1

Funding provided by NIEHS, RO1 ES014565; R25 ES013208; P30 ES-012072; Funding provided by NIEHS, RO1 ES014565; R25 ES013208; P30 ES-012072; DHHS/NIH/NCRR #1UL1RR031977-01; USEPA/ERRG pass-through contractDHHS/NIH/NCRR #1UL1RR031977-01; USEPA/ERRG pass-through contract

Risk Communication StrategiesRisk Communication Strategiesin the DiNEH Projectin the DiNEH Project

Navajo Nation Human Research Review Board ConferenceNavajo Nation Human Research Review Board ConferenceNovember 16, 2011November 16, 2011Window Rock, AZWindow Rock, AZ

Chris Shuey, Glenn Stark, Sandy RamoneChris Shuey, Glenn Stark, Sandy RamoneDiné Network for Environmental Health ProjectDiné Network for Environmental Health Project

Johnnye Lewis, PIJohnnye Lewis, PI

2

Learning ObjectivesLearning Objectives

Demonstrate how summary statistics and modeling Demonstrate how summary statistics and modeling results may be depicted in charts and on maps of the results may be depicted in charts and on maps of the Study AreaStudy Area

Show how photographs and references to local land Show how photographs and references to local land and water features are used to illustrate health risks and water features are used to illustrate health risks from both active-mining era exposures and from both active-mining era exposures and environmental legacy exposuresenvironmental legacy exposures

Outline methods to evaluate these communication Outline methods to evaluate these communication methodsmethods

3

Principles* of Risk Principles* of Risk Communication Adapted for Communication Adapted for

Diné Communities Diné Communities Never forget: Communities are Never forget: Communities are

partners! partners! Use Navajo languageUse Navajo language Integrate iterative research modelsIntegrate iterative research models Use pictures, graphics; Navajo is Use pictures, graphics; Navajo is

descriptivedescriptive Speak clearly, mix in some humorSpeak clearly, mix in some humor Develop community trust through Develop community trust through

frequent contactsfrequent contacts Listen carefully, listen some moreListen carefully, listen some more Understand that on Navajo, uranium Understand that on Navajo, uranium

impacts are historic impacts are historic

*Adapted from: Seven Cardinal Rules of Risk *Adapted from: Seven Cardinal Rules of Risk Communication. Pamphlet drafted by Vincent Communication. Pamphlet drafted by Vincent T. Covello and Frederick H. Allen. U.S. T. Covello and Frederick H. Allen. U.S. Environmental Protection Agency, Environmental Protection Agency, Washington, DC, April 1988, OPA-87-020.Washington, DC, April 1988, OPA-87-020.

4

Column charts Column charts show survey show survey statisticsstatistics Data from survey Data from survey

responsesresponses Self-reported health Self-reported health

problemsproblems Self-reported exposures to Self-reported exposures to

uranium wastesuranium wastes Chapter responses Chapter responses

compared with “All compared with “All Chapters” responsesChapters” responses

Percentages likened to Percentages likened to fractions of one dollarfractions of one dollar

Compare prevalences with Compare prevalences with other study resultsother study results

Percentage of Self-reported Health ProblemsAmong Mariano Lake Chapter Participants (N=69)

v. All Chapter Participants (N=1,304)

0%

10%

20%

30%

40%

50%

60%

70%

Arthrit

is

Autoim

mune

Cance

r*

Diabet

es

Heart

Attack

Heart

Disea

se

High B

lood P

ress

ure

Kidney

Dis

ease

Kidney

Sto

ne

Stroke

None

Mariano Lake All Chapters

Self-reported Exposures to Uranium Wastes, Mariano Lake (N=69) v. All Chapters (N=1,304)

0%

5%

10%

15%

20%

25%

30%

35%

Per

cen

tag

e o

f "Y

es"

Res

po

nse

s Mariano Lake All Chapters

Navajo Nutrition Study (1991-1993) diabetes prevalence = 22% (all ages)

5

Showing “proximity” in pictures, maps Showing “proximity” in pictures, maps and numbersand numbers

29% (374) participants live within 2 miles of AUM, but only 56% of 29% (374) participants live within 2 miles of AUM, but only 56% of those (210) were aware they lived that closethose (210) were aware they lived that close

Proximity by itself consistently predicts increased Proximity by itself consistently predicts increased riskrisk of disease of disease

6

Showing how environmental legacy Showing how environmental legacy exposure surrogate predicts increased exposure surrogate predicts increased

health riskshealth risks

*Environmental legacy exposures are *Environmental legacy exposures are activitiesactivities that bring people close that bring people close

to or in contact with uranium to or in contact with uranium wastes, over their lifetimes:wastes, over their lifetimes:

(A) Lived near abandoned mines(B) herded livestock near mines(C) sheltered livestock in mines

(D) played on or near mines, mills(E) used mine materials in home

(F) drank or contacted mine water

(B)(B)

(D)(D)

(E)(E)

(F)(F)

(C)(C)

About 1 in 4 participants

About 1 in 4 participants

reported 1 or more

reported 1 or more environmental exposures

environmental exposuresWhat’s a “surrogate”? We

What’s a “surrogate”? We

say “substitute” in Navajo

say “substitute” in Navajo

7

““Heat” maps show Heat” maps show increasingincreasing health riskhealth risk (with increasing distance to mine (with increasing distance to mine

features and legacy exposures)features and legacy exposures)

1 exposure1 exposure 2 exposures2 exposures

Maps by Glenn Stark

Red areas represent doubling of risk of high blood pressure, all other risk factors being equal (Odds Ratio

= 2.0)

8

Communicating Risk to Communicating Risk to AvoidAvoid Risk Risk DiNEH results, which apply to the DiNEH results, which apply to the entire study populationentire study population, can , can

be used to be used to reduce individual riskreduce individual risk Red areas in map below, derived from soil sampling, have Red areas in map below, derived from soil sampling, have

known contamination and should be avoidedknown contamination and should be avoided

Know where the abandoned mines are in your community. Visit Know where the abandoned mines are in your community. Visit http://www.epa.gov/region09/superfund/navajo-nation/index.htmlhttp://www.epa.gov/region09/superfund/navajo-nation/index.html

to learn mine locations on the Navajo Nation.

2007 Map by Jamie deLemos, PhD. This can be prevented!This can be prevented!

9

Locations of Locations of Abandoned Uranium Abandoned Uranium

Mines in Mariano Mines in Mariano Lake areaLake area

Báházid!Báházid!Avoid contact with Avoid contact with

uranium mine sites!uranium mine sites!

Did ore hauling Did ore hauling contaminate Old Gulf contaminate Old Gulf Mine Road? Mine Road? Assessment needed!Assessment needed!

10

Water sources newly sampled in DiNEH Project study area 130

Water sources sampled more than once 42

Water sources exceeding 1 or more primary MCLs on at least one occasion 27

Water sources exceeding 1 or more SDWSs 107

Most common toxic contaminants detected Arsenic (10) Uranium (9)

DiNEH water testing programDiNEH water testing programAbout 8% of water sources tested had uranium About 8% of water sources tested had uranium ≥ 30 ug/l, the EPA MCL≥ 30 ug/l, the EPA MCL

11

16K-528 Mariano 16K-528 Mariano Lake Chapter Well Lake Chapter Well (inoperative)(inoperative)

16T-32316T-323Rocky Canyon Rocky Canyon WindmillWindmill

16T-57816T-578

16T-55316T-553(no sample)(no sample)

Mariano Residence WellMariano Residence Well

HiddenSpringHiddenSpring

Only Mariano Lake unregulated water source tested for bacteria; none present

Navajo Nation policy is that livestock-use-only water sources are not to be used for human drinking water.

(dismantled)(dismantled)

•16T-519

Water Sources in Mariano Lake AreaWater Sources in Mariano Lake Area

12

Documentation and Documentation and educational materials educational materials provided to Chaptersprovided to Chapters

DiNEH Project binder for DiNEH Project binder for eacheach chapter chapter

In collaboration with NNEPA In collaboration with NNEPA and USEPA, produced:and USEPA, produced: Safe water-hauling guidesSafe water-hauling guides Contaminated well posters Contaminated well posters

(for chapters having (for chapters having contaminated water sourcescontaminated water sources

Agency posters (maps, Agency posters (maps, contaminated wells)contaminated wells)

13

EvaluationEvaluation

Obtaining feedback from Obtaining feedback from ChaptersChapters Are binders available?Are binders available? Are warning posters publicly Are warning posters publicly

visible?visible? What are materials used for?What are materials used for? How can they be improved? How can they be improved?

Binder present in about half of Binder present in about half of 12 chapters12 chapters

Yellow warning posters still Yellow warning posters still hanging at 4 of 6 chapters, for hanging at 4 of 6 chapters, for nearly 4 yearsnearly 4 years

14

Rick Communication on uranium Rick Communication on uranium impacts throughout the Navajo Nationimpacts throughout the Navajo Nation

Map by Tommy Rock

15

Warnings About Drinkingfrom Unregulated Water Sources

Contaminated well posters for Contaminated well posters for 5 agencies5 agencies Arsenic, Uranium most frequent

contaminants exceeding MCLs

Bacteriological contamination Total coliforms found in 72% of

unregulated water sources more harmful more harmful E. ColiE. Coli were present were present

in about 23% of water sources in in about 23% of water sources in Central Navajo region.Central Navajo region.

Basis for recommendation not Basis for recommendation not to drink from unregulated to drink from unregulated wellswells

41

128

177

Positive E. coli

Positive totalcoliforms

Water sourcestested forbacteria

16

Using geospatial data to Using geospatial data to predict potential health predict potential health

risksrisks Knowing the locations Knowing the locations

of uranium wastes, we of uranium wastes, we can predict areas of can predict areas of greatest potential riskgreatest potential risk

Helps target outreach Helps target outreach for Navajo Birth Cohort for Navajo Birth Cohort StudyStudy

Knowing how Knowing how behaviors add to that behaviors add to that risk can help to reduce risk can help to reduce riskrisk

17

1940s-60s: Uranium Mining1950s-1990s:

Miners & Millers Studies

1980s: Birth Defects Study

Mid-80s: Limited Mid-80s: Limited Livestock Studies Livestock Studies

(NM)(NM)

Tailings covers

Navajo land use & health?

Community health?

2012: Navajo Birth Cohort Study

1979:1979:Church Rock Church Rock

SpillSpill

1990s-2000s: Community Actions for Environmental Health

2003-2007: CRUMP

2001: DiNEH Project 1st Integrated Health Study

2010-12 CUE-JTH: 2010-12 CUE-JTH: medical monitoringmedical monitoring

2007: Waxman Hearing

“Comprehensive” Health Studies?

• Other diseases?• Biological reasons?• Critical exposure ages?• Other contamination?• Early indicators?

Uranium mining, or Uranium mining, or other exposures?other exposures?

19421942

2010-11: DiNEH blood & urine study

Health Health Research Research on Navajo on Navajo Uranium Uranium LegacyLegacy

Identification of health risksIdentification of health risks

Contaminated Contaminated StructuresStructures

1980s-present: UMTRA/AML

Uranium worker Uranium worker familiesfamilies

18

AcknowledgementsAcknowledgements NIEHS, EPA and UNM for financial supportNIEHS, EPA and UNM for financial support Community Advisory BoardCommunity Advisory Board

Ed Carlisle, Jay DeGroat, Herbert Enrico, Ed Carlisle, Jay DeGroat, Herbert Enrico, Thomas Manning,Sr., Lynnea Smith, Jean Thomas Manning,Sr., Lynnea Smith, Jean Whitehorse, Whitehorse,

UNM-HSC Community Environmental Health UNM-HSC Community Environmental Health Program & Clinical and Translational Science Program & Clinical and Translational Science CenterCenter

Johnnye L. Lewis, PhD; Miranda Cajero, Johnnye L. Lewis, PhD; Miranda Cajero, BCH; Matthew Campen, PhD; Jeremy BCH; Matthew Campen, PhD; Jeremy DeGroat; Mallery Downs, RN; Eszter DeGroat; Mallery Downs, RN; Eszter Erdei, PhD; Molly Harmon; Gabriel Erdei, PhD; Molly Harmon; Gabriel Huerta, PhD; Curtis Miller; Bernadette Huerta, PhD; Curtis Miller; Bernadette Pacheco; Glenn Stark; Mary Woodruff; Pacheco; Glenn Stark; Mary Woodruff; research nursing supportresearch nursing support

Crownpoint Service Unit, I H SCrownpoint Service Unit, I H S Virgil DavisVirgil Davis

Navajo Area IHSNavajo Area IHS Lisa Allee, CNM; John Hubbard; Ryan Lisa Allee, CNM; John Hubbard; Ryan

Johnson, MD; Doug Peter, MDJohnson, MD; Doug Peter, MD UT-Houston NephrologyUT-Houston Nephrology

Donald Molony, MDDonald Molony, MD Southwest Research Information CenterSouthwest Research Information Center

Chris Shuey, MPH, Sarah Henio-Adeky, Chris Shuey, MPH, Sarah Henio-Adeky, Teddy Nez, Sandy RamoneTeddy Nez, Sandy Ramone

StudentsStudents Jamie deLemos, PhD – Tufts Univ.Jamie deLemos, PhD – Tufts Univ. Christine George – Stanford Univ.Christine George – Stanford Univ. Tommy Rock, MA, UNM Health Policy Tommy Rock, MA, UNM Health Policy

StudentStudent Christine Samuel-Nakamura, PhD Christine Samuel-Nakamura, PhD

Candidate, UCLACandidate, UCLA DartmouthDartmouth

Ben Bostick, PhDBen Bostick, PhD University of Arizona Cancer Center & University of Arizona Cancer Center &

Northern Arizona University, NACRPNorthern Arizona University, NACRP Jani Ingram, PhD, Margaret Briehl, PhD Jani Ingram, PhD, Margaret Briehl, PhD

USEPA Region IXUSEPA Region IX Harry Allen, Rich Bauer, Clancy TenleyHarry Allen, Rich Bauer, Clancy Tenley

State of New Mexico Diagnostic LaboratoryState of New Mexico Diagnostic Laboratory Navajo Nation EPA Air Quality Division, Public Navajo Nation EPA Air Quality Division, Public

Water Supply Supervision Program, Superfund Water Supply Supervision Program, Superfund ProgramProgram

Navajo Nation Division of HealthNavajo Nation Division of Health Former Contributors:Former Contributors:

Bess Seschillie, Bernice Norton, Jerry Elwood, Bess Seschillie, Bernice Norton, Jerry Elwood, Harrison Gorman, Harris Arthur (in memoriam), Harrison Gorman, Harris Arthur (in memoriam), Alta McCabe, Margaret Menache, PhD, Alexis Alta McCabe, Margaret Menache, PhD, Alexis Kaminsky, PhD; Eastern Navajo Health BoardKaminsky, PhD; Eastern Navajo Health Board

Thanks to the many others who’ve contributedThanks to the many others who’ve contributed