ATSDR - PHA Guidance Manual - Table of Contents

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Public Health Assessment Guidance Manual

Foreword
Disclaimer

Chapter 1: Introduction

1.1 ATSDR's Mandate and Mission
1.2 The Public Health Assessment Process
1.3 Purpose of This Guidance Manual
1.4 Organization of the Guidance Manual

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Chapter 2: Public Health Assessment Overview

2.1 What Is a Public Health Assessment?

2.1.1 Definition and Purpose
2.1.2 Factors to Be Considered in All Public Health Assessments
2.1.3 How Does a Public Health Assessment Differ from a Risk Assessment?

2.2 When Is a Public Health Assessment Conducted?
2.3 Who Conducts Public Health Assessments?
2.4 What Is the Role of the Site Community?
2.5 How Is a Public Health Assessment Conducted?

2.5.1 Getting Started
2.5.2 Collecting Needed Information
2.5.3 Exposure Evaluation: Evaluating Environmental Contamination Data
2.5.4 Exposure Evaluation: Identifying Exposure Pathways
2.5.5 Health Effects Evaluation: Conducting Screening Analyses
2.5.6 Health Effects Evaluation: Conducting In-Depth Analyses
2.5.7 Formulating Conclusions and Recommendations and Developing a Public Health Action Plan

2.6 What Products and Actions Result From the Public Health Assessment Process?

2.6.1 Products
2.6.2 Public Health Actions

2.7 What Is the Format for Public Health Assessment Documents?

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Chapter 3: Obtaining Site Information

3.1 What Information Is Needed?

3.1.1 Background Information
3.1.2 Community Health Concerns
3.1.3 Environmental Contamination Information
3.1.4 Exposure Pathway Information
3.1.5 Health Outcome Data
3.1.6 Substance-Specific Information

3.2 How Is Information Obtained?

3.2.1 Government Agencies
3.2.2 Internet Resources
3.2.3 Community Members and Other Stakeholders
3.2.4 Site Representatives
3.2.5 Conducting the Site Visit

3.3 Identifying Information Gaps
3.4 Documenting Relevant Information
3.5 Confidentiality and Privacy Issues
References
Other Resources

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Chapter 4: Involving and Communicating With the Community

4.1 Definitions, Goals and Objectives, and Program Roles

4.1.1 Definitions
4.1.2 Goals and Objectives for Community Involvement
4.1.3 Program Areas Addressing Community Needs

4.2 Working and Communicating with Community Members

4.2.1 Earning Trust and Credibility
4.2.2 Confidentiality and Privacy
4.2.3 Cultural Sensitivity
4.2.4 Environmental Justice
4.2.5 Principles of Effective Communication

4.3 Planning Community Involvement Activities

4.3.1 Overview of Community Involvement in the Public Health Assessment Process
4.3.2 Developing Community Involvement Strategies
4.3.3 Types of Community Involvement Activities

4.4 Community Involvement Tools

4.4.1 Tools for Initial Data Gathering
4.4.2 Community Meetings
4.4.3 Community Groups and Committees
4.4.4 Fact Sheets and Other Materials
4.4.5 Media Support
4.4.6 Establishing Information Repositories
4.4.7 Access to Experts and Toll-Free Hotline

4.5 Including Community Involvement Activities in the Public Health Assessment Process
4.6 Community Health Concerns in Public Health Assessment Documents

4.6.1 How to Respond to Community Health Concerns
4.6.2 How to Present Responses to Community Health Concerns in The PHA

4.7 Public Comment Process and Release of Final Public Health Assessment Documents

4.7.1 Public Comment Process
4.7.2 Release of Final PHA or PHC

4.8 Disseminating Information to the Community

4.8.1 Developing Mailing Lists
4.8.2 Clearance Procedures

References
Other Resources

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Chapter 5: Exposure Evaluation: Evaluating Environmental Contamination

5.1 Evaluating Environmental Sampling Data

5.1.1 Background Information on Environmental Sampling
5.1.2 Validity of Environmental Sampling Data
5.1.3 Representativeness of Environmental Sampling Data
5.1.4 Conclusions About Data Usability

5.2 Evaluating Modeled Data
5.3 Considering Background Concentrations
5.4 Identifying and Filling Critical Data Gaps
5.5 Summarizing and Presenting Environmental Data in the Public Health Assessment Document
References
Other Resources

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Chapter 6: Exposure Evaluation: Evaluating Exposure Pathways

6.1 Exposure Pathway Evaluation

6.1.1 The Five Elements of an Exposure Pathway
6.1.2 Developing a Site Conceptual Model

6.2 Contamination Source(s) and Releases

6.2.1 Identifying Contamination Sources
6.2.2 Identifying Affected Media
6.2.3 Identifying Physical/Safety Hazards

6.3 Evaluating Fate and Transport of Contaminants

6.3.1 Fate and Transport Processes
6.3.2 Physical and Chemical-Specific Factors That Influence Environmental Fate and Transport
6.3.3 Site-Specific Factors That Influence Environmental Fate and Transport

6.4 Identifying Point(s) of Exposure and Exposure Routes

6.4.1 Possible Exposure Points by Environmental Medium
6.4.2 Exposure Routes
6.4.3 Temporal and Spatial Considerations
6.4.4 Conditions That Could Prevent Exposure

6.5 Identifying Potentially Exposed Populations

6.5.1 Characterizing Potentially Exposed Populations
6.5.2 Estimating Numbers of People in Potentially Exposed Populations

6.6 Categorizing Exposure Pathway Information

6.6.1 Completed Exposure Pathways
6.6.2 Potential Exposure Pathways
6.6.3 Eliminated Exposure Pathways

6.7 Identifying the Need for Gathering Additional Exposure Data

6.7.1 Definition of Exposure Investigations
6.7.2 When an Exposure Investigation Should Be Considered

6.8 Presenting Exposure Pathway Information in the Public Health Assessment Document
References
Other Resources

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Chapter 7: Health Effects Evaluation: Screening Analysis

7.1 What Are Comparison Values?
7.2 Conducting Environmental Guideline Comparisons

7.2.1 Selecting Environmental Guidelines
7.2.2 What If No Comparison Values Exist?

7.3 Conducting Health Guideline Comparisons

7.3.1 Estimating Site-Specific Exposure Doses
7.3.2 Selecting Health Guidelines

7.4 Other Factors That Influence the Screening Analysis
7.5 Presenting Screening Analysis Findings in the Public Health Assessment Document
References
Other Resources

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Chapter 8: Health Effects Evaluation: In-depth Analysis

8.1 When to Conduct an In-depth Analysis
8.2 Tools and Resources Needed to Support an In-depth Analysis
8.3 Evaluating Study(ies) on Which Exceeded Health Guidelines are Based

8.3.1 Compare Site-Specific Doses to Observed Effect Levels
8.3.2 Assess the Relevance of the Critical Study

8.4 Reviewing Other Dose-response Data
8.5 Evaluating Substance-specific Factors that Can Increase or Decrease the Potential for Harm

8.5.1 Biologic Uptake
8.5.2 Mechanistic Data
8.5.3 Sensitive Populations and Life Stages
8.5.4 Multiple Chemical Exposures

8.6 Evaluating Site-specific Health Effects Data

8.6.1 Health Outcome Data
8.6.2 Biologic Data
8.6.3 Medical Data and Information

8.7 Presenting Findings in the Public Health Assessment Document
References
Other Resources

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Chapter 9: Determining Conclusions and Recommendations

9.1 Determining Conclusions

9.1.1 Selecting a Conclusion Category
9.1.2 Presenting Conclusions in the Public Health Assessment Document

9.2 Determining Recommendations and Developing a Public Health Action Plan (PHAP)

9.2.1 Actions To Cease or Reduce Exposures
9.2.2 Actions for Site Characterization
9.2.3 Health Activities
9.2.4 Factors To Consider When Developing Recommendations and the PHAP
9.2.5 Presenting Recommendations and Public Health Action Plan in the Public Health Assessment Document

References

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List of Appendices

Appendix A: Tribal-specific Resources and Considerations

Appendix B: ATSDR Glossary of Terms

Appendix C: Community Check List

Appendix D: Guidelines for Effective Communication

Appendix E: Chemical- and Site-Specific Factors That May Affect Contaminant Transport

Appendix F: Derivation of Comparison Values

Appendix G: Calculating Exposure Doses

Appendix H: Public Health Conclusion Categories

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List of Tables

Table 3-1. Contamination Information Needed by Environmental Medium

Table 3-2. Site-Specific Information That May Be Needed To Evaluate Contaminant Fate and Transport

Table 3-3. Information Available Through Government Agencies

Table 3-4. Useful Government Sources of Information

Table 3-5. Sample Site Summary Table

Table 4-1. ATSDR Program Areas with Responsibilities for Working with Communities

Table 4-2. Issues to be Considered When Developing Community Involvement Strategies

Table 4-3. Activities That Might Be Conducted at Three Different Levels of Community Involvement and Participation

Table 5-1. Example Use of a Table To Display Data: Surface Water Sampling Data for Selected Metals Along the XXX River

Table 6-1. Documenting Exposure Pathways

Table 7-1. Additional Sources of Environmental Guidelines

Table 9-1. Summary of Conclusion Categories

Table 9-2. Summary of Conclusion Categories With Recommended Public Health Actions

Table 9-3. Factors to Consider When Selecting Health Activities

Table 9-4. Worksheet for Developing Recommendations and PHAP (Completed To Show a Biologic Monitoring Action)

Table 9-5. Example Conclusions, Recommendations, and Public Health Actions

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List of Figures

Figure 1-1. Basic Components of the Public Health Assessment Process

Figure 2-1. Types of ATSDR Staff and External Partners That May Be Involved in Supporting a Public Health Assessment

Figure 2-2. Overview of the Public Health Assessment Process

Figure 2-3. Information Needed To Evaluate Exposures and Health Effects

Figure 3-1. The Basic Iterative Information-Gathering Process for a Public Health Assessment

Figure 3-2. Basic Data Needs for Conducting a Public Health Assessment

Figure 4-1. Components of Effective Community Involvement

Figure 5-1. Examples of Maps Used to Display Environmental Data

Figure 5-2. Example of a Chart to Display Data: Number of Exceedances of EPA's Health-based Ozone Standard at Site X since 1982

Figure 6-1. Evaluating Exposure Pathways

Figure 6-2. Site Conceptual Model—Exposure Pathway Schematic

Figure 6-3. Site Conceptual Model—Exposure Pathway Evaluation

Figure 7-1. Screening Analysis Overview

Figure 7-2. Environmental Guideline Hierarchy

Figure 8-1. Overview of In-depth Analysis

Figure 8-2. Schematic of Various Low-dose Extrapolation Methods

Figure 8-3. Factors Affecting Whether Environmental Contamination May Result in Harmful Effects

Figure 8-4. Health Outcome Data Evaluation Decision Tree (for evaluating site-related exposures)

Figure 9-1. Overview of Conclusion and Recommendation Process

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