Medical Surveillance Grants Activities Program Overview
NIOSH medical surveillance of former DOE workers is divided into two
separate areas under different enabling authorizations. Under a Memorandum
of Understanding between DOE and the Department of Health and Human
Services (DHHS), NIOSH administered five DOE-funded research grants. One of
these grants was completed in 1998, and a final report and evaluation were
released. The remaining four grant activities were completed in 1999, and
final reports are being submitted to the NIOSH Grants Office. These grants
are summarized under Research Grants Administration.
Under the requirements of the Defense Authorization Act of 1993, DOE
must work with DHHS, the Centers for Disease Control and Prevention (CDC),
and the National Institute for Occupational Safety and Health (NIOSH)
"regarding determinations of significant health risk resulting from DOE
work-related exposures." Under a Memorandum of Understanding, DOE has asked
that NIOSH independently conduct peer reviews of DOE former worker medical
surveillance projects and make recommendations regarding the conduct of
these projects. These DOE efforts are summarized under Department of Energy
Medical Surveillance Activity.
Oak Ridge Associated Universities William G. Tankersley, M.S.,
CIH
Summary:
The project goals were to 1) evaluate the current
exposure-monitoring programs and data bases at the DOE Y-12 plant, 2)
develop a new system for classification of workers based on
substances with which they commonly work, and 3) develop and test, in
a working environment, a system based on readily available bar code
technology for continual tracking of workers and recording the
primary substances with which they work.
Manuscript:
West CM, Rutherford BF, Tankersley WG [1997]. Current programs
for estimating dose and chemical exposure: Volume I. Oak Ridge, TN:
Oak Ridge Associated Universities; (CDC Grant R01/CCR412029)
Available from the National Institute for Occupational Safety and
Health/Health-Related Energy Research Branch, Cincinnati, OH, 140 pg.
PDF version available
West CM, Rutherford BF, Tankersley WG [1997]. Current programs
for estimating dose and chemical exposure: Volume II. Oak Ridge, TN:
Oak Ridge Associated Universities; (CDC Grant R01/CCR412029)
Available from the National Institute for Occupational Safety and
Health/Health-Related Energy Research Branch, Cincinnati, OH, 122 pg.
PDF version available (1041
KB)
Tankersley WG [1997]. Potential Exposure Profile System (PEPS)
Users Guide. Oak Ridge, TN: Oak Ridge Associated Universities; (CDC
Grant R01/CCR412029) Available from the National Institute for
Occupational Safety and Health/Health-Related Energy Research Branch,
Cincinnati, OH, 34 pg. PDF version
available (195 KB)
Tankersley WG [1997]. Worker Exposure Surveillance System (WESS)
Users Guide. Oak Ridge, TN: Oak Ridge Associated Universities; (CDC
Grant R01/CCR412029) Available from the National Institute for
Occupational Safety and Health/Health-Related Energy Research Branch,
Cincinnati, OH, 38 pg. PDF version
available (257 KB)
Significance:
The evaluation will be useful for future researchers conducting
epidemiologic studies at this facility. Additionally, the development
and testing of these practical and cost-effective informational
systems will complement the existing worker exposure assessment
programs and provide surveillance for a greater percentage of the
worker population.
Worker. Idaho National Engineering and Environmental Laboratory,
Idaho Falls, Idaho. 1975. Photo courtesy of the U.S. Department of
Energy.
Grantee:
University of Cincinnati Eula Bingham, Ph.D.
Grants Office Advisor:
David Pedersen, Ph.D
Award Period:
9/30/95-9/29/99
Summary:
Workers in the construction trades are exposed to a wide variety
of chemical and radiological agents at DOE sites. Creation of an
exposure history for these workers is difficult because complex
exposure patterns across a large number of short-term workplace
assignments must be recalled. To provide an improved basis for the
characterization of worker occupational exposures over time, this
project developed and tested several innovative techniques for
improving occupational history recall.
Manuscript:
Bingham E, Rice C. [1999]. Work Histories--Evaluating New
Participatory Methods. Cincinnati, Ohio: Department of Environmental
Health; (CDC Grant 5RO1 CCR512026-03) Available from the National
Institute for Occupational Safety and Health/Health-Related Energy
Research Branch, Cincinnati, OH, 21pg.
PDF document available (46 KB)
Significance:
Validated improvements in assembling retrospective occupational
exposure histories have general application in increasing the
validity of studies of the associations between exposure histories
and health risk(s). Benefits from this improvement include increased
capability to allocate medical surveillance resources more
effectively, thus reducing unnecessary and duplicative effort.
This project is concerned with the design and implementation of a
model occupational safety and health surveillance system. The goal of
this system is to gather appropriate occupational medicine and
industrial hygiene data to provide information for the systematic
identification of hazardous exposures and adverse health
outcomes.
Manuscript:
Ertell K, Takaro T, Shorter C, Stover B, Beaudet N, Barnhart S,
Rabito F, White LE [2000]. Results of Employee Job Task Analysis
(EJTA) quality assessment: Combined analysis for fourteen Hanford
contractors. Seattle, WA: University of Washington; (NIOSH Grant 1R01
CC12031, Final Report.) Available from the National Institute for
Occupational Safety and Health/Health-Related Energy Research Branch,
Cincinnati, OH, 34 pg. PDF version
available (359KB) Appendices
C-E (375KB)
Significance:
Readily available computerized information about workplace
exposures and health status organized by tasks through an employee
job task analysis provides information for accurate risk assessments
leading to reduction of hazardous exposures. This level of
documentation also supports objective evaluation of occupational
health program intervention effectiveness and contributes to worker
(stakeholder) involvement in prevention efforts.
University of California at Los Angeles John Froines, Ph.D.
Grants Office Advisor:
David Pedersen, Ph.D.
Award Period:
9/30/95-9/29/99
Summary:
This project developed an integrated approach to statistical
models for exposure assessment, especially characterization of
occupational exposure to complex, mixed exposures to chemicals and
biomechanical problems. Based on measured task-specific exposure
data, the project was dedicated to identifying appropriate
statistical tools to model single and mixed agent exposures and
resulting internal doses.
Manuscript:
Froines JR [1999]. Hazard Surveillance in the Defense Nuclear
Industry. Los Angeles, California: University of California; (NIOSH
Grant 5 Ro1 CC912034-03, Final Report Summary.) Available from the
National Institute for Occupational Safety and Health/Health-related
Energy Research Branch, Cincinnati Ohio, 2 pg. PDF document (66 KB)
Significance:
This research has application in complex exposure situations by
providing an additional avenue for evaluating the relationships
between exposure concentration and worker dose. The modeling
capabilities of the developed system will provide a risk-based
estimation of adverse health effect incidence on the basis of
assessed environmental exposures to guide health interventions,
including medical surveillance.
Additional Publications
Chen WG, McKone TE [2001]. Chronic Health Risks from Aggregate
Exposures to Ionizing Radiation and Chemicals: Scientific Basis for
an Assessment Framework. Risk Analysis 21: 25-42.
Wu JD, Milton DK, Hammond SK, Spear RC [1999]. Hierarchical
Cluster Analysis Applied to Workers' Exposures in Fiberglass
Insulation Manufacturing. Ann Occup Hyg. 43: 43-45.
This project is intended to develop a generic hazard surveillance
and evaluation system for exposures to chemical and radiation
exposures. According to a job/task evaluation and analysis, the
sentinel exposure event system will include exposure level
measurements, worker-specific task definitions, and observation data
(controls, exposure conditions, and defined health and safety
policies). This input will be incorporated into a system for
evaluating exposures, enhancing worker communications, and
identifying necessary interventions through internally generated
reports.
Manuscript:
Awaiting final report.
Significance:
The practice of using job/task definition as the fundamental unit
of observation in a comprehensive exposure evaluation and reporting
system provides generic capabilities identifying and directing
occupational health interventions and enhanced worker communications.
The potential for indicating and guiding improvements in occupational
health program initiatives may have direct impact on the conduct of
medical surveillance programs.
Department of Energy Medical Surveillance Activity
Worker at Oak Ridge Gaseous Diffusion Plant uses a special
leak-detection device to examine large piping of process equipment in the
plant. K-25 Site, Oak Ridge, Tennessee. Date unknown. Photo courtesy
of the U.S. Department of Energy.
University of Colorado James Ruttenber, M.D., Ph.D.
Exposure Concerns:
Internal/external radiation, asbestos, lead, heavy metals,
solvents, formaldehyde
Target Population:
Former Rocky Flats production workers (excluding cleanup workers)
who were involved with weapons production between 1951 and 1989. The
phase I effort estimated the target population at 14,430 former
production workers.
Current Status:
This project is in the second year of phase II activity. A roster
of more than 15,000 former workers has been developed, and interviews
with former workers regarding their occupational exposures are being
conducted. The project anticipates the notification of more than
7,500 former workers in the current project year, accompanied by
approximately 700 selective medical screening examinations based on
exposure assessments and physician input.
Asbestos, silica, beryllium, heavy metals, solvents, welding
fumes.
Target Population:
Former construction workers who worked on selected buildings at
the Oak Ridge site, including the Gaseous Diffusion Plant (K-25), the
Y-12 Plant and the Oak Ridge National Laboratory (X-10). The needs
assessment phase estimated that at least 7,000 former workers were
eligible for medical screening in the second phase, based on
selection from construction workers employed since 1943 (the start of
construction at Oak Ridge).
Current Status:
This project is in the second year of phase II activity. The
project has completed an initial contact mailing to more than 1,200
former construction workers, and has conducted more than 200 worker
interviews. Medical screening examinations, based on assessment of
occupational exposures and medical considerations, are scheduled to
begin in the current project year.
University of Washington
Drew Brodkin, M.D., Tim Takaro, M.D.
Exposure Concerns:
Asbestos, noise, beryllium
Target Population:
Following the phase I needs assessment, the investigators limited
this notification/medical screening program to former (1943-1997)
nonconstruction trade workers who were potentially exposed to
asbestos (~10,000 workers ), noise (~14,000 workers), or beryllium
(~6,000 workers). The investigators also intend to evaluate available
site records to determine whether data on other hazardous exposures
would identify more candidates for medical screening.
Current Status:
This project is currently in the second year of phase II
activity, and has sent out more than 12,000 letters announcing the
project to identified workers, intending to continue the outreach
process in the current year. The project has collected more than 700
occupational exposure histories and has assessed the hazardous
exposures for these workers. At the end of the first year of phase
II, the project had performed more than 100 medical screening
examinations, and is continuing them in the current project
year.
External/internal radiation, various chemical exposures, diesel
exhaust, beryllium
Target Population:
Former Nevada test site construction trade workers (underground
and excavation construction workers and re-entry crews) who were
employed between 1956 and 1991. Approximately 16,400 workers were
represented by six construction trade unions for this period. The
phase I investigation estimated that approximately 15,000 of these
workers might be eligible for the program. The investigators were
particularly concerned with exposures to internal and external
radiation and were evaluating other hazardous exposures.
Current Status:
This project is currently in the third year of phase II activity.
Continuing research has indicated that more than 10,000 workers are
potential candidates for the screening process, and more than 2,500
of these were individually notified in the second year of phase II.
The project has provided medical screening for more than 700 workers,
and intends to continue occupational history interview and medical
screening efforts at similar levels in the current project year.
Queens College, NY
Steven Markowitz, M.D.
Paper, Allied Industrial, Chemical and Energy Workers Union
(PACE)
Robert Wages
Exposure Concerns:
Beryllium, plutonium, radiation
Target Population:
Former DOE production workers at the gaseous diffusion plants in
Portsmouth, Ohio; Paducah, Kentucky; and the Oak Ridge, Tennessee
K-25 complex. The investigators limited the notification and medical
screening programs to (1) those workers with potential risk for
bladder cancer at K-25 (estimated to be 500-600 workers who might be
located and be eligible) and (2) those workers at the Paducah and
Portsmouth sites at risk for a variety of lung diseases, including
chronic obstructive lung disease, pneumoconioses and lung cancer. The
phase I investigation estimated a first priority group of workers at
risk of lung disease to be 2,300-3,500 workers at K-25, 300-400
workers at Portsmouth and 200-300 workers at Paducah; a second
priority group was estimated to include 5,000-7,000 workers at K-25,
3,000-5,000 workers at Portsmouth and about 2,000 workers at
Paducah.
Current Status:
The project is currently in the second year of phase II activity.
The project developed extensive worker contacts and outreach
mechanisms and engaged in risk-mapping and exposure data
investigations in the first year of phase II. Plans for the second
year of phase II activity include the continued administration of
occupational exposure history questionnaires, and the provision of
more than 1,000 medical screening examinations.
Center to Protect Workers' Rights Knut Ringen, Dr.P.H.
Exposure Concerns:
Asbestos, beryllium, silica, heavy metals, solvents
Target Population:
Former construction workers at Hanford who were involved in
building construction from 1950 to 1963, excluding workers from
before 1950 because of their age and a lack of records. The initial
target population was estimated at 59,000, and narrowed down to
29,100 after determination of vital status and excluding those lost
to followup.
Current Status:
This project has just begun the third year of phase II activity.
In years 1 and 2, this project contacted more than 2,500 workers,
conducted more than 950 worker interviews, and provided more than 500
medical screening examinations.
The target population includes all former workers at the Idaho
National Engineering and Environmental Laboratory site. During phase
I, the investigators estimated that the number of workers eligible
for the medical screening program might be as high as 17,500. The
investigators also identified a number of exposures (including
asbestos, beryllium, solvents, chromium, and radiation) that may
further identify the study cohort for the site.
Current Status:
This project is in the first year of phase II activity. Efforts
are ongoing to add to the existing former worker roster, particularly
from site contractor lists. Current exposure assessment efforts rely
on both construction of a job exposure matrix and on the development
of building/job classification categories for the Idaho National
Engineering and Environmental Laboratory site. Medical screening
protocols have been developed.
The Johns Hopkins University
Brian Schwartz, M.D., M.S. and Patrick Breysse, Ph. D.
Exposure Concerns:
Ionizing radiation, chlorinated solvents, asbestos, beryllium,
lead
Target Population:
The target population includes all former Los Alamos National
Laboratory workers employed since operations began in 1943. The
number of workers eligible for the medical screening program was
estimated at about 36,000 during phase I. Hazardous exposures that
may further define the target populations were identified during
phase I, and include asbestos, beryllium, chlorinated solvents,
ionizing radiation, lead and noise.
Current Status:
This project is in the first year of phase II activity. Existing
employee records have been analyzed for the refinement of the study
cohort, and a two-stage questionnaire process for selecting workers
for screening has been developed. Extensive procedures for
communicating study results to both affected workers and the
community have been developed. The investigators anticipate
approximately 600 medical screening examinations and medical records
examinations in the first year of phase II.
Center to Protect Workers Rights Knut Ringen, Dr.P.H.
Exposure Concerns:
Asbestos, cadmium, heavy metals, lead
Target Population:
The estimated target population includes about 62,000 former and
current building trades workers at the Savannah River site who worked
from 1950 to the present. During Phase I, the investigators concluded
that approximately 38,000 of these workers are alive. Phase I
investigations estimated that medical screening tests might be
administered to approximately 8,000 of these workers.
Current Status:
This project is in the second year of phase II activity. In year
1, the project located nearly 6,000 workers, conducted nearly 500
worker interviews, and provided more than100 medical screening
examinations. In phase II, year 2, the investigators anticipate
locating an additional 2,500 workers, interviewing 1,500, and
conducting a total of more than 1,000 medical screening
examinations.
Former production workers at the Savannah River site from 1962 to
the present. In phase I, the investigators estimated this to be
approximately 23,000 living workers. Hazardous exposures defining
this population include asbestos, beryllium, hydrazine, solvents, and
internal and external radiation.
Current Status:
This project is in the second year of phase II activity. Efforts
to date have included developing screening questionnaires and risk
assessment and medical screening protocols. Worker outreach efforts
are ongoing, and the investigators have developed a Web site to
assist in communications. Using existing hazard exposure and medical
records, the project recently began providing medical screening
examinations.
University of Iowa
Laurence Fuortes, M.D.
Stephen Reynolds, Ph.D.
Exposure Concerns:
Radioactive materials, explosives, solvents, epoxies, heavy
metals, and fibrogenic dusts
Target Population:
Former production workers in the Line 1 facility of the Iowa Army
Ammunition Plant, which served as an atomic weapons production and
testing area operated by the Atomic Energy Commission from 1945 to
1975. The primary focus is on machinists employed in the area. An
estimated 4,000 workers were employed in the Line 1 area, with
approximately 1,000 employed at any one time.
Current Status:
This project is regarded by DOE as effectively operating in phase
II status at the time of project initiation. This is because DOE
concluded that the proposal adequately demonstrated an understanding
of the site and the exposures of the target population, adequately
documenting the need for medical surveillance.
The purpose of the program is to locate and provide medical
screening to former workers at the Amchitka site. This screening is
targeted to the occupational exposures of former workers at the site,
especially radiation.
Target Population:
Former workers employed at Amchitka from 1963 to the middle
1990s, when the U.S. government maintained a nuclear testing facility
on the island. Approximately 3,000 workers may have been employed at
the site, and it is estimated that about 1,500 will be located and
screened.
Current Status:
This project was initiated in 1999, and approximately 750 workers
have been identified to date despite a wide geographical
distribution. About 100 of these were deceased. Efforts to locate
more former workers continue, with the help of union and Alaska
Native organizations.
![[Worker]](images/2001-133j-1.jpg)
![[Worker using leak-detection device]](images/2001-133j-2.jpg)
![[Laundry worker]](images/2001-133j-3.jpg)
