPM annual meetings, facilitate telephone conferences, design educational materials, and implement onsite educational activities.

ACPM’s methodology to conduct the I-131 education program contains four major components: a flexible work plan and activities, input from HESs and other stakeholders, integration with existing community-based initiatives, and experience from past and present projects. Due to public concern about potential nuclear disasters, ACPM incorporated a section on potassium iodide in its work plan. Other activities will also be modified in the future based on public input.

To date, ACPM has participated in meetings and conference calls with ATSDR, CDC and NCI; designed a comparison chart to track I-131 projects at various sites; attended SRSHES and Hanford HES meetings; formed a technical advisory committee; and initiated development of the I-131 web site. ACPM’s session at its 2001 annual meeting was conducted by several presenters with solid expertise in I-131. These presentations and links to other I-131 resources can be accessed by the public on the ACPM web site.

Ms. Theresa NeSmith of ATSDR announced that the draft Case Studies in Environmental Medicine were distributed to SRSHES. These documents serve as valuable tools for ATSDR to educate physicians, nurses and other health care professionals. Since the draft is currently being pilot tested, an evaluation form is attached to the document that asks health care providers to record the amount of time to complete the activity and rate the usefulness of the case studies. This input will allow ATSDR to revise and finalize the case studies and assign CME credits.

Ms. NeSmith urged SRSHES to distribute the draft document to health care providers only during the pilot test. In terms of outstanding issues, she reminded the members that Dr. Karl Markiewicz of ATSDR made a presentation during the last meeting on the toxicity of heavy metals and radionuclides. If SRSHES desired additional information on this subject, Dr. Markewicz is willing to be placed on a future SRSHES agenda.

Ms. Yolanda Freeman of ATSDR provided a status report on the SRS environmental health education needs assessment. The purposes of this activity are to gather useful information for all communities and agencies involved at SRS as well as to develop and implement a public health action plan in partnership with communities. Data collected for the project will be used to develop tools and training for outreach activities and health education and promotion initiatives. The draft report on the needs assessment was included in the pre-meeting briefing books.

To gather input for the needs assessment, ATSDR conducted 18 focus groups with 110 community leaders in ten counties within a 50-mile radius of SRS. The data showed that focus group participants had a general lack of knowledge of SRS activities; expressed concerns about respiratory illnesses, cancer, chemicals, SRS initiatives and health effects; placed most trust in health care providers to provide health information; and preferred receiving printed materials from churches. The focus group participants made several recommendations to SRSHES and agencies participating in the needs assessment. Existing SRS environmental health materials should be modified to be easier to read and understand. Current communication channels used by SRS should be revised to reach broader audiences.

Communication channels and media formats identified and recommended by communities should be utilized, such as news outlets, printed materials, Internet, and self-study courses. The effectiveness of these communication channels should be analyzed for effectiveness. Community suggestions to expand SRS participation in outreach activities should be implemented. SRS should collaborate with community leaders, schools, health care providers and other organizations to deliver messages, improve knowledge about SRS and provide science-based education. Follow-up activities should be evaluated on an ongoing basis.

Community leaders who participated in the needs assessment were extremely appreciative of capacity-building skills obtained during the project. ATSDR trained participants in facilitation, data analysis, and focus groups. The needs assessment also provided an opportunity for community leaders to network and build coalitions for grant writing and other initiatives at the local level. To advance the project, however, ATSDR needs assistance from SRSHES from both community and health care provider perspectives. First, Dr. McClain spearheaded the effort and served as the driving force for the community-based component of the SRSHES needs assessment, but her term has expired. Nevertheless, ATSDR will continue to seek Dr. McClain’s expertise in the project.

Second, ATSDR’s efforts to engage SRS health care professionals in the needs assessment have been unsuccessful. Involvement from this group will be critical since community leaders cited health care providers as the most trusted source of health information. ATSDR also asked the members to review the draft needs assessment report and suggest mechanisms to deliver messages to communities, such as the SRSHES brochure and periodic updates. ATSDR hopes to discuss these recommendations during the next meeting.

Discussion.
Ms. Kato inquired about feedback ACPM has received on the I-131 educational materials. Dr. Rock replied that ACPM has not obtained input to date because the five-year project was not initiated until October 2001. Mr. Hills asked about pathways for SRS populations to become exposed to I-131 and potential health effects. Dr. Rock explained that during the initial years of operation at SRS, I-131 was released in the air and deposited on vegetation consumed by dairy cows. Persons who consumed milk contaminated with I-131 would be at risk for damage to the thyroid. Other potential pathways for I-131 include goat milk, consumption of leafy vegetables or inhalation from a downwind plume.

Ms. Perry was pleased that ACPM plans to share data among impacted sites to avoid duplicating existing efforts. She raised the possibility of the Outreach or Proactive Workgroup gathering information from other HESs on experiences and ongoing activities of these groups. Dr. Lee proposed that ATSDR’s requests to SRSHES on the needs assessment be assigned to the Outreach Workgroup. Recommendations could then be presented to SRSHES for review and comment before being presented to ATSDR. Ms. Kato wanted to ensure that all SRSHES members were provided an opportunity to give input on the next steps of the needs assessment. To engage health care providers in the needs assessment, Dr. Wilson offered to develop a quick and simple form that would be designed to obtain effective information. Dr. Bustos recessed the meeting for a break from 2:45-3:16 p.m.