Savannah River Site Health Effects Subcommittee (SRSHES) Meeting

Final Meeting Minutes
January 11, 2002

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First, ATSDR convenes grand rounds for health care providers at sites where contaminants of concern have been detected. These sessions are held in hospitals to educate physicians about contaminants, potential health effects and questions patients may ask. Second, ATSDR has developed cooperative agreements for partners and 31 states to conduct health-care-provider education activities on a wider basis. Third, ATSDR publishes Case Studies in Environmental Medicine that describe contaminants of concern. These documents are available to doctors, nurses and other health care professionals. Pre- and post-tests are included in the case studies for providers to complete, submit to ATSDR, and obtain continuing medical education credits.

Fourth, ATSDR’s Medical Management Guidelines provide guidance to hospitals and health-care providers on symptoms, decontamination and other issues that may arise during a chemical exposure to a large population or other hazardous waste emergency. For community health education, Ms. NeSmith introduced Mr. Mike Barry, Ms. Jessica Cafarella and Dr. Sandy Rock of the American College of Preventive Medicine (ACPM). The organization is an ATSDR grantee that is conducting health education on iodine- 131. She hoped ACPM could be placed on the next SRSHES agenda to discuss its activities in more detail. Ms. NeSmith asked other ATSDR partners in attendance to describe ongoing community-based initiatives.

Dr. McClain was pleased to announce that ATSDR incorporated recommendations by Citizens for Environmental Justice into the SRS environmental health education needs assessment. In particular, community leaders who were previously excluded from federal initiatives now serve as partners in the project. ATSDR empowered grassroots organizations by providing a friendly and open forum for local residents to participate in focus groups, attend meetings, provide input, and share community-based expertise.

The Oak Ridge Institute for Science and Education (ORISE) is another ATSDR partner that is conducting community-based health education activities in general and the SRS environmental health education needs assessment in particular. Ms. Linda Hodges of ORISE provided an update on this initiative. In 1999, Phase I of the project was completed by researching the demographics of the target counties, such as major employers and social infrastructure. In 2000, Phase II was completed by locating key contacts at federal, state, and county levels and identifying previous outreach activities. Phase 3 is currently underway. Meetings were held with 20 community leaders from 11 target counties in Aiken, South Carolina and Savannah, Georgia in February and June 2001, respectively. Participants were also trained in conducting community-level focus group meetings.

In July and August 2001, ORISE held 18 focus group meetings in ten target counties with 110 participants to obtain input from communities about SRS in five major areas. Preliminary data show the following results: For “perceptions of SRS”, respondents generally lacked knowledge and information about the site. Some noted that discussions in communities about SRS are minimal, while others acknowledged the contribution of SRS to contamination of air, water, soil, fish and wildlife. For “perceived health concerns”, respondents primarily focused on respiratory illness and cancer. For “desired information”, chemicals, contaminants, human health effects and environmental impacts from releases, spills, generated wastes and other SRS activities were the major areas for which data were requested.

For “credible sources”, respondents placed the most amount of trust in medical journal and web-site self-studies as well as personal physicians, nurses, pharmacists, and other health care providers. For “preferred channels”, respondents were most interested in receiving brochures, fliers, newsletters, and other printed materials in the mail or a public location, i.e., doctor’s office, library or church. Overall, the focus group process resulted in two significant outcomes that will help to strengthen capacity building and networking at the local level. Community leaders actively participated in project planning and recruiting activities, while focus group participants were provided a forum to express views. However, ORISE cautioned that the needs assessment is not a quantitative scientific-based study. The sample may not represent the full target population due to the large number of college-educated black females in the focus groups.

Before and during the focus group meetings, ORISE did not provide explanations, distribute information or clarify comments by the participants, such as distinguishing between contaminants and radionuclides. After the sessions, however, ORISE informed participants about the SRS web site and other information resources. The next steps in the project will be to continue to analyze data and develop a final report. A draft document has been distributed to ATSDR and community leaders for review and comment. Follow-up activities will be conducted to fill gaps in information that communities know versus do not know and want versus need to know. Ms. Hodges conveyed that the American Association of Occupational Health Nurses (AAOHN) is partnering with ORISE in conducting the needs assessment and has asked SRSHES to provide guidance in contacting health-care providers in the target counties. Telephone solicitations in this effort proved to be an ineffective approach.

Discussion.
Dr. Crawford mentioned that a South Carolina educational television station broadcast a panel discussion on health perceptions by small-town residents. The program was supported by the Medical University of South Carolina and may serve as a useful data source for ORISE and the Outreach Workgroup. Ms. Still urged ORISE to make strong efforts to recruit persons for the needs assessment who represent the target population. For example, the large number of college-educated participants in the focus groups excludes community members with less education.

Dr. McClain confirmed that Citizens for Environmental Justice translate SRS data into laymen’s terms and present this information in community-based workshops. In response to AAOHN’s request, Ms. Drye committed to contacting the Georgia Nurses Association and American Nurses Association; Dr. Wilson will contact the South Carolina Medical Association and podiatrists in Orangeburg County.