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Learning Objectives

Risk Communication Strategies in the DiNEH Project Navajo Nation Human Research Review Board Conference November 16, 2011 Window Rock, AZ Chris Shuey, Glenn Stark, Sandy Ramone Diné Network for Environmental Health Project Johnnye Lewis, PI.

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Learning Objectives

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  1. Risk Communication Strategiesin the DiNEH ProjectNavajo Nation Human Research Review Board ConferenceNovember 16, 2011Window Rock, AZChris Shuey, Glenn Stark, Sandy RamoneDiné Network for Environmental Health ProjectJohnnye Lewis, PI Funding provided by NIEHS, RO1 ES014565; R25 ES013208; P30 ES-012072; DHHS/NIH/NCRR #1UL1RR031977-01; USEPA/ERRG pass-through contract

  2. Learning Objectives • Demonstrate how summary statistics and modeling results may be depicted in charts and on maps of the Study Area • Show how photographs and references to local land and water features are used to illustrate health risks from both active-mining era exposures and environmental legacy exposures • Outline methods to evaluate these communication methods

  3. Principles* of Risk Communication Adapted for Diné Communities • Never forget: Communities are partners! • Use Navajo language • Integrate iterative research models • Use pictures, graphics; Navajo is descriptive • Speak clearly, mix in some humor • Develop community trust through frequent contacts • Listen carefully, listen some more • Understand that on Navajo, uranium impacts are historic *Adapted from: Seven Cardinal Rules of Risk Communication. Pamphlet drafted by Vincent T. Covello and Frederick H. Allen. U.S. Environmental Protection Agency, Washington, DC, April 1988, OPA-87-020.

  4. Column charts show survey statistics Navajo Nutrition Study (1991-1993) diabetes prevalence = 22% (all ages) • Data from survey responses • Self-reported health problems • Self-reported exposures to uranium wastes • Chapter responses compared with “All Chapters” responses • Percentages likened to fractions of one dollar • Compare prevalences with other study results

  5. Showing “proximity” in pictures, maps and numbers • 29% (374) participants live within 2 miles of AUM, but only 56% of those (210) were aware they lived that close • Proximity by itself consistently predicts increased risk of disease

  6. Showing how environmental legacy exposure surrogate predicts increased health risks (B) About 1 in 4 participants reported 1 or more environmental exposures What’s a “surrogate”? We say “substitute” in Navajo (C) (D) *Environmental legacy exposures are activities that bring people close to or in contact with uranium 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 (E) (F)

  7. “Heat” maps show increasing health risk (with increasing distance to mine features and legacy exposures) Red areas represent doubling of risk of high blood pressure, all other risk factors being equal (Odds Ratio = 2.0) 1 exposure 2 exposures Maps by Glenn Stark

  8. Communicating Risk to Avoid Risk • DiNEH results, which apply to the entire study population, can be used to reduce individual risk • Red areas in map below, derived from soil sampling, have known contamination and should be avoided 2007 Map by Jamie deLemos, PhD. This can be prevented! Know where the abandoned mines are in your community. Visit http://www.epa.gov/region09/superfund/navajo-nation/index.html to learn mine locations on the Navajo Nation.

  9. Locations of Abandoned Uranium Mines in Mariano Lake area Did ore hauling contaminate Old Gulf Mine Road? Assessment needed! Báházid! Avoid contact with uranium mine sites!

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

  11. Water Sources in Mariano Lake Area Mariano Residence Well Navajo Nation policy is that livestock-use-only water sources are not to be used for human drinking water. 16T-323 Rocky Canyon Windmill Only Mariano Lake unregulated water source tested for bacteria; none present HiddenSpring 16K-528 Mariano Lake Chapter Well (inoperative) (dismantled) 16T-553 (no sample) 16T-578 • 16T-519

  12. Documentation and educational materials provided to Chapters • DiNEH Project binder for each chapter • In collaboration with NNEPA and USEPA, produced: • Safe water-hauling guides • Contaminated well posters (for chapters having contaminated water sources • Agency posters (maps, contaminated wells)

  13. Evaluation • Obtaining feedback from Chapters • Are binders available? • Are warning posters publicly visible? • What are materials used for? • How can they be improved? • Binder present in about half of 12 chapters • Yellow warning posters still hanging at 4 of 6 chapters, for nearly 4 years

  14. Rick Communication on uranium impacts throughout the Navajo Nation Map by Tommy Rock

  15. Warnings About Drinkingfrom Unregulated Water Sources • Contaminated well posters for 5 agencies • Arsenic, Uranium most frequent contaminants exceeding MCLs • Bacteriological contamination • Total coliforms found in 72% of unregulated water sources • more harmful E. Coli were present in about 23% of water sources in Central Navajo region. • Basis for recommendation not to drink from unregulated wells

  16. Using geospatial data to predict potential health risks • Knowing the locations of uranium wastes, we can predict areas of greatest potential risk • Helps target outreach for Navajo Birth Cohort Study • Knowing how behaviors add to that risk can help to reduce risk

  17. 1940s-60s: Uranium Mining “Comprehensive” Health Studies? 1942 1950s-1990s: Miners & Millers Studies Contaminated Structures 1980s-present: UMTRA/AML 2012: Navajo Birth Cohort Study Community health? 2010-11: DiNEH blood & urine study 1979: Church Rock Spill Health Research on Navajo Uranium Legacy Navajo land use & health? Tailings covers 2010-12 CUE-JTH: medical monitoring 1980s: Birth Defects Study • Other diseases? • Biological reasons? • Critical exposure ages? • Other contamination? • Early indicators? Uranium mining, or other exposures? Uranium worker families 2007: Waxman Hearing 2001: DiNEH Project 1st Integrated Health Study 1990s-2000s: Community Actions for Environmental Health Mid-80s: Limited Livestock Studies (NM) 2003-2007: CRUMP Identification of health risks

  18. NIEHS, EPA and UNM for financial support Community Advisory Board Ed Carlisle, Jay DeGroat, Herbert Enrico, Thomas Manning,Sr., Lynnea Smith, Jean Whitehorse, UNM-HSC Community Environmental Health Program & Clinical and Translational Science Center Johnnye L. Lewis, PhD; Miranda Cajero, BCH; Matthew Campen, PhD; Jeremy DeGroat; Mallery Downs, RN; Eszter Erdei, PhD; Molly Harmon; Gabriel Huerta, PhD; Curtis Miller; Bernadette Pacheco; Glenn Stark; Mary Woodruff; research nursing support Crownpoint Service Unit, I H S Virgil Davis Navajo Area IHS Lisa Allee, CNM; John Hubbard; Ryan Johnson, MD; Doug Peter, MD UT-Houston Nephrology Donald Molony, MD Southwest Research Information Center Chris Shuey, MPH, Sarah Henio-Adeky, Teddy Nez, Sandy Ramone Students Jamie deLemos, PhD – Tufts Univ. Christine George – Stanford Univ. Tommy Rock, MA, UNM Health Policy Student Christine Samuel-Nakamura, PhD Candidate, UCLA Dartmouth Ben Bostick, PhD University of Arizona Cancer Center & Northern Arizona University, NACRP Jani Ingram, PhD, Margaret Briehl, PhD USEPA Region IX Harry Allen, Rich Bauer, Clancy Tenley State of New Mexico Diagnostic Laboratory Navajo Nation EPA Air Quality Division, Public Water Supply Supervision Program, Superfund Program Navajo Nation Division of Health Former Contributors: Bess Seschillie, Bernice Norton, Jerry Elwood, Harrison Gorman, Harris Arthur (in memoriam), Alta McCabe, Margaret Menache, PhD, Alexis Kaminsky, PhD; Eastern Navajo Health Board Thanks to the many others who’ve contributed Acknowledgements

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