ORRHES Minutes
August 26, 2003
Agenda Review, Correspondence and Announcements
Agenda Review. . Dr. Davidson noted
the following changes to the published agenda. The discussion on the
final draft report of the ORR needs assessment would begin at 2:15 p.m.
instead of 2:45 p.m. The floor would be opened for public comments at
2:45 p.m. instead of 3:30 p.m. ORRHES’s vote on the needs assessment
recommendations at 2:55 p.m. and an open forum with ATSDR staff at 3:00
p.m. were added as separate agenda items. The presentation on next steps
in health education activities was deleted from the agenda.
All other agenda items remained the same: the needs assessment overview,
discussion and recommendations beginning at 12:35 p.m.; remaining work
group reports, recommendations and votes beginning at 4:00 p.m.; an update
on the project plan at 5:45 p.m.; and ORRHES business beginning at 6:30
p.m. Mr. Lewis pointed out that before these changes were made to the
agenda, an hour was set aside for him to present the Health Education
Needs Assessment Work Group (HENAWG) findings and lessons learned from
the project. His presentation on the needs assessment recommendations
was now included in this agenda item, but his understanding was that
the full hour would still be set aside for him to present the original
topics.
Regardless of the revisions to the agenda, Mr. Lewis conveyed that the
meeting should still be flexible to accommodate his full presentation
and other unexpected items arising from ORRHES’s deliberations.
He also emphasized the need for workgroup discussions to be clearly documented
in writing to minimize any misunderstanding. Ms. Sonnenburg conveyed
that ORRHES typically listens to presentations, engages in a discussion
and takes a break before a vote is taken on recommendations. This approach
allows the members to discuss recommendations off the record before the
chair calls for a vote. However, this practice was not followed in the
modified agenda.
To address this issue, Dr. Davidson should ask if ORRHES is ready to
vote on the needs assessment report or needs more discussion time when
the floor is opened for this agenda item. Ms. Sonnenburg added that she
was not aware of these changes because the agenda was revised after the
Agenda Work Group developed the document. Dr. Davidson responded to the
comments as follows. The revised agenda is flexible and accommodates
all issues ORRHES needs to address during the meeting. The changes were
based on her discussion with ATSDR staff on the previous day. ORRHES’s
vote on the needs assessment recommendations was added as a separate
agenda item before the open forum with ATSDR because staff cannot make
any comments to prejudice the vote. However, Dr. Davidson agreed to inquire
about ORRHES’s readiness to vote on the document when the floor
is opened for this agenda item.
Correspondence. No correspondence was
noted for the record.
Announcements. Ms. Spencer distributed
the current membership roster and asked the members to review their contact
information for accuracy or make changes as needed. She mentioned that
e-mail messages to some members have been returned to ATSDR as “undeliverable.”
Review of June 2003 ORRHES Meeting Minutes
Dr. Davidson entertained a motion to approve the previous meeting minutes.
Mr. Hill so moved; Mr. Washington seconded the motion. There being no
abstentions, opposition or further discussion, the June 3, 2003 ORRHES
Meeting Minutes were unanimously approved with no changes.
Review of Pending ORRHES Action Items
Ms. Spencer provided a status report of three items listed as “pending” on
the ORRHES list of recommendations and action items.
- The Division of Health Education and Promotion (DHEP) will return
to future ORRHES meetings to discuss health education programs that
will be conducted in Phase II of the needs assessment.
- ATSDR provided
ORRHES with data on the uncertainties for air releases modeled in the
Task 6 Report. Ms. Susan Kaplan’s initial request
for this information was included in the briefing packets for the current
meeting.
- Mr. Jack Hanley of ATSDR will speak with Dr. Timothy Joseph of
DOE to clarify the suggestion to update the compendium of all health-related
research studies conducted at Oak Ridge. The outcome of this discussion
will be reported at the next ORRHES meeting.
Update on the ORR Needs Assessment
Overview. Ms. Donna Mosby, the HENAWG Co-Chair, noted that HENAWG received
the final draft needs assessment report in June 2003. The document was
also distributed in the pre-meeting briefing packets for review by the
remaining ORRHES members. She highlighted the key outcomes of the report.
The goal of the needs assessment was to facilitate health decision-making
of ORR residents. The project was designed to be completed in two phases
with the needs assessment being conducted in Phase I and follow-up activities
being implemented in Phase II. The purposes of the needs assessment were
to develop new knowledge and insights about current health concerns and
needs of target communities as well as to provide a summary of the findings.
The objectives of the project were to develop a sound foundation for
a health education needs assessment; conduct the needs assessment; report
results to the community and project sponsors; and make recommendations
for a community health education action plan. Several activities were
conducted to achieve the needs assessment objectives. First, efforts
were made to interact with the community. The project investigators attended
ORRHES and workgroup meetings, held conference calls and gave weekly
updates. Second, the ORR historical literature was reviewed. Reports
on environmental exposures and health issues related to the ORR site
that have been published over the past 15 to 20 years by various health
departments, environmental agencies and researchers were accessed and
reviewed if available.
These data were used to examine the history and context of health concerns
and priorities of residents; understand current issues of residents in
a broader context; and finalize questions that would be asked during
key resource interviews. Project investigators ensured that key resource
interviews included questions about the health and current concerns of
residents, educational strategies to address these issues, and the success
or failure of previous programs. However, the interviewers did not ask
questions about specific health issues to avoid biasing key resource
responses.
Third, interviews were held with key resources. Health concerns of area
residents were identified from persons who regularly hear about these
issues in their professions or volunteer work or those with knowledge
of these concerns based on an extensive or long-term relationship with
residents. For purposes of the needs assessment, “key resources” were
defined as health care providers, public health professionals and community
members. Efforts were made to ensure that all health concerns known to
key resources were included in telephone surveys and focus groups. The
health issues most frequently mentioned during key resource interviews
were cancer, respiratory disease, neurological or mental health conditions,
heart disease, as well as smoking, substance abuse and other behavioral
or social-related issues.
The needs assessment report concluded that findings from the key resource
interviews were consistent with health concerns cited in historical Oak
Ridge literature. Fourth, telephone surveys were conducted. Health issues
of most concern to residents, health information needs, mechanisms to
locate health information, and preferred methods to receive information
were identified. Feedback was also obtained on whether health resources
can be used as a mechanism to address concerns. Of the health conditions
most frequently mentioned by telephone survey respondents, 21% listed
heart disease as the number one concern and 14% stated cancer was the
major issue.
Fifth, focus groups were convened. These discussions were designed to
obtain additional information and a deeper insight on health concerns
of residents; the rationale for these concerns; and issues mentioned
during the telephone surveys. Focus group data were combined with results
from the other components of the needs assessment to provide input on
the health education action plan. One of the most significant challenges
in conducting the focus groups was the disappointingly low number of
participants. Nevertheless, two focus groups were convened with workers
and elderly persons. The health concerns most frequently mentioned by
participants were diabetes, obesity, heart disease, cancer, berylliosis,
thyroid disease, autoimmune disease and suicide. Questions asked during
the key resource interviews, telephone survey and focus groups are attached
to the final needs assessment report in appendices.
The conclusions of the final needs assessment report are as follows.
The relatively low response rate in all components of the project may
be an indication of “study fatigue” within the ORR population.
The needs assessment results may not reflect the views of all ORR residents
since participants were somewhat different than the study area population.
Health issues identified during the project were consistent with prior
ORR reports and publications; these concerns focused on cancer, heart
disease and respiratory problems. Physicians were most frequently cited
as the method to obtain health information, while short written materials
were the preferred format. Comments about health information and educational
services widely varied.
Hospital-based programs were often favored, but no single educational
strategy or resource was described as the best mechanism to meet the
needs of ORR residents. Health information and educational programs are
clearly comprehensive strategies to meet the priorities and goals of
ORR residents. The needs assessment results were used as the basis to
propose a health education action plan and formulate recommendations.
The purpose of this component of the project is to enhance the capacity
of the ORR population to make informed decisions about health issues
by disseminating current health information that is relevant to recent
and ongoing community input. The major focus areas of the health education
action plan were found to be follow-up activities and future studies
at the ORR site.
HENAWG Findings. Mr. James Lewis, the HENAWG Co-Chair, thanked several
ORRHES members for their diligent efforts in reviewing the needs assessment
report and providing valuable input: Mr. Gartseff, Dr. Malmquist, Ms.
Mosby and Ms. Sonnenburg. He particularly recognized Mr. Al Brooks for
his contributions in assisting HENAWG. He distributed a document that
outlined ORRHES’s historical challenges and comments about the
overall needs assessment process and also described the background of
ORRHES’s involvement with the project.
ORRHES charged HENAWG with specific activities: critique the overall
needs assessment methodology; assess the purpose, techniques and results
of the four project components; review the report; evaluate results;
and present formal recommendations to the full ORRHES. HENAWG established
several evaluation criteria to fulfill its charge. First, were the priorities,
surveys and other methodologies in the project design of the needs assessment
appropriate? Second, were geographical areas and surrounding counties
identified and included in the project? Third, did George Washington
University (GWU) Medical Center, the needs assessment subcontractor,
accomplish the goals and objectives established for the literature review,
key resource interviews and telephone surveys?
As an additional resource during its evaluation of the needs assessment
report, HENAWG also reviewed statements made by President George W. Bush
in the ATSDR Final Performance Plan Report: “The government should
be results-oriented and guided not by process, but guided by performance.
There comes a time when every program must be judged whether a success
or failure. Where we find success, we should repeat it, share it and
make it the standard. And where we find failure, we must call it by its
name. Government action that fails in its purpose must be reformed or
ended.” Mr. Lewis opened the floor for other HENAWG members to
weigh in on the final draft needs assessment report.
General
- ATSDR did not oversee its contractor or subcontractor, the Association
of Occupational and Environmental Clinics (AOEC) and GWU, respectively.
Due to the poor quality of GWU’s telephone survey, focus
groups and other activities, ORRHES should not accept the final
needs assessment
report.
- The purpose, goals and objectives of the project are vague,
not clearly defined, not associated with specific items, and poorly
stated for comparative purposes.
- GWU’s flawed approach
with the literature review, key resource interviews, telephone survey
and focus groups does not present
a strong rationale, firm foundation and solid data to build on the needs
assessment and advance to Phase II activities.
Community Interaction
- GWU attended ORRHES and HENAWG meetings to obtain feedback on
appropriate methods to outreach to the community and increase participation
in the
needs assessment. However, the techniques described in the final
draft report and the extremely low participation rate in the project
indicate
that GWU did not implement ORRHES’s suggestions.
- Figure I-1
in the report depicts interaction with the Oak Ridge area community
during all seven steps of the project: the proposal, literature
review, site visit, key resource interviews, telephone survey, focus
groups and final report. However, GWU’s communication with ORRHES
dramatically decreased after the key resource interviews were conducted.
Moreover, ORRHES had minimal input in the selection process for focus
group participants and development of survey questions.
- Planning, marketing
and community outreach strategies were weak. The advertisement seeking
focus group participants was generic, vague
and only mentioned “health concerns.” The two newspapers
where the advertisement was published and the two radio stations where
an announcement about the project was broadcast were not identified
in the report. Therefore, few persons outside the Oak Ridge area would
see
the advertisement if the Oak Ridger was used. The same situation would
be true for the Roane County News because no individuals in Meigs,
Loudon, Knox or Morgan counties would see the advertisement. Only one
day was
set aside for focus group sessions.
- GWU asked each HENAWG member and
the 70 key resources to provide names and telephone numbers of potential
focus group participants. The
report does not describe GWU’s outreach efforts to contact these
individuals or the percentage of residents who accepted or declined the
offer to participate in focus groups.
Telephone Survey
-
The report states that GWU identified all telephone exchanges in the
eight-county target area, but only 33% were used. The randomization
process to select telephone exchanges was not transparent; the actual
numbers
GWU used were not identified as well. The 400 telephone calls made
in the survey did not cover the entire Oak Ridge area. For example,
one
of the most impacted areas would not have been surveyed if the 376
exchange in Roane County was not used. The methodology was inappropriate
and is
an extreme shortcoming of the project. Sample telephone surveys should
have been conducted in each of the eight target counties to ensure
that all areas potentially affected by the ORR site were represented
in the
needs assessment.
- The report states that the needs assessment was
designed to identify current health issues of residents in the
ORR area and nearby
counties. During the telephone surveys, however, GWU obtained information
about current health issues of adult residents in Tennessee. This introduction
may have contributed to the 70% of residents who refused to be interviewed.
Of the 30% of telephone survey respondents, 84% were not interested
in additional information about their health concerns.
- GWU did not mention
uranium or other specific contaminants to avoid biasing the telephone
surveys, but this technique yielded extremely
generic responses. The needs assessment should have been conducted in
a manner similar to the ORR dose reconstruction. This project was more
specific and generated meaningful results that could be tracked. GWU’s
approach with the telephone surveys is questionable and does not validate
the project.
Focus Groups
- HENAWG spent a considerable amount of time and effort in
identifying 15 categories of residents who should be contacted as focus
group participants,
including former ORR workers; surviving relatives of deceased persons;
long-term residents downstream of the Clinch River; persons with
long-term exposures to airborne plumes; children with genetic defects;
and persons
with long-term exposures and illnesses not directly related to
ORR releases. HENAWG did not recommend hardly any of the categories
GWU selected to
participate in focus groups: mid-life women, long-term elderly
residents, persons with respiratory diseases, cancer patients, heart
disease patients,
ill workers, and three groups of general residents. The final draft
report does not list the 15 categories originally identified by HENAWG.
- The
methodology to recruit focus group participants was severely flawed.
The majority of information gathered during the focus groups
was from eight workers, but onsite exposures among this population are
beyond ATSDR’s mandate and ORRHES’s charter. The only other
focus group was convened for elderly persons; only one individual participated.
- GWU
did not review successful techniques that have been used to convene
focus groups at other sites. For example, clergy, teachers
and other groups trusted by the local community were extensively involved
in recruiting participants.
- Key resources and focus group participants
were interested in health information or education from credible
and trustworthy sources
only. The low participation rate in the focus groups suggests that
the ORR community did not find GWU to be credible.
Key Resource Interviews
-
The report mentions that physicians and other key resources at the ORR
site rarely returned GWU’s telephone calls. The low response rate
was heavily impacted by GWU’s location in Washington, DC and
its inability to directly interact with key resources on a regular
basis.
GWU should have asked the Oak Ridge Field Office to hold face-to-face
meetings with key resources and gather information.
Literature Review
-
GWU was provided historical data from technical reports, telephone surveys,
interviews, focus groups and other activities conducted at the ORR site
over the past ten to 20 years. Dr. Henry Falk, the ATSDR Assistant Administrator,
made statements to GWU about the project during the January 2001 ORRHES
meeting. He hoped that the ORR needs assessment would assist in defining
and clarifying concerns and issues and would also help ATSDR’s
focus in completing site activities. Dr. Falk also informed GWU of ATSDR’s
efforts in gathering community needs and concerns at the beginning of
the project. Despite its access to ORR historical data and knowledge
of Dr. Falk’s comments, GWU did not provide a detailed summary
of community concerns in the final draft needs assessment report.
- GWU
did not apply significant outcomes from historical data. For example,
the final draft needs assessment report states that “study
burnout” contributed to the low participation rate in the project.
The state of Tennessee reached the same conclusion in the ORR dose reconstruction
eight years previously.
- The report misinterprets historical data in some
instances. For example, Table III-3 shows K-25 water contamination
from 1940 to
2000, but K-25 was not built in 1940.
Public Comment Period
The Chair called for public comments on the needs assessment only; no
attendees responded.
<<Back Next
>>
|