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Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services (2006)

Chapter: 2 Scientific Program Assessment: National Institute for Occupational Safety and Health

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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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2
Scientific Program Assessment: National Institute for Occupational Safety and Health

The committee reviewed the research priorities for the epidemiological projects, research project selection, dissemination of results of completed research, and contribution of research to the Department of Energy (DOE). The output of selected products of the Occupational Energy Research Program (OERP) of the National Institute for Occupational Safety and Health (NIOSH) program as of May 2006 is presented in Annex 2A. The remainder of this chapter presents material relevant to the committee’s statement of task as follows: (1) a review of selected but representative components of NIOSH’s research program for quality; (2) an evaluation of the research priorities to date; (3) a summary of the usefulness of the results of the NIOSH program and its impact on DOE policies and decisions; and (4) recommendations for enhancements of the NIOSH research program for the future.

To evaluate whether the research programs were of high scientific quality (i.e., methodologically sound, relevant, reasonable interpretation of results), the committee sampled research products at three DOE sites: Hanford, Oak Ridge National Laboratory (ORNL), and Los Alamos National Laboratory (LANL). The committee also reviewed selected multisite studies that included data from these three locations. These studies were judged by the committee to represent relevant combined analyses of occupational health DOE-wide and to be representative of the types of studies carried out across the program. In addition, because beryllium has been used extensively in various components and processes in the U.S. nuclear weapons industry since the 1940s, the committee reviewed the beryllium-related research performed under the Memorandum of Understanding (MOU).

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Specifically, the committee reviewed the following NIOSH research:

  1. Publications examining exposures at Hanford and ORNL in relation to cancer and non-cancer mortality—the committee also discusses the one single-site publication that used the LANL mortality data in a risk analysis;

  2. The U.S.-based multisite studies that include Hanford and ORNL data (the Childhood Leukemia Case-Control Study and the Female Nuclear Workers Study);

  3. The multisite case-control study of multiple myeloma and the ongoing multisite case-control study of leukemia;

  4. Non-radiologic health studies focused primarily on beryllium-related issues; and

  5. The contribution of DOE sites to international studies of cancer mortality among nuclear workers.

COMPLEXITIES AND LIMITATIONS INVOLVED IN THE EPIDEMIOLOGICAL STUDIES

One of the most contentious issues in the fields of radiation protection and radiation epidemiology relating to cancer causation is that of the linearity of the dose response and the related question of dose-rate effects, i.e., whether the same dose delivered over an extended period has different effects than a dose delivered instantaneously. High-dose studies, particularly the A-bomb survivor study, show unequivocally that radiation can cause cancer, including most leukemias and most solid tumors. Interpolation of the high-dose studies down to the levels of exposure that are experienced in today’s occupational settings indicates that workers exposed near the maximum levels (2 rem/year) allowed by DOE will experience perhaps a ½ percent to 1 percent increase in the relative hazard of all tumors (for each year of such exposure). Current radiation protection standards and compensation programs are based upon the results of this extrapolation of high-dose effects down to low dose. The considerable uncertainty, however, in this high-dose extrapolation provides the fundamental rationale for conducting epidemiological studies of occupational radiation.

Direct studies of low-dose effects are desirable because there are scientific questions concerning the theoretical basis for extrapolation of human epidemiological data from acute radiation exposures in excess of about 200 mSv to lower doses delivered at the long-term chronic exposure rates experienced by most radiation workers. However, in direct studies of workers, the relatively low degree of excess risk poses enormous difficulties for epidemiological studies of current exposure levels, since even a perfect epidemiological study, where dose is known precisely and the chance for confounding is very limited, would require many decades of follow-up of hundreds of thousands of workers in order to accrue enough cases of cancer to have adequate statistical power to detect such relatively small increases. For example, to study the relationship between a spe-

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

cific outcome (disease of interest, e.g., overall or cause-specific cancer mortality) and radiation, if 20 percent of workers in the industry were exposed to enough radiation to result in a 10 percent increase in the outcome, it would be necessary to observe over 5,000 cases of disease (in a cohort study) or over 10,000 cases (in a 1-1 matched case-control study) before there would be good statistical power to detect that this level of radiation was harmful. It would be expected that less than 2 percent of all cases would be caused by exposure. Currently the total workforce at a large DOE facility is on the order of 10,000 people.

These risks are at the limit of what current epidemiological methods can achieve, especially given that no analytic observational study is free of confounders, and that doses are not perfectly measured. Furthermore, individuals, or even groups of individuals, may differ in their susceptibility to exposures. For certain cancers (e.g., some leukemias), the relative risks due to radiation exposure may be considerably higher, so that far fewer cases of cancer are required in a study. However, even though the fraction of these types of radiogenic cancers is correspondingly higher, the cancers are often quite rare requiring a lengthy surveillance of large numbers of workers.

Going beyond the expected small excesses of radiation-caused cancers, other important issues increase the difficulty of the epidemiological studies performed under the MOU. For example, the extraordinary history of the weapons plants, including the speed at which the processes and weapons were first developed, the rate at which the DOE workforces grew in the early years, the urgency of their mission, the complexity of the research and industrial processes, the many decades that this work force has been in existence, and the potentially long-lived effects of exposure on risk, all contribute to the challenges of epidemiological investigations performed under the MOU from the 1990s to the present. Only one exposure of interest, namely external radiation, is demonstrably captured with any degree of completeness, and even for this exposure there are continuing uncertainties, related to the uniformity of monitoring requirements, monitor performance, recording practices, and record retention. The situation for chemical exposures and for internal dose estimation appears to be rather more difficult, with large “documentation” gaps affecting the ability to either directly study these exposures as a cause of disease, or to correct for them in the analysis of radiation effects. The same applies to lifestyle-related exposures, especially to tobacco, a known cause of some of the same diseases (e.g., lung cancer) that are also of interest as an effect of radiation exposure. In addition, the socioeconomic status of various types of workers (known to affect health and mortality) has a complex interplay with exposure as well, with most exposures at most sites being received by lower-status workers. Over these studies as a whole, therefore, the committee notes enormous challenges in the evaluation of existing records of exposure, especially chemical and internal radiation exposures, but also in many cases (generally for the early years) to external penetrating radiation.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

DOE SINGLE-SITE MORTALITY STUDIES

Oak Ridge National Laboratory, Hanford, and Los Alamos National Laboratory Epidemiological Studies

There are three major DOE sites in the Oak Ridge area: ORNL (formerly the site of the X-10 reactor), the K-25 gaseous diffusion plant, and the Y-12/TEC site (formally the site of the electromagnetic separator and later of specialized research projects). According to Frome et al. (1997), only workers at the ORNL site and a fraction of the workers at Y-12 had individualized external dosimetry data that could be used in dose-response analyses. Data from one ongoing case-control study of multiple myeloma at the K-25 facility, which began in 1995, have yet to be analyzed. Much of the work has focused on ORNL (X-10). Data from Y-12 has apparently been used in only one published dose-response analysis (Frome et al. 1997); Y-12 has not been chosen for inclusion in the multisite leukemia study described below, having not met that study’s requirement that the potential for internal exposure be minimized. For similar reasons Y-12 workers have not been included in the international pooled studies (Cardis et al. 1995, 2005). Work began at the Oak Ridge and Hanford sites quite early, so many of the publications on Oak Ridge and Hanford are reports of work that were started under contract to DOE and were later transferred to NIOSH after the MOUs were initiated.

The Hanford operations were larger than those at ORNL. More workers were monitored for radiation exposure, and the average dose of workers who were exposed to radiation was higher at Hanford (26 versus 22 mSv), although the general dose distribution was similar (Gilbert et al. 1993a). The fraction of subjects exposed to greater than 100 mSv is also similar at the two sites. Early studies included workers initially employed at Hanford between 1944 and 1978 and at ORNL between 1943 and 1972. Several analyses and reanalyses of the data have been undertaken. These have involved (1) updating the follow-up from the mid-1980s (Wing et al. 1991; Gilbert et al. 1993a) to the early 1990s; (2) expanding the ORNL cohort to include women and non-white workers as well as others not included in some earlier studies; and (3) working to improve the dosimetry data, partly through efforts to capture additional historical records and partly through improvements in the statistical treatment of missing doses (Gilbert et al. 1996; Xue et al. 2004; Daniels and Schubauer-Berigan 2005; Daniels et al. 2006; Richardson et al. 1999). In addition some work on internal plutonium exposure has been performed for the Hanford cohort (Wing et al. 2004) although no formal dose-response analysis has been possible since internal measurements are available only for small numbers of potentially exposed workers. In general, however, the cohort of workers studied at ORNL and Hanford has been fixed, with no new subjects entering the studies after the middle to late 1970s.

Overall there is limited evidence from these sites of an ionizing radiation dose-response relationship for all cancers. For example Gilbert et al. (1993b)

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

found non-significant negative dose-response relationships between external penetrating dose and either solid tumor or leukemia mortality in the Hanford cohort (follow-up through 1986). A few specific tumor sites (multiple myeloma, cancer of the pancreas, and non-Hodgkin’s lymphoma) appeared to be positively related to exposure at a marginally statistically significant level. The estimated excess relative risks (ERRs)1 per unit exposure were found early on (Gilbert et al. 1993a) to be much greater in the ORNL data than in either the Hanford data or the data for A-bomb survivors (Gilbert et al. 1993a). However, because the ORNL cohort was considerably smaller than the Hanford cohort, 95 percent confidence intervals for ORNL still overlap the values for Hanford and include the null value indicating that no association was found between an increase in cancer risk and protracted low-level exposures.

Some reports (Mancuso et al. 1977; Wing and Richardson 2005) have found that exposures received by workers at older ages were more strongly related to cancer occurrence than exposures received at younger ages, which runs counter to certain other epidemiological data such as for thyroid exposure to 131I from Chernobyl, as well as high-dose exposures among the A-bomb survivors and all solid tumor cancer incidence and mortality, where age at exposure has been found to be inversely related to ERR (NRC 2006a).

As described below, even the most recent international pooled study of Cardis et al. (2005) did not take into account all available follow-up data from these two sites only follow-up data for ORNL and Hanford through 1984 and 1986, respectively, were made available to the International Agency for Research on Cancer (IARC) for the international study.

Although the cohorts at LANL and ORNL are approximately the same size, fewer findings have been published from the LANL cohort than either ORNL or Hanford because dosimetry data were unavailable until recently. Data from this cohort were not included in the international pooled studies (Cardis et al. 2005), but this site has been chosen for inclusion in the multisite leukemia case-control study. The one published report that the committee reviewed (Wiggs et al. 1994) analyzed cause-specific mortality for approximately 15,000 white male workers who were hired between 1943 and 1977 and followed through 1990. The study found limited evidence of any dose-response relationships for radiogenic cancers. As with the other DOE sites, investigators were not able to control for potential confounding with lifestyle factors or occupational exposures other than ionizing radiation.

1

The ERR is the rate of disease in an exposed population divided by the rate of disease in an unexposed population minus 1.0.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

MULTISITE EPIDEMIOLOGICAL STUDIES

In the 1980s the need for joint analyses of occupational groups was recognized and studies were underway. IARC began the three country study (Cardis et al. 1995) and Gilbert in the United States (Gilbert et al. 1989), and investigators in the United Kingdom (Carpenter et al. 1998) had initiated joint analyses of occupational groups. A key criticism made by the “Dead Reckoning” monograph (PSR 1992) of pre-MOU occupational radiation exposure studies at DOE sites was their reliance on small sample sizes at single facilities rather than on an overall evaluation of hazards to the entire DOE workforce. Pooling efforts therefore have been given priority, both under the MOU and in the study of nuclear workers in general (Cardis et al. 1995, 2005). A key issue impeding pooling has been the degree of heterogeneity of the types of radiation exposures considered. Generally, data from sites where internal radiation exposures are expected to predominate, such as Fernald, have not been pooled with data from cohorts exposed primarily to external penetrating radiation. In addition, the Portsmouth Navy Shipyard (PNS), a non-DOE site that services nuclear submarines and their components, where workers are exposed exclusively to external radiation, has been included in NIOSH’s work under the MOU. There were efforts even before the MOU to conduct combined analyses, such as in combining Hanford, ORNL, and Rocky Flats (Gilbert et al. 1989, 1993a); the goal of combining homogeneous DOE data has not yet been fully realized, however (see recommendations). In this section the committee reviews two different types of multisite studies conducted under the MOU:

  1. Multisite studies aimed at either incorporating additional sites beyond Hanford and ORNL into the analyses and/or addressing questions regarding dose estimation and confounding whether by lifestyle or other occupational exposures; and

  2. Special multisite studies addressing specific questions that have arisen in relation to exposures and health of the DOE workforce or their families, but not specifically directed at improving or extending the understanding of radiation health effects on the workforce as a whole (e.g., female workers study, study of childhood leukemia).

Multisite Leukemia Case-Control Study

The ongoing multisite leukemia case-control study is important both with respect to the findings it may report and as a pilot study for future proposed NIOSH studies of solid tumors. The proposed studies would use similar methods but would require considerably larger numbers of cases and controls because of the lower risks caused by radiation.

Leukemia is the most radiogenic of all cancers, although this differs by leukemia subtype, with chronic lymphocytic leukemia (CLL) generally consid-

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

ered to be unrelated to radiation exposure (for an exception, see the recent study by Rericha et al. 2006). Excesses of leukemia have been observed at one DOE site, Savannah River (Cragle et al. 1988). Currently, the epidemiological evidence for effects of protracted exposure to low doses in elevating leukemia risk is somewhat equivocal. The 1995 international study (Cardis et al. 1995) found a significantly higher ERR estimate, but this weakened to borderline statistical significance in the 2005 update (Cardis et al. 2005).

The committee’s evaluation of the multisite leukemia study is based on a protocol received from NIOSH, several published papers on methodology (Daniels and Schubauer-Berigan 2005; Daniels and Yiin 2006; Daniels et al. 2006), and a 2006 presentation by Mary Schubauer-Berigan (NIOSH) at the American Statistical Association’s 2006 radiation meeting. There have been important methodological findings from the multisite leukemia study. First, very little external dose was found to be “missed” because of either recording practices (e.g., round-off methods, detection limits) or missing records. For example, Daniels and Yiin (2006) presented a convincing case that only a few percent of total collective external dose was likely lost because of detection limit issues. Second, an intensive search for records on internal dose revealed a relatively small contribution (Daniels et al. 2006) to bone marrow dose from internal sources, although this contribution did appear to be positively correlated with external doses, leaving the possibility of some confounding of the effects of the two types of exposure. Finally, from the American Statistical Association presentation noted above, the investigators were successful in building a job exposure matrix to estimate exposure to carbon tetrachloride and benzene for cases and controls.

These findings have relevance for evaluating the likelihood of success of proposed future work by NIOSH DOE sites (see recommendations). Furthermore, when properly combined with the IARC pooled analysis, this study could provide important information regarding leukemia risk as a function of protracted exposure to low-dose-rate radiation.2

Multisite Multiple Myeloma Study

This study was undertaken by investigators at the University of North Carolina. The nested case-control method was used to assess exposure to radiation and chemicals, including benzene, among 98 cases with multiple myeloma and 391 controls. One published report (Wing et al. 2000) and an extensive final report3

2

About 30 percent of the cases in the multisite leukemia study are included in the IARC 2005 publication (NIOSH 1996, 2006). The multisite leukemia study had approximately 10 years more of follow-up from Hanford and ORNL and included four other sites (LANL, PNS, SRS, Zia) not included in the IARC publication. IARC analyzed 196 leukemia cases. This would be increased to approximately 340 in the combined analyses.

3

See http://www.cdc.gov/niosh/oerp/completed.html. Last accessed August 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

were reviewed by the committee. The multisite multiple myeloma study found no overall excess risk due to exposure to external radiation. However, the investigators noted that doses received at older ages were positively related to risk, while doses received at younger ages were inversely associated with risk. The interpretation of this unexpected finding is not something about which the committee can make a judgment, but it could be a chance finding as a result of multiple comparisons. However, in light of findings in the ORNL and Hanford studies of positive associations for doses received at older ages and null associations at younger ages, this result does suggest that the issue of age interactions with exposure needs further investigation, possibly through pooling of studies, including DOE and international nuclear worker studies. One study that could potentially add valuable information to address this question is the multiple myeloma study being conducted at the K-25 (the Oak Ridge Gaseous Diffusion Plant) facility. This separate single-site study has a large number of cases of multiple myeloma for a rare cancer (63, according to the Agency for Toxic Substances and Disease Registry [ATSDR]4), but it has been considerably delayed from its original expected completion date of 2002.

Multisite Female Nuclear Workers Mortality Study

The pooled female worker study surveyed the mortality of approximately 68,000 female workers at 12 DOE sites (Wilkinson et al. 2000).5 The mean cumulative doses (external) for those monitored ranged from 0.6 mSv at Fernald to approximately 10 mSv at Savannah and the maximum lifetime dose for any monitored female worker ranged from 51 mSv at Fernald to 420 mSv at Los Alamos (Table 16). There was a total of 88 person Sv (Table 17) collective exposure in total for all monitored female workers at the facilities included in the study. The multisite female worker study sought in two ways to determine whether some lethal radiation effects may be unique to, or more common in, females: first, by an overall survey of death certificates, and second, as a follow-up on the one positive finding from the mortality survey, by a case-control study of mental disorders. Since approximately two-thirds of the women in the mortality survey did not have records of external radiation exposure, a “yes-no” surrogate for radiation exposure between badged and unbadged workers was used in many analyses. Overall mortality and overall cancer mortality, especially from lung cancer, were higher in the unbadged than the badged workers. In addition, a few positive associations between the yes-no surrogate and the risk of cancer or other diseases were noted, and death due to so-called mental disorders was elevated in the badged group. The general tendency for unbadged workers to have higher

4

See http://www.atsdr.cdc.gov/HAC/oakridge/phact/c_1.html#213. Last accessed August 2006.

5

See http://www.cdc.gov/niosh/oerp/pdfs/2001-133g17.pdf. Last accessed October 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

cancer mortality than badged workers is likely due to differences in lifestyle factors, particularly smoking, that could not be controlled for in this analysis. The significant finding for mental disorders was followed up in a case-control study in which individual dose estimates were obtained (Sibley et al. 2003). While a marginally significant dose response for this outcome was observed, the biological basis of such an effect if it is confirmed is unclear. However, since many outcomes were surveyed, multiple comparisons may have produced a chance finding. Among approximately 21,000 women with external monitoring data, statistically significant positive dose responses, based on a total of 11 deaths, were observed for leukemia and suggestive results were obtained for all cancer mortality and breast cancer mortality.

To increase sample size, female workers from 12 DOE sites were considered in the analysis. As noted by the authors, workers received both internal and external radiation exposures. Therefore the exposures may have been both more heterogeneous and less well measured by radiation badges than in studies such as the multicenter leukemia case-control study, which concentrated on DOE sites where external exposures were expected to predominate. In addition, lack of control for confounding and lack of any quantitative dosimetry for most workers limit the contribution of this study to understanding worker-related adverse health outcomes or sex-specific response to radiation.

Multisite Offspring Leukemia Study

The committee reviewed one case-control study of childhood leukemia in relation to pre-conception parental exposure among children living in locations near three DOE nuclear facilities (Idaho, Oak Ridge, and Hanford) (Sever et al. 1997). This study was designed to follow-up on the well-known Sellafield study (Gardner et al. 1990) that found an association between pre-conception paternal radiation exposure at the Sellafield nuclear plant in the United Kingdom and risk of childhood leukemia. A total of 233 cases of childhood cancer with either parent employed at any one of three DOE sites were identified from hospitals, cancer registries, and death certificates, and 4 controls were chosen for each case from among parents of children without cancer working at the same DOE sites. The comparison of cases and controls gave no indication of a positive association between childhood leukemia and parental dose, since for all three worksites the mean dose to the fathers of cases prior to conception was lower than the mean dose to the fathers of controls prior to conception. This study made a significant contribution to a topic of interest. While limited in statistical power, the results of the study were consistent with subsequent similar studies that also did not support the findings at Sellafield.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

International Collaborative Study of Nuclear Industry Workers

This study conducted by IARC was partially funded by NIOSH through the OERP extramural research program. The study updated the earlier IARC study (Cardis et al. 1995) of mortality data from nuclear workers in 3 countries, expanding it to include data for worker cohorts from a total of 15 countries (Cardis et al. 2005). The stated goals of the study were to include data from existing cohorts with individual monitoring data for external penetrating exposures and with follow-up for mortality for all cohort members. This study included data from three DOE sites: Idaho National Laboratory (INL), Hanford, and ORNL. IARC and its collaborators conducted a series of studies of dosimetry practices (Gilbert et al. 1996) exposure conditions, and dosimeter response (Thierry-Chef et al. 2002) in support of the efforts to meaningfully combine radiation dosimetry data from all 15 countries and the various facilities therein. While this study of approximately 600,000 workers (which included approximately 5,000 deaths from cancer in the main analyses) is the largest study in existence of low-dose external penetrating exposure to workers, it does necessarily suffer from many of the same drawbacks as do the DOE studies. While facilities where internal radiation doses were the predominant source of exposure were likely excluded from study, the potential for confounding by chemical and tobacco exposure and other workplace exposures remains a serious concern. Overall, a positive dose response for solid tumors was reported, amounting to approximately a 1 percent increase in the relative risk of solid tumor mortality for each 10 mSv of cumulative exposure. The confidence intervals for this estimate remained wide, however, and thus the estimated risk is not inconsistent with the (lower) risk estimates from the A-bomb survivors. It is especially notable that approximately 43 percent of cancers were at tumor sites considered to be smoking-related. Since risk estimates for these tumor sites may be seriously biased if tobacco use and radiation exposure are correlated, additional analyses were conducted restricted to solid tumor sites unrelated to smoking. These showed somewhat smaller risk estimates and were not statistically significant. For leukemia, not including CLL, a non-significant positive slope was estimated. In the committee’s overall appraisal, the IARC study is regarded as important, but as described below, there are important gaps related to the contribution or exclusion of data from specific DOE cohorts, and the length of mortality follow-up used for Hanford and ORNL.

Non-Radiologic Health Studies

As highlighted in NIOSH public information documents, workers at DOE facilities have been exposed to a variety of chemical and physical hazards (e.g., solvents, gases, metals and other toxicants, loud noises, heat, non-ionizing radia-

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

tion), some of which are unique to specific DOE facilities.6 In fact, NIOSH points out that “the chemical exposures may actually be the primary concern for certain health outcomes.” The stated objectives of NIOSH studies include estimating uncertainties and biases in exposure assessments and conducting more comprehensive exposure assessments of chemicals. Few studies have focused on site-specific non-radiological hazards. The unpublished chemical worker study is an exception; the primary studies that have been performed to date related to chemical and physical hazards have focused primarily on beryllium and to a lesser extent on mercury and excessive heat exposure.

Beryllium

A listing of DOE sites with current or past beryllium work includes Hanford, ORNL, and LANL, as well as the Ames Laboratory, Argonne East, Argonne West, Brookhaven National Laboratory, Energy Technology Engineering Center, East Tennessee Technology Park (K-25), Fermilab, Kansas City, Lawrence Livermore National Laboratory (LLNL), Mound, Nevada Test Site, ORNL, Pantex, Rocky Flats Environmental Technology Site, Sandia National Laboratory (SNL), Savannah River, Stanford Linear Accelerator Center, and Y-12.7 In a 1996 survey of current beryllium use at DOE facilities, both ORNL and LANL, as well as Allied Signal-Kansas City Plant, Fermilab, LLNL, Pantex, Rocky Flats, SNL, and Y-12, reported potential worker exposures to beryllium. Even short-term exposures to beryllium fumes, dust, or metal oxides can result in beryllium sensitization and subsequently chronic beryllium disease in some workers.8

As part of an epidemiological research review provided to DOE in 1989, the National Research Council (NRC 1989) recommended that DOE make efforts to quantify exposures to and effects from agents in addition to ionizing radiation. The NRC also urged DOE to begin cautiously developing and using molecular markers of chemicals in future studies (NRC 1994). The ongoing DOE epidemiological studies that were transferred to NIOSH in 1991 under the first MOU did not include any epidemiological studies focusing on beryllium. However, the participants at a 1991 workshop devoted to developing an energy-related epidemiological research agenda recommended the completion of health studies related to beryllium exposures. At the initial Advisory Committee on Energy-Related Epidemiological Research (ACERER 1993) meeting, the NIOSH

6

See http://www.cdc.gov/niosh/2001-133a.html. Last accessed August 2006.

7

See http://www.eh.doe.gov/administration/training/be/BerylliumSites.pdf. Last accessed August 2006.

8

DOE (U.S. Department of Energy). 2006. Final Draft. DOE Beryllium Information Survey Report. DOE Facility Experience from 1994 to 1996. [on-line]. Available: http://www.eh.doe.gov/be/docs/96survey.pdf. Last accessed October 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Occupational Energy Research Program (OERP) proposed studies examining the health effects of DOE-related occupational exposures to beryllium (CDC 1993). NIOSH reports (NIOSH 2005) in this area were complete by November 2005 (Sanderson et al. 1999; Martyny et al. 2000; Newman et al. 2001, 2005; Kelleher et al. 2001; Rosenman et al. 2001; Newman 2002).

Beryllium-related research performed under the MOU followed several lines of scientific investigation including beryllium exposure-disease relationships; the rate of progression from beryllium sensitization to chronic beryllium disease; use of the blood beryllium lymphocyte proliferation test (BeLPT) for surveillance; results of medical screenings for beryllium sensitization in relation to exposure measures; cellular and molecular responses to beryllium that promote granuloma formation; and the potential for inadvertent movement of residual beryllium off-site from contamination of workers hands and clothing. The majority of these findings (Sanderson et al. 1999; Martyny et al. 2000; Kelleher et al. 2001; Newman et al. 2001, 2005; Rosenman et al. 2001) were reported in the peer-reviewed scientific literature. The scope of the work is congruent with the mission of OERP to conduct relevant, unbiased research to identify and quantify health effects related to occupational exposures. The research adds important information that enhances and helps guide current research on beryllium performed by NIOSH (outside OERP), DOE, the Department of Defense (DOD), and the National Institute of Environmental Health Services as well as other agencies. The OERP beryllium-related research has also provided information that can be used to help interpret the findings from DOE’s Former Worker Medical Surveillance Program (FWMSP). As noted elsewhere (NIOSH 2005), OERP maintains the beryllium worker and health outcomes exposure registry and acts in an advisory capacity to the FWMSP.

Beryllium-related research needs have been developed by DOE with input from DOD, the Occupational Safety and Health Administration, and NIOSH.9 Many of these needs are directly relevant to the OERP mission. Steps that would directly impact both the power of epidemiological studies and the cost of surveillance would be to develop and validate improved screening and diagnostic tests, and to identify genetic factors that affect either sensitization or disease process. “The BeLPT, which is commercially available at only a limited number of institutions, suffers from low sensitivity with a high rate of false negatives, inaccessibility of labs that can perform the test, and significant problems with both inter and intralaboratory reproducibility of abnormal BeLPT results” (Deubner et al. 2001; Stange et al. 2004). The development and validation of an improved test would also enhance the ability of researchers to successfully address many of the other Be-related research opportunities developed by DOE.

9

See http://www.eh.doe.gov/be/researchprograms.pdf. Last accessed July 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×
Mercury

In addition to the beryllium-related studies, the committee reviewed a single-site NIOSH study of neurologic defects after occupational exposure to elemental mercury (Letz et al. 2000) that involved Y-12 (Oak Ridge). The study suffered from low participation rates so the results, apparent deficits in peripheral nervous system function decades after exposure, remain equivocal.

Epidemiological and Statistical Methods Research

NIOSH, through its extramural and intramural activities, supported a range of epidemiological and statistical methods research. Some of this work was very focused upon problems of direct relevance to the analysis and interpretation of data from the DOE workers cohorts, while other projects (mainly through the extramural activities) were more inclusive, supporting research with relevance to the general analysis and interpretation of radio-epidemiological data or supporting the analysis and interpretation of data from other radiation-exposed cohorts of workers. The general areas of research included:


Research that focused on understanding the effects of measurement error in the analysis and interpretation of the DOE worker studies included the following research subjects:

Substantial efforts to estimate and assess the impact of workers’ exposure to doses that were below the limits of detection for radiation monitors in use at various time periods, as well as the impact of various recording practices used historically (e.g., weekly versus quarterly reading of film badge doses).

Assessment of bias factors and other uncertainties inherent in personal monitors historically used to assess external dose.

Incorporation of the uncertainty of dose estimation into dose-response analysis in DOE and occupational radiation epidemiology studies in general.

Assessment of the quality of records for assessing exposure to chemicals, lifestyle-related exposures, and external and internal radiation for the DOE worker cohorts including:

  • historical worker exposures,

  • current practices (e.g., for cleanup workers),

  • research into modeling the effects of exposure using both empirical and “mechanistic” models for cancer occurrence.

Other special issues such as development of computerized occupational exposure databases and research into exposures to Russian nuclear workers or Chernobyl cohorts that may produce informative information regarding DOE worker cohorts radiation-related risks.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Measurement error problems are especially important in epidemiology for two reasons: (1) random measurement errors have an adverse impact on the power of a study to make inferences about the presence of radiation effects, and (2) both random and systematic measurement errors impact the interpretation and comparability of results from one study to another by biasing risk estimates (most often, but not always towards zero effect).

The problem of estimating doses below the minimum detectable limit of contemporary personal dosimeters was treated both by externally funded investigators and by NIOSH researchers. Much of this work focused at least in part on doses to Hanford and ORNL workers, and most studies addressed monitoring of external radiation. The problem of potential exposures below the level of detection is important to the degree that a significant contribution to workers’ dose could be hidden by either the limits of sensitivity of the detectors or by recording practices (e.g., weekly versus quarterly reading of film badge doses) in use historically. If a significant amount of radiation dose was hidden beneath the detection limit, this would have the effect both of weakening the power of studies to detect true radiation effects, but also of tending to give an upward bias to risk estimates. A series of journal articles (Xue and Shore 2003; Xue et al. 2004; Daniels and Yiin 2006) or reports (Ostrouchov et al. 1998) discussed this problem, generally in similar terms, by introducing a model for the true dose distribution in relation to distributions of un-truncated data (for doses above the detectible limit), which provided interpolations of the distribution of true dose below the detectable limit. On a related topic, Richardson et al. (1999) addressed the question regarding whether or not all workers with likely exposure (at Hanford) were properly monitored. In general, it appears that the quality of these studies was quite high, although in some cases perhaps over-elaborate methods were recommended to deal with the problem. Nonetheless, it is apparent that useful findings came out of the studies. The recent publication by Daniels and Yiin (2006) estimates that for the PNS workers only about 1 percent or less of the total collective dose was below the detectable limit, which would imply virtually no significant effect of this issue on risk estimation. The relevance of this finding to the DOE sites is not completely clear, but other indications (such as the dose-response analyses performed by Xue and colleagues for the ORNL cohort, Xue et al. 2004), before and after correcting for doses below the detection limits using their own somewhat different modeling approach, also appeared to suggest that the truncation problem had little effect on the risk estimates. For example, in an analysis of all-cause mortality, risk estimates changed by less than 6 percent after adjustment for “missing” doses. Richardson and colleagues (1999) found that about 2 percent of collective external dose at Hanford was imparted to workers not wearing personal radiation monitors. To obtain this estimate, they used a “nearby” analysis in which doses for monitored workers in similar locations or jobs were applied to the unmonitored workers. This degree of missing dose again would appear to have very little impact on risk estimates. Similar results were

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

also reported by the same investigators for the Savannah River site (Richardson et al. 2006).

The performance of radiation monitoring badges over the range of external doses was addressed in several projects. Gilbert and colleagues (1996) reviewed the types of dosimeters used and the experimental methods used to calibrate the dosimeters over the history of the Hanford site. Summarizing laboratory studies designed to calibrate the dosimeters to known exposures, Gilbert and colleagues (1996) provided bias factors and estimates of the uncertainty of these bias factors for external doses of several energies and by organs of interest. The derivation of bias and uncertainty factors for external dose was extended to the DOE sites considered in the multi-site leukemia study by Daniels and Schubauer-Berrigan (2005). The view of the committee is that the work on biases of radiation dosimeters described by these two groups of investigators is scientifically sound. To date only the biases, and not the uncertainty in the biases of the external dosimeters, have been incorporated into risk estimation for the major studies or cohorts, except in the case of Hanford where Gilbert (1998) did reanalyze the data using the bias factors and uncertainties discussed in Gilbert et al. (1996). However, the committee does not believe that these uncertainties will strongly influence the overall appraisal of whether radiation effects exist at the low doses and dose rates that the workers were exposed to, although uncertainties in bias factors may have an impact on the comparability of results within these studies or to high-dose studies.

More general methodological work has been funded by NIOSH that was designed to either further develop statistical methods for empirically modeling the effect of exposures on disease (cancer) risk, when the exposures are accumulated over time throughout a worker’s working lifetime (Richardson et al. 2004), or to relate these exposures to current thinking about some aspects of cancer etiology (via “mechanistic models”) (Hazelton et al. 2006). While much of this work is directly relevant to the analysis of real or apparent modifications of risk by such factors as age, dose rate, etc., it does not appear to have added greatly to the existing statistical tools available for analysis this type of data. In addition, no novel techniques in this regard appear to have been developed under the MOU.

As emphasized elsewhere in this report, the problem of identifying and characterizing internal radiation dose (Wing et al. 2004), chemical exposures, and lifestyle exposures is an extremely challenging one, especially for the early time periods at the DOE sites. While efforts have gone into addressing these problems, they appear to the committee in many cases quite intractable. However, documenting both current and future radiologic and non-radiologic exposures deserves much greater attention. An important study by Silver and colleagues (2000) describing the state of exposure assessment for a relatively new class of workers (e.g., the cleanup or remediation workers) indicates that there are considerable gaps in current practices for chemical and other workplace hazard monitoring

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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that are exacerbated by the decentralized organization of cleanup work. While external radiation exposures for cleanup workers apparently are monitored and the data are centrally retained, chemicals and other hazards that these workers are exposed to as well as the ability to follow these workers prospectively, based on current employment record retention and practice, appear extremely limited. The identification of this gap by NIOSH in current DOE practice is an important contribution. One project funded extramurally, “Sentinel Exposure Event Surveillance/Evaluation at DOE Sites” (LaMontagne et al. 2001), sought to develop prototype databases for future exposure surveillance at DOE sites. Implementation of exposure databases by DOE is strongly recommended by this committee and the committee views this study as adding worthwhile information.

Overall, the committee’s evaluation is that useful methodological work was funded. While some problems (e.g., the detection limit problem) may in retrospect seem to have been given more attention than warranted, given the likely quantity of “missed dose” (this is a judgment informed by hindsight), the committee concludes that relevant and useful work was performed.

RESEARCH PRIORITIES, SCIENTIFIC MERIT OF RESEARCH, RESEARCH DISSEMINATION, AND BENEFITS OF RESEARCH TO DOE

In the remainder of this chapter, the committee provides additional comments regarding its overall perspectives on the research priorities embodied in NIOSH research to date, the scientific merit of the studies undertaken by NIOSH, benefits to DOE provided by the research studies, the impact of these studies on DOE policies and decisions, the dissemination of research results, and the overall effectiveness of the MOU in promoting needed DOE-related occupational research. In addition, the committee provides a series of recommendations intended to enhance the effectiveness of NIOSH’s DOE-related research and activities.

Research Priorities

Under the MOUs, NIOSH successfully took over and completed DOE studies that were in progress, including studies of cause-specific mortality at the Hanford and ORNL sites. Research agendas during the early years of the OERP appear to be closely aligned with the recommendations of the Secretarial Panel for the Evaluation of Epidemiologic Research Activities. In addition, many of the studies proposed by OERP at the initial meeting of ACERER in 1993 (Table 1-2 of the NIOSH evidence package; see NIOSH 2005) have been completed except for the following:

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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  • A study of plutonium workers across DOE sites, which remains a proposal in the 5-year agenda for Department of Health and Human Services (HHS) Public Health Activities;10

  • A case-control study of lung cancer mortality at the PNS and a multiple myeloma case-control study at the K-25 uranium enrichment facility;

  • A chemical laboratory workers cohort mortality study; and

  • Numerous ongoing studies focused on radiation exposure measurements.

Additional studies that NIOSH lists as uncompleted include the following:11


Intramural

  • Chronic Lymphocytic Leukemia (CLL)

  • Cohort Mortality Study of Fernald Environmental Management Plant

Extramural

  • Health Effects of Occupational Exposures in Paducah Gaseous Diffusion Plant Workers

  • Stochastic Models for Radiation Carcinogenesis: Temporal Factors and Dose-Rate Effects

  • Susceptibility and Occupational Radiation Risks

  • Radon and Cigarette Smoking Exposure Assessment in Fernald Workers

ACERER continued to provide advice to the Secretary of HHS regarding the OERP research agenda until 2000. NIOSH reports (NIOSH 2005) that since the dissolution of ACERER, the research agenda has been formulated by “the scientific staff and program managers of the OERP through public and stakeholder meetings, as well as consultation with scientific experts on research needed in specific areas.”

As part of the overall OERP research agenda, NIOSH occasionally solicits proposals from extramural investigators in specific research areas. Extramural solicitations for proposals in 199412 focused on retrospective exposure assessment, radiation measurement issues, non-cancer morbidity and mortality outcomes, meta-analysis and combined analysis methodologies, uncertainty analysis, and effects of measurement error on risk estimates. While the most recent NIOSH extramural solicitations for proposals13 continued to focus on a number of the above areas of research including retrospective exposure assessment, meta-analysis and combined analysis methodologies, uncertainty analysis, and effects

10

See http://www.cdc.gov/niosh/pdfs/hhsdoe_2005-2010-2.pdf. Last accessed August 2006.

11

See http://www.cdc.gov/niosh/oerp/. Last accessed November 2006.

12

See http://grants.nih.gov/grants/guide/rfa-files/RFA-OH-94-001.html. Last accessed August 2006.

13

See http://grants.nih.gov/grants/guide/rfa-files/RFA-OH-02-002.html. Last accessed August 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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of measurement error on risk estimates, two new categories—epidemiological analysis of the health effects of radiation and statistical modeling—were added to the solicitation. Two categories from the 1994 solicitation including non-cancer morbidity and mortality outcomes as well as radiation measurement issues were not included in the 2002 solicitation.

The majority of the areas of research opportunities, both in 1994 and as late as 2002, appropriately sought to develop methods to improve the validity of the occupational epidemiological studies. However, the category “non-cancer morbidity and mortality outcomes,” which is listed in 1994 but not in 2002, sought proposals from researchers to perform epidemiological studies examining adverse health effects such as possible effects of radiation on cardiovascular disease and chronic obstructive pulmonary disease, and on the reproductive, neurologic, and immune systems as well as diseases related to beryllium and mercury exposure. The category also requested researchers to submit applications proposing to examine the identification, validation, and use of biomarkers of disease. It is clear that the primary research focus, at least for radiological exposures, is still on cancer incidence and mortality. While there is a high level of interest in the emerging evidence for cardiovascular effects in both the A-bomb survivors and some high-dose medical exposure patients (NRC 2006a), the evidence for these heath effects comes from exposures that are much higher on average than those received by the workers at the DOE sites. In the A-bomb studies the absolute numbers of excess non-cancer deaths (those due to radiation) is somewhat more than half of the excess number of solid cancer deaths (250 versus 440, respectively) and the relative risks (RRs) are even lower for non-cancer mortality, in part because the baseline number of deaths is higher. In the A-bomb study the RR per Sv for all non-cancers is about one-third of the number for all solid tumors. This means that “much” larger case-control studies would be necessary to confirm that low protracted doses also raise risks of all non-cancer mortality. As noted elsewhere in the report, and by the committee’s own simplified calculations, as many as 5,000 cases and more controls would likely be required in order to demonstrate an increased risk of overall cancer mortality in relation to extended low-dose-rate worker exposures. Even larger studies will be required if non-cancer outcomes, such as cardiovascular disease, are to be considered. Numbers this large are available from the cohort studies, however important covariates (e.g., cigarette smoking) are missing for many or most cohort members, expanding the nested case-control approach for the non-cancer outcomes clearly is problematical.

Through the combination of extramural and intramural programs, the research that was performed by NIOSH and extramural scientists followed a logical sequence by

  1. Extending, updating, and pooling existing cohorts and collaborating in the international studies of mortality of nuclear workers;

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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  1. Undertaking nested case-control studies to better address confounders and to seek to improve information on internal exposures to radiation and other exposures; and

  2. Undertaking or supporting special emphasis studies such as that of childhood leukemia in relation to parental occupational exposures, numerous beryllium-related studies, and so forth.

In support of this work, NIOSH investigators and projects that were extramurally funded placed importance on conducting or supporting methodological studies that dealt with statistical issues such as the effects of systematic errors in the personal dosimeters, the truncation of dose from badge readings, and the effects of dosimetric uncertainties upon epidemiological studies.

Scientific Merit of NIOSH Research

As described in other places in this review, the occupational epidemiology conducted or supported by NIOSH faced major obstacles in attempting to ascertain whether working for DOE placed workers at risk to their health, especially for those workers exposed to low dose rates of radiation for extended periods of time. Here the committee examines the question of the overall scientific merit of the studies in terms of (1) whether the overall direction of research by NIOSH and the purpose of the individual studies was meritorious; (2) whether obstacles to particular studies were so intractable that it should have been obvious at the outset that the goals would not be achievable; and (3) for feasible studies, whether NIOSH or its subcontractors conducted the research and analyzed the data appropriately. The committee notes that individual studies need to be viewed within the broader context of the overall goals of the whole program of research.

The committee finds that the scientific problems that the majority of the DOE/NIOSH studies address (e.g., the health consequences of low-dose-rate exposures over extended periods) are meritorious. Specifically, there were important and outstanding scientific issues addressed by the research under the MOU concerning the effect of chronic low dose exposures, especially in comparison to the extrapolations made from high-dose studies that have been used previously to develop radiation protection standards.

It appears to the committee that a major NIOSH effort for improving the epidemiology at DOE sites was to move from cohort mortality studies, relying on the limited amount of data14 available for all workers in a given cohort, to nested

14

Generally age, sex, race, and in most cases summaries of employment and external radiation dose history, as well as life status at end of follow-up and cause of death for the deceased.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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case-control studies, in which information on other workplace and lifestyle exposures could be collected for the subjects in the study to evaluate possible confounding. Overall, the committee views this transition as meritorious.

Viewed in isolation and in hindsight, some of the NIOSH case-control studies might not be viewed as meritorious or feasible. For example, the multisite multiple myeloma case-control study began with the identification of 98 cases of multiple myeloma from various cohorts, all of which had summaries of external dose available (Wing et al. 1997). That number of cases matched to 4 controls per case would only have the power to detect the influence of a potential confounder that is present in 25 percent of controls and which doubles the risk of multiple myeloma. Based on this limited number of cases and also the fact that no other exposure to this cohort is thought to produce risks this large (leaving aside race, which is already considered in the cohort study), it might be reasonably argued that in isolation this case-control study should not have been initiated, e.g., that everything about multiple myeloma that could be learned in a case-control study had already been learned from the initial examination of the cohort studies. However, in the context of the transition to using a case-control study design, the multiple myeloma study is informative as a pilot study, and shows the degree to which other occupational and smoking exposure histories can or cannot be quantified. Since these same exposures will be of interest for other disease outcomes, for which many more cases are available, the multiple myeloma study has more value when viewed as a part of the whole NIOSH endeavor than in isolation.

In the committee’s own simplified calculations, as many as 5,000 cases and more controls would likely be required in order to demonstrate an increased risk of overall cancer mortality in relation to extended low-dose-rate exposures. Even larger studies would be required if non-cancer outcomes, such as cardiovascular disease, were to be considered. The case-control studies that have been done to date can and should be used to evaluate the feasibility of performing case-control studies of this magnitude in the future. The finding, for example, that in the multiple myeloma study, smoking exposure could only be categorized as ever/ never, even after viewing occupational medical records and after contact with survivors of the cases, should significantly affect NIOSH decisions about the feasibility of addressing smoking-related cancers or other smoking-related diseases using the case-control design.

The same general issue arises in evaluating other studies; for example, the subjects in the female nuclear workers study had a dose distribution that is lower than the cohorts overall, and therefore, studies of female workers have less power to define radiation effects than would studies of cohorts of male and female workers or a cohort of only male workers. Moreover, on an absolute risk scale, females do not appear to be more sensitive than men to radiation in the high dose studies. However, past and future DOE occupational research includes women and improving the compilation of radiation dose records and the linkage to mortality records for all DOE workers, as done for female workers in that study, is considered to be

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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important by the committee. Therefore, this study is also more significant in the context of the overall NIOSH research program than when viewed alone.

Regarding whether these studies were conducted properly, the committee finds that the case-control studies that NIOSH undertook appeared to have been well executed given the constraints that they operated under, some of which may have been unique to the DOE setting. There is evidence provided, for example, in the final report from the multisite multiple myeloma investigators, that the history and culture of secrecy that was associated with the weapons plants had an adverse impact upon the ability of NIOSH investigators and grantees to perform their work in a timely and complete fashion. Given the decentralized nature of management at the DOE facilities, it seems likely that any group of investigators, whether from DOE or from NIOSH, would have faced similar problems.

Overall then, while in some cases there have been serious and not fully explained delays in execution of studies (as in the K-25 multiple myeloma study), and while certain confounding exposures (e.g., smoking) appear to have been especially problematic to address in the studies that have been completed, the committee finds that the work performed by NIOSH under the MOU has been sound, especially if each project is viewed as contributing to the whole program.

It is, however, notable and disappointing to the committee that the NIOSH cohort studies have not made their fullest possible contribution to the pooled international (15 countries) studies (Cardis et al. 2005). In particular, data should have been provided to IARC to extend follow-up of the Hanford and ORNL cohorts through 1994 and 1990, respectively, in time to be included in the most recent publications available to the committee. The committee notes the importance of further pooling with international data in the committee’s recommendations.

Scientific Research Dissemination

The NIOSH extramural and intramural programs have not been highly productive in terms of contributions to the peer-reviewed literature. Two of the studies reviewed above, the Female Nuclear Workers Study and the Childhood Leukemia Case Control Study, did not result in any peer-reviewed publications. Gaps in the research record include reports from long-delayed studies such the K-25 multiple myeloma case-control study. While the exposure reconstruction for the myeloma study is especially complex (e.g., internal and external radiation exposures, chemical exposures) and appears to have been subject to many administrative and security roadblocks, it is unclear to the committee why such a relatively small study of 63 cases and their age-matched controls should be delayed to such an extent.

In total, NIOSH and colleagues have published more than 88 scientific papers (16 from the intramural program) to date. Many of the NIOSH-funded “completed projects” listed in the NIOSH evidence package or on the OERP web site produced

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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only a final report and in some cases no report (NIOSH 2005). While the committee recognizes that not every worthwhile project will either need or merit peer-reviewed publication, and many of the unpublished reports are useful and accessible through the OERP web site, the committee expected that an overall program of this size would be more productive, especially the intramural program.

Benefits of Research to DOE

The committee concludes that positive benefits have accrued to DOE as a result of having the occupational epidemiological studies performed by agencies and investigators outside its direct control. While recognizing that a sizable body of good work had been started before the MOUs, and without implying that DOE was incapable of developing appropriate follow-up programs to the studies that were in existence, it is clear to the committee that the acceptance by the scientific community of the DOE-based work performed by NIOSH is high. In addition, the research performed under the MOU has directly benefited DOE in several ways. First, the data that have been generated by NIOSH and its extramural researchers have provided important information to DOE’s Comprehensive Epidemiologic Data Resource (CEDR) that can be used in future worker health studies.

Second, and perhaps the most important contribution, is that the worker health studies have made a significant contribution to our understanding of the risks of protracted low-dose radiation exposure for human health, especially in combination with the international workers studies. The results of the 15-country IARC study (Cardis et al. 2005) show significant dose-response relationships for solid tumors and nearly significant dose response for leukemia. In combination with the very recent results from the multisite leukemia case-control study, which has relatively little overlap with the IARC study, the leukemia dose-response to this low-dose-rate, protracted exposure should also be better defined. In all likelihood, these findings will impact DOE policy directly by buttressing the current administrative limits of 2 rem per year for occupational exposure with additional empirical evidence for the effects of protracted low-dose-rate radiation exposures on cancer risk. In addition, these data may be viewed as strengthening the scientific foundations for defining acceptable levels of passive, non-occupational exposures of the larger populations living near current, future, or past (decommissioned) DOE sites. Given that Richardson and Wing (1999) reported more than 460 deaths from all cancers in a follow-up of the ORNL cohort through 1990, it is not clear why these were not utilized in the IARC 15-country study. Similarly, Wing and Richardson (2005) report follow-up of the Hanford cohort through 1994, compared to 1986 for Cardis et al. (2005). The Frome et al. (1997) study, which had 4,673 white male cancer deaths using all of the Oak Ridge workers was also not included but that study included the K-25 and Y-12 Oak Ridge sites where the workers had substantial uranium exposures.

Third, NIOSH acts in an advisory role for several of the worker surveillance

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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activities, including the beryllium-sensitization screening program, thereby contributing important scientific support for DOE’s FWMSP.

Finally, the committee concludes that the occupational beryllium studies completed by NIOSH have made a significant contribution to the scientific community in general, as well as to DOE’s understanding of the potential for beryllium exposure, sensitization, and progression of disease. The beryllium-related studies followed earlier NRC recommendations (NRC 1994) of quantifying exposures to and effects from agents in addition to ionizing radiation. The research appropriately explored several important areas of research related to beryllium and followed a logical progression of research. However, the continued poor interlaboratory and intralaboratory agreement for the BeLPT, necessitating costly split samples and compromising the validity of worker screenings, remains a concern (Stange et al. 2004; Borak et al. 2006).

Summary of Benefits to DOE

Continued research into the health of past and current DOE workers benefits DOE in the following ways:

  1. It assists DOE in fulfilling obligations to its employees to provide the best possible information about health effects resulting from their employment.

  2. It contributes directly to scientific knowledge regarding protracted low-dose-rate exposures to radiation that are relevant to radiation protection of nuclear workforces both in the United States and generally.

  3. It enhances methods for reconstructing past exposures. The committee concludes that the continued development of such methodology is important to the evaluation of worker and public health effects at the DOE sites.

  4. It adds indirectly to scientific information about the health effects of other low-dose-rate exposures of the American population as a whole to radiation. These other sources of exposure include diagnostic radiation exposures, environmental or residential exposures, or potential radiological exposures resulting from industrial accidents or an act of terrorism.

By having this work continue under the auspices of NIOSH, DOE benefits by enhancing the openness and independence with which the studies are conducted, thereby reducing public perceptions of, or actual potential for, conflicts of interest between DOE’s responsibilities to the health of its workers and citizens and its other responsibilities and mandates.

FINDINGS AND RECOMMENDATIONS

1. Completion of Ongoing Projects

The committee noted in its review of the NIOSH program that a number of studies remain unfinished. The committee therefore recommends that:

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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The multisite leukemia case-control study be completed as soon as possible and the results published. In addition, the scientific value of completing the long-delayed K-25 multiple myeloma study as well as the Chemical Workers study15 in their entirety or limited to selected specific aims should be critically evaluated prior to any additional funding. The remaining unfinished studies (see Research Priorities section above) should be evaluated and prioritized by NIOSH and DOE for future funding decisions.

2. Development and Integration of a Repository for Exposure Records

As will be discussed in more detail in chapter 6, “one of the biggest problems affecting the program has been the difficulty researchers have had in obtaining exposure and other relevant data to use in their epidemiological studies. Common data collection protocols and standardized data are needed for epidemiology and public health studies. The fundamental problem was that the worker exposure data had never been collected, processed, or stored with any regard to the possibility that they might be needed in the future for such studies. This situation leads to difficulty in comparing health outcomes with exposure characteristics and in the investigators’ ability to combine information from more than one source in order to increase the power of the studies. The committee recommends that:

All contractor-assembled data be submitted to DOE’s Office of Environmental Safety and Health for compilation, management, and storage in centralized databases, using standardized formats. DOE should explore the development of a process that captures current exposure data as well as health outcome data for placement in a secure centralized repository: this process should include external radiation exposure, internal radiation exposure, chemical exposure, medical surveillance (e.g., spirometry, liver function tests, smoker versus never smoker), and biological monitoring, as well as social security number and demographic information (e.g., gender, birth date) on a continual basis for all DOE employees, DOE contractors, and DOE subcontractors who may have occupational exposures to radiation or toxic chemicals. The database would have to be integrated with existing data repositories, (e.g., Radiation Exposure Monitoring System, CEDR). However, unlike CEDR, which facilitates public access to data collected for studies regarding the health impacts associated with working at or living near DOE operations, information compiled in the recommended repository

15

“The chemical workers study addresses hazards outside the DOE complex, including chemical and mixed exposures. The sites selected include Savannah River and three facilities at Oak Ridge (X-10, Y-12, and K-25). To address sample size needs, a fifth site (Hanford) is under evaluation for inclusion.” Abstracted from http://www.cdc.gov/niosh/oerp/ongoing.html. Last accessed September 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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would be available to NIOSH’s scientific investigators or to researchers funded extramurally through NIOSH to perform DOE-related health studies. Such a database would be of paramount importance for expanding existing cohort studies or performing nested case-control studies.

3. Improved Techniques to Reconstruct Past Exposure

The committee finds that continued research into the health of the past and current DOE workforce benefits DOE by enhancing methods of reconstructing past exposures and that the continued development of such methodology is important to the evaluation of worker and public health effects at the DOE sites. The committee therefore recommends:

Further investigation into the utility of novel methods to reconstruct dose, such as fluorescence in situ hybridization, the glycophorin A somatic mutation assay (GPA), in vivo electron paramagnetic resonance of teeth, and other promising biologic markers, should be given a high priority.16 In addition, NIOSH should continue to support methodological studies that address statistical issues such as the effects of systematic errors in the personal dosimeters, the truncation of dose from badge readings, and the effects of dosimetric uncertainties upon epidemiological studies.

As noted repeatedly in the committee’s assessment of the quality of the studies performed by NIOSH, the objective of adequately reconstructing retrospective radiation and chemical exposures is paramount. Although biologic materials may not be available for a significant portion of each cohort, these novel methods may be helpful as validation methods for existing dose reconstructions.

In addition, because of the lack of a reliable screening test to detect workers who have been sensitized to beryllium, the committee recommends that any future beryllium-related research focus first on developing a substantially improved screening tool to identify beryllium-sensitized workers.

4. Continued Mortality Follow-up of Existing Cohorts

The latest published follow-up for any of the DOE cohorts ended in the mid-1990s when considerably more than half of the participants in these studies were still alive. The numbers of cause-specific deaths for any particular facility are still relatively small and further follow-up of the study cohorts will provide a larger number of deaths for analyses. Therefore, the committee recommends that:

Follow-up of the existing cohorts be continued for all causes of mortality and possibly for cancer incidence (see recommendation 7) and that analyses of these data be updated on a regular basis. Cardiovascular

16

The committee recognizes that the uncertainty at low doses is very large for these techniques and that this fact may limit the usefulness of such techniques for the mostly low doses received by the DOE workers.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

disease mortality as well as cancer mortality (both known to be related to high-dose radiation) should be specifically addressed in these updated analyses. As much attention should be paid as possible to the influence of other exposures that may confound the radiation relationship while recognizing the limitations of these studies in this regard.

5. Development of an Overall Strategy for Selecting Sites for Pooled Analyses of Cancer Mortality

The committee recommends a phased approach toward further pooling of DOE and international nuclear workers studies. The initial phase would be for NIOSH to provide a justification for pooling particular DOE sites and cohorts based on the completeness and accuracy of radiation exposure data and on the site-specific potential for confounding between measured external radiation exposures and unmeasured (e.g., internal radiation, chemical, asbestos) exposures.

Deficiencies in data quality or the percent completeness of radiation dose should be resolved before undertaking further pooled analyses. For some tumor types (e.g., lung) it is questionable whether further analyses are warranted if potential confounders, particularly tobacco use, cannot be addressed. In addition, consideration should be given to sensitivity analyses that address uncertainty in risk estimates due to incomplete and biased data. These analyses should incorporate reasonable assumptions about correlations between observed radiation dose and the other exposures or confounders that are relevant for major cancer sites.

If further pooling appears justified, then updated data from ORNL and Hanford as well as data from other DOE sites that pass the initial screen should be made available to IARC in the event that updated analyses of the 15-country study are conducted. Until that occurs, statistical methods for combining the updated DOE cohort datasets with the published data from IARC for the non-DOE sites should be considered as an approximation to an updated full pooled analysis.

6. Additional Nested Case-Control Studies

NIOSH provided two short concept plans (identified as FY06 High-LET.pdf and FY06 Low-LET.pdf) that propose to extend the use of the multisite case-control studies for DOE sites (and including Navy sites such as PNS) to the study of solid tumor mortality. Such studies should be carefully justified. NIOSH also conducted nested case-control studies to better address confounders and to seek to improve information on internal exposures to radiation and other exposures. The committee finds that planning of additional nested case-control studies of solid tumors should include the following:

  • The scientific advantages and disadvantages of developing combined analyses of risk for all solid tumor sites and the scientific advantages and disad-

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

vantages of separate analyses of specific tumor types should be carefully assessed.

  • The quality of the data on smoking that will be available in the case-control studies on a site-by-site basis should be assessed carefully. Careful assessment of the correlation of unmeasured smoking with radiation dose, and the likely effects of such correlation in biasing risk estimates, will have to be addressed. If the quality of the smoking data is deficient, NIOSH may wish to consider restricting case-control studies to cancers not strongly associated with smoking.

  • Realistic power calculations should be obtained.

  • The likely value of job exposure matrix-based methods for retrospectively assigning exposures to chemicals, asbestos, and other workplace toxicants should realistically be assessed.

This preliminary phase of the study will be an essential part of an informed decision about whether to proceed with full-scale studies. Such preliminary studies will also have considerable impact on the conduct of pooled analyses of mortality data described above. Sites that do not meet criteria for inclusion in the case-control studies should not be included in the pooled analyses of existing data. Therefore, the committee recommends:

That NIOSH proceed with the careful planning of additional nested case-control studies of solid tumors. Without implication for past study designs, the planning phase for future studies should include the considerations described in the findings above.

7. Use of the State Cancer Registries to Assess Cancer Incidence

There are some important advantages to studying cancer incidence in addition to cancer mortality in cohort studies. First, the power to detect effects of exposure for non-uniformly fatal cancers is increased. Second, coding of specific sites of cancer, or even documenting cancer as a contributing factor to death, is more precise. For example, death records may not be clear about the origin of metastases and the role of primary versus secondary cancers as a cause of death. Starting in 1994, the Centers for Disease Control and Prevention-supported National Program of Cancer Registries has provided funds and oversight for the development of cancer registries in all 50 states. These registries provide the opportunity to link future follow-up of the DOE cohorts to state cancer registries to identify incident cancers in this population for a follow-up period beginning in the mid- to late 1990s. An intramural NIOSH project (Foster and Espinoza 2000) examined population-based state cancer registries to determine their feasibility and suitability for occupational studies. Information was collected from statewide cancer registries in 16 states, including those that contained DOE sites and adjacent states. Despite limitations in statewide cancer registry systems, the study concluded that it is feasible to use many statewide registries for occupational health studies. By the mid-1990s, more than half of the workers involved in the major DOE occupational

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

cohorts were still alive, although, because radiation exposures to workers have greatly decreased over time, some of the higher-exposed workers may have died prior to the establishment of the registries. Nonetheless, in many cases the majority of information from these cohorts regarding the risk of both generally fatal cancers with a long latency period and cancers with better survival (e.g., thyroid cancer, chronic lymphocytic leukemia, prostate cancer) may be yet to come. Therefore, the committee recommends:


Establishing linkages between existing cohorts and the 50 state cancer registries.


8. Increase the number of peer-reviewed publications.

The committee finds that the NIOSH extramural and intramural programs have not been highly productive in terms of contributions to the peer-reviewed literature. Two of the studies reviewed, the Female Nuclear Workers Study and the Childhood Leukemia Case Control Study, did not result in any peer-reviewed publications. Gaps in the research record include reports from long-delayed studies such the K-25 multiple myeloma case-control study. While the exposure reconstruction for the myeloma study is especially complex (e.g., internal and external radiation exposures, chemical exposures) and appears to have been subject to many administrative and security roadblocks, it is unclear to the committee why such a relatively small study of 63 cases and their age-matched controls should be delayed to such an extent. In total, NIOSH and colleagues have published more than 88 scientific papers (16 from the intramural program) to date. Many of the NIOSH-funded “completed projects” listed in the NIOSH evidence package or on the OERP web site produced only a final report and in some cases no report (NIOSH 2005). While the committee recognizes that not every worthwhile project will either need or merit peer-reviewed publication, and many of the unpublished reports are useful and accessible through the OERP web site, the committee expected that an overall program of this size would be more productive, especially the intramural program. The committee finds that the NIOSH extramural and intramural programs have not been highly productive in terms of contributions to the peer-reviewed literature. Therefore, the committee recommends:

NIOSH should increase substantially the number of intramural scientific research findings that are submitted to high-quality scientific journals.

9. Future Studies

The committee concludes that future studies should represent all categories of workers (e.g., contract cleanup workers and others) on DOE sites with potential exposures. These future studies should also include diseases in addition to cancer. Since non-cancer outcomes may not be accurately ascertained through death certificates, other methods of data collection including questionnaires, physical examinations, and diagnostic tests should be considered. Much is likely to be learned in the future about baseline genetic susceptibility to cancer and other diseases, and it will be of increasing importance to determine whether

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

individuals with a higher baseline risk of disease, because of inherited variation, also have higher excess risks from exposure. Similarly, genes found to confer sensitivity to high-dose radiation exposures, such as those now being evaluated in studies of second cancers following radiation therapy, should also be studied in people with protracted exposure to radiation at low-dose rates. The committee recommends that:

As these questions surface in the future, NIOSH and DOE explore the possibility of addressing them through studies that utilize DNA from DOE workers diagnosed with cancer and from controls. To facilitate these future studies DOE and NIOSH should consider the following:

  • Establishment of a database of workers with appropriate data to facilitate follow-up and to evaluate potential confounders (e.g., see recommendation 2);

  • Development of valid methods to identify non-cancer health outcomes including the use of periodic questionnaires, and specific diagnostic tests (e.g., pulmonary function); and

  • Support for the continuance of biorepositories such as that funded by ATSDR (Gunter 1997; NRC 2006b) that archive specimens such as blood and DNA to support future studies.

ANNEX 2A
NIOSH RESEARCH PUBLICATIONS

NIOSH provided independently (NIOSH 2005), and also in response to committee requests, information detailing the DOE-funded output of the NIOSH OERP program. In addition, the committee accessed the NIOSH OERP website,17 which is periodically updated with new publications that cite OERP funding. These sources also identified the material as intramural and extramural. That information was updated during the committee’s 10-month study period and is included in Table 2A-1 that follows. The table is based on information received from NIOSH May 9, 2006. NIOSH noted in responding to a committee information request that: “… the bibliography has been revised and updated to include all known publications that acknowledge whole or partial funding by DOE through the NIOSH Occupational Energy Research Program. This includes those studies funded directly by DOE between 1991 and 1993 but overseen by NIOSH under the OERP. Studies and literature that may relate to the OERP but did not acknowledge either DOE or NIOSH funding were not included. The committee should be aware that, for grants, there is no requirement that grantees report publications to NIOSH; therefore, we have identified many of these publications

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

through literature searches and inspection of the acknowledgments for mention of NIOSH grant numbers.” This committee has not included certain categories from the provided list, such as extended abstracts. The committee also notes that the NIOSH Intramural and Extramural catagories are apparently classified as such for NIOSH record-keeping purposes. For example, NIOSH lists the Cardis 15-country publication as “intramural” while the funding for the study came from multiple sources. The complete and current OERP program output can be accessed at http://www.cdc.gov/niosh/oerp/ (last accessed October 2006).

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

TABLE 2A-1 NIOSH Research Supported by DOE Including Papers Published in Refereed Journals by Intramural and Extramural Investigators

Subject

Site if Applicable

Reference

 

Intramural Peer-Reviewed Journal Articles

Evaluation of an unanticipated contaminant

 

Ahrenholz SH [1996]. Case studies: A mysterious yellow-white paste: evaluation of an unanticipated contaminant. Appll Occup Environ Hyg 11(12)1371-1375.

Radiation exposure from work-related chest X-rays

 

Cardarelli J, Spitz H, Rice C, Buncher R, Elson H, Succop P [2002]. Significance of radiation exposure from work-related chest X-rays for epidemiological studies of radiation workers. Am J Ind Med 42(6):490-501.

Proposed model for estimating dose to inhabitants of 60Co contaminated buildings.

Taiwan

Cardarelli EL, Hornung R, Chang WP [1997]. Proposed model for estimating dose to inhabitants of 60Co-contaminated buildings. Health Phys 72(3):351-360.

Risk of cancer after low doses of ionizing radiation

15 countries

Cardis E, Vrijheid M, Blettner M, Gilbert E, Hakama M, Hill C, Howe G, Kaldor J, Muirhead CR, Schubauer-Berigan MK, Yoshimura T, and the international study group [2005]. Risk of cancer after low doses of ionising radiation—retrospective cohort study in 15 countries. Brit Med J 327:765-768.a

Plutonium exposures for an epidemiological study of U.S. nuclear workers.

Multisite

Daniels RD, Lodwick CJ, Schubauer-Berigan MK, Spitz HB [2006]. Assessment of plutonium exposures for an epidemiological study of US nuclear workers. Radiat Prot Dosimetry 118(1):43-55.

Bias and uncertainty of penetrating photon dose measured by film dosimeters

 

Daniels RD, Schubauer-Berigan MK [2005]. Bias and uncertainty of penetrating photon dose measured by film dosemeters in an epidemiological study of US nuclear workers. Radiat Prot Dosimetry 113(3):275-289.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Radiation exposure assessment

Portsmouth Naval Shipyard

Daniels RD, Taulbee TD, Chen P [2004]. Radiation exposure assessment for Portsmouth Naval Shipyard health studies. Radiat Prot Dosimetry 111(2):139-150.

Estimation of less than detectable ionizing radiation exposures

 

Daniels RD, Yiin J [2006]. Estimation of less than detectable ionizing radiation exposures. Radiat Prot Dosimetry Mar 3; [Epub ahead of print].

Leukemia mortality and ionizing radiation

Portsmouth Naval Shipyard

Kubale TL, Daniels RD, Yiin JH, Couch J, Schubauer-Berigan MK, Kinnes GH, Silver SR, Nowlin SJ, Chen P [2005]. A nested case-control study of leukemia mortality and ionizing radiation at the Portsmouth Naval Shipyard. Radiat Res 164(6):810-819.

Use of historical uranium air sampling data to estimate worker exposure

 

Methner MM, Feng HA, Utterback DF [2001]. Use of historical uranium air sampling data to estimate worker exposure potential to airborne radioactive particulate in a uranium processing facility. Appl Occup Environ Hyg 16(12):1150-1157.

Identification of potential sources of arsenic exposure

 

Methner MM [2004]. Identification of potential sources of arsenic exposure during scrapyard work at a former uranium enrichment facility. J Occup Environ Hyg 1(9):D96-D100.

Diagnostic radiation and risk of multiple myeloma

 

Robinson C, Cardarelli J, Spitz HB, Utterback DF [2002]. Re: Diagnostic radiation and the risk of multiple myeloma (United States). Cancer Causes Control 13(10):975; author reply 977.

Leukemia mortality among radiation-exposed workers

 

Schubauer-Berigan MK, Wenzl TB [2001]. Leukemia mortality among radiation-exposed workers. Occup Med 16(2):271-287.

Differences in mortality by radiation monitoring status

Portsmouth Naval Shipyard

Silver SR, Daniels RD, Taulbee TD, Zaebst DD, Kinnes GM, Couch JR, Kubale TL, Yiin JH, Schubauer-Berigan MK, Chen PH [2004]. Differences in mortality by radiation monitoring status in an expanded cohort of Portsmouth Naval Shipyard workers. J Occup Environ Med 46(7):677-690.

Magnetic field exposures of rail maintenance workers

 

Wenzl TB [1997]. Estimating magnetic field exposures of rail maintenance workers. Am Ind Hyg Assoc J 58(9):667-671.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Assessment of magnetic field exposures for a mortality study at a uranium enrichment plant

 

Wenzl TB [1999]. Assessment of magnetic field exposures for a mortality study at a uranium enrichment plant. Am Ind Hyg Assoc J 60(6):818-824.

Risk of lung cancer and leukemia from exposure to ionizing radiation

Portsmouth Naval Shipyard

Yiin JH, Schubauer-Berigan MK, Silver SR, Daniels RD, Kinnes GM, Zaebst DD, Couch JR, Kubale TL, Chen PH [2005]. Risk of lung cancer and leukemia from exposure to ionizing radiation and potential confounders among workers at the Portsmouth Naval Shipyard. Radiat Res 163(6):603-613.

In Press

Bone marrow dose estimates

 

Anderson JL, Daniels RD [inpress]. Bone marrow dose estimates from work-related medical X-ray examinations given between 1943 and 1966 for personnel from five U.S. nuclear facilities. Health Phys.

The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: study of errors in dosimetry

15 countries

Thierry-Chef I, Marshall M, Fix JJ, Bermann F, Gilbert ES, Hacker C, Heinmiller B, Murray W, Pearce MS, Utterback D, Bernar J, Deboodt P, Eklof M, Griciene B, Holan K, Hyvonen H, Kerekes A, Lee M-C, Moser M, Pernicka F, Cardis E [inpress]. The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: study of errors in dosimetry. Radiat Res.

Extramural Peer-Reviewed Journal Articles

Characteristics of the healthy survivor effect

Hanford

Baillargeon J, Wilkinson GS [1999]. Characteristics of the healthy survivor effect among male and female Hanford workers. Am J Ind Med 35(4):343-347.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Characteristics of the healthy worker effect

Hanford

Baillargeon J, Wilkinson G, Rudkin L, Baillargeon G, Ray L [1998]. Characteristics of the healthy worker effect: a comparison of male and female occupational cohorts. J Occup Environ Med 40(4):368-373.

Biodosimetry of Chernobyl cleanup workers

Chernobyl

Bigbee WL, Jensen RH, Veidebaum T, Tekkel M, Rahu M, Stengrevics A, Auvinen A, Hakulinen T, Servomaa K, Rytomaa T, et al. [1997] Biodosimetry of Chernobyl cleanup workers from Estonia and Latvia using the glycophorin A in vivo somatic cell mutation assay. Radiat Res, 147(2):215-24.

Lung cancer and internal lung doses among plutonium workers

Rocky Flats site

Brown SC, Schonbeck MF, McClure D, Baron AE, Navidi WC, Byers T, Ruttenber AJ [2004]. Lung cancer and internal lung doses among plutonium workers at the Rocky Flats Plant: a case-control study. Am J Epidemiol 15;160(2):163-172.

Lung cancer and plutonium exposure

Rocky Flats site

Brown SC, Ruttenber AJ [2005]. Lung cancer and plutonium exposure in Rocky Flats workers. Radiat Res 163(6):696-697.

Direct estimates of cancer mortality due to low doses of ionizing radiation

3 countries

Cardis E, Gilbert ES, Carpenter L, Howe G, Kato I, Levé EC, Armstrong BK [1994]. Direct estimates of cancer mortality due to low doses of ionising radiation: an international study. IARC Study Group on Cancer Risk Among Nuclear Industry Workers. Lancet 344(8929):1039-1043.

Cancer mortality among nuclear industry workers in three countries

3 countries

Cardis E, Gilbert ES, Carpenter L, Howe G, Kato I, Armstrong BK, Beral V, Cowper G, Douglas A, Fix J, et al. [1995]. Effects of low doses and low dose rates of external ionizing radiation: cancer mortality among nuclear industry workers in three countries. Radiat Res 142(2):117-132.

Chronic health risks from aggregate exposures to ionizing radiation and chemicals

 

Chen WC, McKone TE [2001]. Chronic health risks from aggregate exposures to ionizing radiation and chemicals: scientific basis for an assessment framework. Risk Anal 21(1):25-42.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Risk factors associated with the classification of unspecified and/or unexplained causes of death

Oak Ridge

Cragle DL, Fetcher A [1992]. Risk factors associated with the classification of unspecified and/or unexplained causes of death in an occupational cohort. Am J Public Health 82(3):455-457. Comment: Am J Public Health 83(10):1492-1493.

Case-control study of brain tumors and ionizing radiation

 

Dimarco JH, Wilkinson GS [1995]. Case-control study of brain-tumors and ionizing-radiation nested within a cohort of nuclear workers. Am J Epidemiol 14(11):S30-S30.

Falls in workers during pregnancy

 

Dunning K, LeMasters G, Levin L, Bhattacharya A, Alterman T, Lordo K [2003]. Falls in workers during pregnancy: risk factors, job hazards, and high risk occupations. Am J Ind Med 44(6):664-672.

Uranium dust exposure and lung cancer risk in four uranium processing operations

Oak Ridge National Laboratory

Dupree EA, Watkins JP, Ingle JN, Wallace PW, West CM, Tankersley WG [1995]. Uranium dust exposure and lung cancer risk in four uranium processing operations. Epidemiology 6(4):370-375.

External radiation exposure and mortality

 

Dupree-Ellis E, Watkins J, Ingle JN, Phillips J [2000]. External radiation exposure and mortality in a cohort of uranium processing workers. Am J Epidemiol 152(1):91-95.

Mortality study of employees of the nuclear industry

Oak Ridge National Laboratory

Frome EL, Cragle DL, Watkins JP, Wing S, Shy CM, Tankersley WG, West CM [1997]. A mortality study of employees of the nuclear industry in Oak Ridge, Tennessee. Radiat Res 148(1):64-80.

Health and mortality among contractor employees

Multisite

Fry SA, Cragle DL, Crawford-Brown DJ, Dupree EA, Frome EL, Gilbert ES, Petersen GR, Shy CH, Tankersley WG, Voelz GL, Wallace PW, Watkins JP, Watson JE, Wiggs LD [1995]. Health and mortality among contractor employees at US Department of Energy facilities. Radiation and Public Perception; Adv Chem 243:239-258.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Mortality and morbidity among persons occupationally exposed to >50 mSv in a year

Multisite

Fry SA, Dupree EA, Sipe AH, Seiler DL, Wallace PW [1996]. A study of mortality and morbidity among persons occupationally exposed to >50 mSv in a year: phase I, mortality through 1984. Appl Occup Environ Hyg 11(4):3343-3343.

Updated analyses of combined mortality data

Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Plant

Gilbert ES, Cragle DL, Wiggs LD [1993]. Updated analyses of combined mortality data for workers at the Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Weapons Plant. Radiat Res 136(3):408-421.

Accounting for bias in dose estimates

 

Gilbert ES, Fix JJ [1995]. Accounting for bias in dose estimates in analyses of data from nuclear worker mortality studies. Health Phys 68(5):650-660.

Mortality of workers

Hanford Site

Gilbert ES, Omohundro E, Buchanan JA, Holter NA [1993]. Mortality of workers at the Hanford Site: 1945-1986. Health Phys 64(6):577-590.

Evaluating bias and uncertainty in estimates of external dose

Hanford Site

Gilbert ES, Fix JJ, and Baumgartner WV. 1996. An approach to evaluating bias and uncertainty in estimates of external dose obtained from personal dosimeters. Health Phys 70:336-345.

Accounting for errors in dose estimates

Hanford Site

Gilbert ES. 1998. Accounting for errors in dose estimates used in studies of workers exposed to external radiation. Health Phys 74:22-29.

Glycophorin A as a biological dosimeter (biomarker study)

 

Jensen RH, Reynolds JC, Robbins J, Bigbee WL, Grant SG, Langlois RG, Pineda JD, Lee T, Barker WC [1997]. Glycophorin A as a biological dosimeter for radiation dose to the bone marrow from iodine-131. Radiat Res 147(6):747-752.

Beryllium particulate exposure and disease relations

 

Kelleher PC, Martyny JW, Mroz MM, Maier LA, Ruttenber AJ, Young DA, Newman LS [2001]. Beryllium particulate exposure and disease relations in a beryllium machining plant. J Occup Environ Med 43(3):238-249.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Studies of cancer risk among Chernobyl liquidators

Chernobyl

Kesniiniene A, Cardis E, Tenet V, Ivanov VK, Kurtinaitis J, Malakhova I, Stengrevics A, Tekkel M [2002]. Studies of cancer risk among Chernobyl liquidators: materials and methods. J Radiol Prot 22(3A):A137-A141.

Exposure surveillance for chemical and physical hazards

 

LaMontagne AD, Ruttenber AJ, Wegman DH [2000]. Exposure surveillance for chemical and physical hazards. In Maizlish N, ed. Workplace Health Surveillance: Principles and Practice. New York: Oxford University Press, 219-234.

Exposure surveillance

 

LaMontagne AD, Herrick RF, Van Dyke MV, Martyny JW, Ruttenber AJ [2002]. Exposure databases and exposure surveillance: promise and practice. AIHA J 63(2):205-212.

Cleanup worker exposures

 

LaMontagne AD, Van Dyke MV, Martyny JW, Ruttenber AJ [2001]. Cleanup worker exposures to hazardous chemicals at a former nuclear weapons plant: piloting of an exposure surveillance system. Appl Occup Environ Hyg 16(2):284-290.

Development of an exposure database

 

LaMontagne AD, Van Dyke MV, Martyny JW, Simpson MW, Holwager LA, Clausen BM, Ruttenber AJ [2002]. Development and piloting of an exposure database and surveillance system for DOE cleanup operations. Department of Energy. AIHA J 63(2):213-224.

Latency analysis in epidemiological studies

Colorado Plateau uranium miners

Langholz B, Thomas D, Xiang A, Stram D [1999]. Latency analysis in epidemiological studies of occupational exposures: application to the Colorado Plateau uranium miners cohort. Am J Ind Med 35(3):246-256.a

Residual neurologic deficits after occupational exposure to elemental mercury

Oak Ridge Y-12

Letz R, Gerr F, Cragle D, Green RC, Watkins J, Fidler AT [2000]. Residual neurologic deficits 30 years after occupational exposure to elemental mercury. Neurotoxicology 21(4):459-474.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Mortality of workers at a nuclear materials production plant

Oak Ridge National Laboratory

Loomis DP, Wolf SH [1996]. Mortality of workers at a nuclear materials production plant at Oak Ridge, Tennessee, 1947-1990. Am J Ind Med 29(2):131-141. Comment: Am J Ind Med 199731(1):121.

Aerosols generated during beryllium machining

 

Martyny JW, Hoover MD, Mroz MM, Ellis K, Maier LA, Sheff KL, Newman LS [2000]. Aerosols generated during beryllium machining. J Occup Environ Med 42(1):8-18.

Dose estimation

Oak Ridge National Laboratory

Mitchell TJ, Ostrouchov G, Frome EL, Kerr GD [1997]. A method for estimating occupational radiation dose to individuals, using weekly dosimetry data. Radiat Res 147(2):195-207.

Beryllium

 

Newman LS, Mroz MM, Balkissoon R, Maier LA [2005]. Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care 171(1):54-60.

Beryllium

 

Newman LS, Mroz MM, Maier LA, Daniloff EM, Balkissoon R [2001]. Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant. J Occup Environ Med 43(3):231-237.

Lung fibrosis in plutonium workers

 

Newman LS, Mroz MM, Ruttenber AJ [2005]. Lung fibrosis in plutonium workers. Radiat Res 164(2):123-131.

Downsizing and health at the DOE

 

Pepper L, Messinger M, Weinberg J, Campbell R [2003]. Downsizing and health at the United States Department of Energy. Am J Ind Med 44(5):481-491.

Lung cancer mortality among workers

Oak Ridge National Laboratory

Richardson D, Wing S [2006]. Lung cancer mortality among workers at a nuclear materials fabrication plant. Am J Ind Med 49(2):102-111.

Healthy worker survivor effect

 

Richardson D, Wing S, Steenland K, McKelvey W [2004]. Time-related aspects of the healthy worker survivor effect. Ann Epidemiol 14(9):633-639.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Evaluation of annual external radiation doses

Hanford

Richardson D, Wing S, Watson J, Wolf S [2000]. Evaluation of annual external radiation doses at values near minimum detection levels of dosimeters at the Hanford nuclear facility. J Expo Anal Environ Epidemiol 10(1):27-35.

Missing radiation dosimetry data

Hanford

Richardson D, Wing S, Watson J, Wolf S [1999]. Missing annual external radiation dosimetry data among Hanford workers. J Expo Anal Environ Epidemiol 9(6):575-585.

Greater sensitivity to ionizing radiation at older age

Oak Ridge National Laboratory

Richardson DB, Wing S [1999]. Greater sensitivity to ionizing radiation at older age: follow-up of workers at Oak Ridge National Laboratory through 1990. Int J Epidemiol 28(3):428-436.

Age differences in the effects of prolonged exposures

Oak Ridge National Laboratory

Richardson DB, Wing S [1998]. Methods for investigating age differences in the effects of prolonged exposures. Am J Ind Med 33(2):123-130.

Radiation and mortality of workers

Oak Ridge National Laboratory

Richardson DB, Wing S [1999]. Radiation and mortality of workers at Oak Ridge National Laboratory: positive associations for doses received at older ages. Environ Health Perspect 107(8):649-656.

Radiation exposure and cancer mortality

 

Ritz B [1999]. Radiation exposure and cancer mortality in uranium processing workers. Epidemiology 10(5):531-538.

Chronic beryllium disease

 

Rosenman K, Hertzberg V, Rice C, Reilly MJ, Aronchick J, Parker JE, Regovich J, Rossman M [2005]. Chronic beryllium disease and sensitization at a beryllium processing facility. Environ Health Perspect 113(10):1366-1372.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Integrating workplace exposure databases

 

Ruttenber AJ, McCrea JS, Wade TD, Schonbeck MF, LaMontagne AD, Van Dyke MV, Martyny JW [2001]. Integrating workplace exposure databases for occupational medicine services and epidemiological studies at a former nuclear weapons facility. Appl Occup Environ Hyg 16(2):192-200.

Improving estimates of exposures for epidemiological studies of plutonium workers

 

Ruttenber AJ, Schonbeck M, McCrea J, McClure D, Martyny J [2001]. Improving estimates of exposures for epidemiological studies of plutonium workers. Occup Med 16(2):239-258.

Structure and function of occupational health services

Multisite

Salazar MK, Takaro TK, Ertell K, Gochfeld M, O’Neill S, Connon C, Barnhart S [1999]. Structure and function of occupational health services within selected Department of Energy sites. J Occup Environ Med 41(12):1072-1078.

Evaluation of factors affecting hazardous waste workers’ use of respiratory protective equipment

Hanford

Salazar MK, Connon C, Takaro TK, Beaudet N, Barnhart S [2001]. Anevaluation of factors affecting hazardous waste workers’ use of respiratory protective equipment. AIHA J 62(2):236-245.

Respiratory protective equipment use

Hanford

Salazar MK, Takaro TK, Connon C, Ertell K, Pappas G, Barnhart S [1999]. A description of factors affecting hazardous waste workers’ use of respiratory protective equipment. Appl Occup Environ Hyg 14(7):470-478.

Beryllium contamination

 

Sanderson WT, Henneberger PK, Martyny J, Ellis K, Mroz MM, Newman LS [1999]. Beryllium contamination inside vehicles of machine shop workers. Appl Occup Environ Hyg 14(4):223-230.

Beryllium contamination

 

Sanderson WT, Henneberger PK, Martyny J, Ellis K, Mroz MM, Newman LS [1999]. Beryllium contamination inside vehicles of machine shop workers. Am J Ind Med Suppl 1:72-74.

Chronic beryllium disease

 

Sawyer RT, Maier LA, Kittle LA, Newman LS [2002]. Chronic beryllium disease: a model interaction between innate and acquired immunity. Int Immunopharmacol 2(2-3):249-261.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Mortality from dementia within a pooled cohort of female nuclear weapons workers

Multisite

Sibley RF, Moscato BS, Wilkinson GS, Natarajan N [2003]. Nestedcase-control study of external ionizing radiation dose and mortality from dementia within a pooled cohort of female nuclear weapons workers. Am J Ind Med 44(4):351-358.

Correcting for exposure measurement error in uranium miner studies

 

Stram DO, Huberman M, Langholz B [2000]. Correcting for exposure measurement error in uranium miners studies: impact on inverse dose-rate effects. Radiat Res 154(6):738-739; Discussion 739-740.b

Power and uncertainty analysis of epidemiological studies of radiation-related disease risk

 

Stram DO, Kopecky KJ [2003]. Power and uncertainty analysis of epidemiological studies of radiation-related disease risk in which dose estimates are based on a complex dosimetry system: some observations. Radiat Res 160(4):408-417.b

Correcting for exposure measurement error

 

Stram DO, Langholz B, Huberman M, Thomas DC [1999]. Correcting for exposure measurement error in a reanalysis of lung cancer mortality for the Colorado Plateau uranium miners cohort. Health Phys 77(3):265-275.b

Barriers and solutions in implementing occupational health and safety services

Hanford

Takaro TK, Ertell K, Salazar MK, Beaudet N, Stover B, Hagopian A, Omenn G, Barnhart S [2000]. Barriers and solutions in implementing occupational health and safety services at a large nuclear weapons facility. J Healthc Qual 22(6):29-37.

Impact of a worker notification program

 

Tan-Wilhelm D, Witte K, Liu WY, Newman LS, Janssen A, Ellison C, Yancey A, Sanderson W, Henneberger PK [2000]. Impact of a worker notification program: assessment of attitudinal and behavioral outcomes. Am J Ind Med 37(2):205-213.

A method to assess predominant energies of exposure

Saclay (France)

Thierry-Chef I, Cardis E, Ciampi A, Delacroix D, Marshall M, Amoros E, Bermann F [2001]. A method to assess predominant energies of exposure in a nuclear research centre—Saclay (France). Radiat Prot Dosimetry 94(3):215-225.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Dosimeters

 

Thierry-Chef I, Pernicka F, Marshall M, Cardis E, Andreo P [2002]. Study of a selection of 10 historical types of dosemeter: variation of the response to Hp(10) with photon energy and geometry of exposure. Radiat Prot Dosimetry 102(2):101-113.

Development of an exposure database

 

Van Dyke MV, LaMontagne AD, Martyny JW, Ruttenber AJ [2001]. Development of an exposure database and surveillance system for use by practicing OSH professionals. Appl Occup Environ Hyg 16(2):135-143.

Collection, validation, and treatment of data for a mortality study

Oak Ridge National Laboratory

Watkins JP, Cragle, DL, Frome EL, Reagan JL, West CM, Crawford-Brown D, Tankersley WG [1997]. Collection, validation, and treatment of data for a mortality study of nuclear workers. Appl Occup Environ Hyg 12(3):195-205.

Age-based methods to explore time-related variables in occupational epidemiology studies

Oak Ridge National Laboratory

Watkins JP, Frome EL, Cragle DL [2005]. Age-based methods to explore time-related variables in occupational epidemiology studies. Proceedings of the American Statistical Association, Section on Statistics in Epidemiology [CD-ROM], Alexandria, VA.

Estimation of radiation doses

Oak Ridge National Laboratory

Watson JE Jr, Wood JL, Tankersley WG, West CM [1994]. Estimation of radiation doses for workers without monitoring data for retrospective epidemiological studies. Health Phys 67(4):402-405.

Lung dose estimates

Oak Ridge National Laboratory

West CM, Watkins JP, Tankersley WG, Payne DD [1995]. Lung dose estimates from air sampling and bioassay data—a comparison. Health Phys 69(4):481-486.

Mortality among workers monitored for 210Po exposure

 

Wiggs LD, Cox-DeVore CA, Voelz GL [1991]. Mortality among a cohort of workers monitored for 210Po exposure: 1944-1972. Health Phys 61(1):71-76.

Mortality among workers exposed to external ionizing radiation

Mound Plant, OH

Wiggs LD, Cox-DeVore CA, Wilkinson GS, Reyes M [1991]. Mortality among workers exposed to external ionizing radiation at a nuclear facility in Ohio. J Occup Med 33(5):632-637.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Mortality through 1990 of white male workers

Los Alamos National Laboratory

Wiggs LD, Johnson ER, Cox-DeVore CA, Voelz GL [1994]. Mortality through 1990 among white male workers at the Los Alamos National Laboratory: considering exposures to plutonium and external ionizing radiation. Health Phys 67(6):577-588.

Risk factors form alignant melanoma

 

Wilkinson GS [1997]. Invited commentary: are low radiation doses or occupational exposures really risk factors for malignant melanoma? Am J Epidemiol 145(6):532.

Healthy worker effect

 

Wilkinson GS, Morgenstern H [1995]. Internal comparisons do not always control for the healthy worker effect. Am J Epidemiol 141(11):S58.

Cancer mortality among plutonium and radiation workers

 

Wilkinson GS, Baillargeon J, Ray L, Baillargeon G, Trieff N [1997]. Cancer mortality among plutonium and radiation workers. Am J Epidemiol 145(11):158.

Relevance of occupational epidemiology to radiation protection standards

 

Wing S, Richardson D, Stewart S [1999]. The relevance of occupational epidemiology to radiation protection standards. New Solutions 9(2):133-151.

Case-control study of multiple myeloma at four nuclear facilities

Multisite

Wing S, Richardson D, Wolf S, Mihlan G, Crawford-Brown D, Wood J [2000]. A case control study of multiple myeloma at four nuclear facilities. Ann Epidemiol 10(3):144-153.

Plutonium-related work and cause-specific mortality at DOE

Hanford site

Wing S, Richardson D, Wolf S, Mihlan G [2004]. Plutonium-related work and cause-specific mortality at the United States Department of Energy Hanford Site. Am J Ind Med 45(2):153-164.

Age at exposure to ionizing radiation and cancer mortality

Hanford site

Wing S, Richardson DB [2005]. Age at exposure to ionizing radiation and cancer mortality among Hanford workers: follow up through 1994. Occup Environ Med 62(7):465-472.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Mortality among workers

Oak Ridge National Laboratory

Wing S, Shy CM, Wood JL, Wolf S, Cragle DL, Frome EL [1991]. Mortality among workers at Oak Ridge National Laboratory. Evidence of radiation effects in follow-up through 1984. JAMA 265(11):1397-1402. Erratum: JAMA 1991 266(5):657, 1992 268(11):1414. Comment: JAMA 1991 266(5):652-655, JAMA 1992 267(7):929-930.

Job factors, radiation, and cancer mortality

Oak Ridge National Laboratory

Wing S, Shy CM, Wood JL, Wolf S, Cragle DL, Tankersley W, Frome EL [1993]. Job factors, radiation and cancer mortality at Oak Ridge National Laboratory: follow-up through 1984. Am J Ind Med 23(2):265-279. Erratum: Am J Ind Med 23(4):673.

Recording external radiation exposures

Oak Ridge National Laboratory

Wing S, West CM, Wood JL, Tankersley W [1994]. Recording of external radiation exposures at Oak Ridge National Laboratory: implications for epidemiological studies. J Expo Anal Environ Epidemiol 4(1):83-93.

Smoking history

 

Woo JG, Pinney SM [2002]. Retrospective smoking history data collection for deceased workers: completeness and accuracy of surrogate reports. J Occup Environ Med 44(10):915-923.

Cluster analysis

 

Wu JD, Milton DK, Hammond SK, Spear RC [1999]. Hierarchical cluster analysis applied to workers’ exposures in fiberglass insulation manufacturing. Ann Occup Hyg 43(1):43-55.

Estimating dose-response relationship for occupational radiation exposure

Oak Ridge National Laboratory

Xue X, Shore RE, Ye X, Kim MY [2004]. Estimating the dose response relationship for occupational radiation exposure measured with minimum detection level. Health Phys 87(4):397-404.

Estimating occupational radiation doses

Oak Ridge National Laboratory

Xue X, Shore RE [2003]. A method for estimating occupational radiation doses subject to minimum detection levels. Health Phys 84(1):61-71.

NIOSH Numbered Reports

Epidemiological use of non-detectable values in radiation exposure measurements

 

Cardarelli, J, Spitz H, Elliott L [1993]. NIOSH Research Issues Workshop: Epidemiological Use of Nondetectable Values in Radiation Exposure Measurements. Cincinnati, OH: U.S. Department of Health and Human Services, NIOSH Publication No.224647; 27 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Study of leukemia and ionizing radiation

Portsmouth Naval Shipyard

Kubale TL, Daniels RD, Yiin JH, Kinnes GM, Couch J, Schubauer-Berigan MK, Silver SR, Nowlin SJ, Chen PH [2004]. Anestedcase-control study of leukemia and ionizing radiation at the Portsmouth Naval Shipyard. Cincinnati, OH: U.S. Department of Health and Human Services, NIOSH Publication No. 2005-104; 182 pp.

NIOSH Occupational Energy Research Program

 

NIOSH [2001]. NIOSH Occupational Energy Research Program. Cincinnati, OH: U.S. Department of Health and Human Services, NIOSH Publication No. 2001-133.

Report of public meeting to seek input on gaps in CLL radiogenicity research

 

NIOSH [2005]. Report of Public Meeting to Seek Input on Gaps in Chronic Lymphocytic Leukemia (CLL) Radiogenicity Research Held July 21, 2004.Cincinnati, OH: U.S. Department of Health and Human Services, NIOSH Publication No. 2006-100; 104 pp.

Mortality and radiation-related risk of cancer among workers

Idaho National Engineering and Environmental Laboratory

Schubauer-Berigan MK, Macievic GV, Utterback DF, Tseng C-Y, Flora JT [2005]. An epidemiological study of mortality and radiation-related risk of cancer among workers at the Idaho National Engineering and Environmental Laboratory, a U.S. Department of Energy Facility. Cincinnati, OH: U.S. Department of Health and Human Services, NIOSH Publication No. 2005-131; 224 pp.

Mortality update

Pantex weapons facility

Silver SR, Anderson-Mahoney P, Burphy J, Hiratzka S, Schubauer-Berigan MK, Waters KM [2005]. Mortality update for the Pantex weapons facility: final report. Cincinnati, OH: U.S. Department of Health and Human Services, NIOSH Publication No. 2005-124; 24 pp.

Unnumbered Intramural Reports

Cancer incidence and sentinel event registries

 

Foster S, Espinoza R [2000]. Cancer incidence and sentinel eventregistries. Cincinnati, OH: NIOSH; 107 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Specificity of the National Death Index and Social Security Administration Death Master File when information on Social Security number is lacking

 

Foster SO, Schubauer-Berigan MK, Waters KM [2000]. The specificity of the National Death Index and Social Security Administration Death Master File when information on Social Security Number is lacking. Cincinnati, OH: NIOSH.

Adverse reproductive outcomes among females employed at DOE facilities

 

Massoudi BL [1996]. Adverse reproductive outcomes among females employed at Department of Energy facilities: the feasibility of epidemiological studies. Cincinnati, OH: NIOSH; 18 pp.

Dosimetry data compilation for international radiation workers study

 

Murray B [1997]. Dosimetry data compilation for international radiation worker study: final report. IARC Collaborative Study; Cincinnati, OH: NIOSH; 52 pp.

Mortality patterns among uranium enrichment workers

Portsmouth Gaseous Diffusion Plant

Rinsky R, Cardarelli J, Ahrenholz S, Wenzl T, Hornung R, Reeder D, Waters K, Dill P [2001]. Final technical report: Mortality patterns among uranium enrichment workers at the Portsmouth Gaseous Diffusion Plant, Piketon, Ohio. Cincinnati, OH: NIOSH; 179 pp.

Feasibility assessment: epidemiological study of personnel involved in the underground nuclear detonation, Cannikin site, Amchitka, Alaska

 

Rinsky R, Taulbee T [1998]. Report to Deputy Assistant Secretary, U.S. Department of Energy. Feasibility assessment. Epidemiological study of personnel involved in the underground nuclear detonation, Cannikin site, Amchitka, Alaska. Cincinnati, OH: NIOSH; 18 pp.

Evaluation of data for DOE site remediation workers

 

Silver SR, Robinson CF, Kinnes G, Taulbee T, Ahrenholz S [2000]. Evaluation of data for DOE site remediation workers. Cincinnati, OH: NIOSH; 37 pp.

Depleted uranium: sources, exposure and health effects

 

Schmid E, Keith S, TenfordeT, Alberth D, Cloeren M, Kramp R, et al. [2001]. Depleted uranium: sources exposure and health effects. Dept Prot Hum Env Apr:1-209.

Electromagnetic fields and rail maintenance workers

 

Wenzl TB, Mills P, Murray WE [1996]. Electromagnetic fields [EMF] and rail maintenance workers: final report of an exposure survey and feasibility investigation. Cincinnati, OH: NIOSH; 7pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Extramural Reports

Remediation workers’ exposure assessment feasibility study

Rocky Flats

Back DA, Stevens GW [1998]. Remediation workers’ exposure assessment feasibility study at the Department of Energy’s Rocky Flats site—Phase I report.

Glycophorin A biodosimetry in patients treated with iodine-131

 

Bigbee WL, Brown ML, Burmeister LA, Carty SE, Swanson D, Watson CG [1998]. Final performance report: Glycophorin A (GPA) biodosimetry in I-131 treated patients. Pittsburgh, PA: Center for Environmental and Occupational Health and Toxicology, Department of Environmental and Occupationa Health, Graduate School of Public Health, University of Pittsburgh; 36 pp.

Work histories—evaluating new participatory methods

 

Bingham E, Rice C [1999]. Work histories—evaluating new participatory methods. Cincinnati, OH: Department of Environmental Health, University of Cincinnati; 21 pp.

Surveillance methods for solvent-related hepatotoxicity

 

Brodkin CA, Checkoway H, Bushley A, Stover B, McDonald G, Lee S, Wang K, Carpenter K, Dubinsky T, Green D [2001]. Surveillance methods for solvent-related hepatotoxicity. Seattle, WA: University of Washington. Available from NIOSH/Health-Related Energy Research Branch (HERB), Cincinnati, OH; 7pp.

Reconstruction of doses for Chernobyl liquidators

Chernobyl

Cardis E, Krjuchkov VP, Anspaugh L, Bouville A, Chumak VV, Drozdovich V, Gavrilin Y, Golovanov I, Hubert P, Illychev S, Ivanov VK, Kesminiene A, Kurtinaitis J, Maceika E, Malakhova IV, Mirhaidarov AK, Pitkevitch VA, Stengrevics A, Tekkel M, Tenet V, Tsykalo A [2003]. Reconstruction of doses for Chernobyl liquidators (Final performance report). Available from the NIOSH/HERB, Cincinnati, OH; 53 pp.

Cancer risk among radiation workers in the nuclear industry

 

Cardis E, Martuzzi M, Amoros E [1997]. International Collaborative Study of Cancer Risk Among Radiation Workers in the Nuclear Industry—II. Procedures Document (1997 revision). Lyon, France: International Agency for Research on Cancer, World Health Organization; 102 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Mortality among a cohort of white male workers at a uranium processing plant

Fernald Feed Materials Production Center, 1951-1989

Cragle DL, Watkins JP, Ingle JN, Robertson-Demers K, Tankersley WG, West CM [1995]. Mortality among a cohort of white male workers at a uranium processing plant: Fernald Feed Materials Production Center, 1951-1989. Oak Ridge, TN: Center for Epidemiological Research, Oak Ridge Institute for Science and Education; unpublished; 29 pp.

Study of the health effects of exposure to elemental mercury

Y-12 plant in Oak Ridge

Departments of Behavioral Sciences and Health Education and of Environmental and Occupational Health; Rollins School of Public Health of Emory University, and Center for Epidemiological Research Environmental and Health Sciences Division Oak Ridge Associated Universities [undated]. A study of the health effects of exposure to elemental mercury: a followup of mercury exposed workers at the Y-12 plant in Oak Ridge, Tennessee. Available from the NIOSH/HERB, Cincinnati, OH; 134 pp.

Mortality among workers employed between 1945 and 1984 at a uranium gaseous diffusion facility

Oak Ridge

Dupree EA, Wells SM, Watkins JP, Wallace PW, Davis NC [1994]. Mortality among workers employed between 1945 and 1984 at a uranium gaseous diffusion facility. Oak Ridge, TN: Center for Epidemiological Research Medical Sciences Division. Available from NIOSH/ HERB, Cincinnati, OH; 24 pp.

Job task analysis quality assessment

14 sites

Ertell K, Takaro T, Shorter C, Stove 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; 34 pp.

Occupational magnetic field personal exposures

Seattle metro transit’s electric trolley system

EM Factors [1999]. Study of occupational magnetic-field personal exposures associated with Seattle metro transit’s electric trolley system. Richland, WA. Available from NIOSH/HERB, Cincinnati, OH; 67 pp.

Evaluation of dosimetry data

 

Fix JJ [2001]. Interim final report: evaluation of dosimetry data for National Institute for Occupational Safety and Health (NIOSH) Collaboration with the International Agency for Research on Cancer (IARC) Nuclear Worker Study. Richland, WA: Pacific Northwest National Laboratory; 65 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Dose validation study

Multisite

Fix JJ, Scherpelz RI, Strom DJ, Traub RJ [2005]. Dose validation for NIOSH/HERB multisite leukemia case control study. PNWD-3538. Richland WA: Battelle Pacific Northwest Division, 218 pp.

Mortality in an ethnically diverse radiation-exposed occupational cohort

Los Alamos National Laboratory

Galke GA, Johnson ER, Tietjen GL [1992]. Mortality in an ethnically diverse radiation exposed occupational cohort. Los Alamos, NM: Los Alamos National Laboratory; unpublished; 70 pp.

Occupational magnetic field personal exposures

 

Kaune WT [1999]. Study of occupational magnetic-field personal exposures of non-flying airline employees. Richland, WA: EM Factors. Available from NIOSH/HERB Cincinnati, OH; 52 pp.

Method for estimating occupational radiation dose to individuals

Oak Ridge National Laboratory

Mitchell RJ, Ostrouchov G, Frome EL, Kerr GD [1993]. Amethod for estimating occupational radiation dose to individuals, using weekly dosimetry data. Oak Ridge, TN: Oak Ridge National Laboratory; 46 pp.

 

 

Newman LS [2002]. Final performance report: beryllium disease natural history and exposure-response. Denver, CO: Division of Environmental and Occupational Health Sciences, National Jewish Medical and Research Center; 17 pp.

Lung fibrosis in plutonium workers

 

Newman LS, Mroz MM, Ruttenber JA [2002]. Lung fibrosis in plutonium workers. Division of Environmental and Occupational Health Sciences, National Jewish Medical and Research Center, Denver, CO. Available from NIOSH/HERB, Cincinnati, OH; 19 pp.

Adequacy of vital status follow-up in the Hanford Worker Mortality Study

Hanford

Omohundro E, Gilbert E [1993]. An evaluation of the adequacy of vital status follow-up in the Hanford Worker Mortality Study. Richland, WA: Hanford Environmental Health Foundation. Available from NTIS, Springfield, VA; DE94005179, 40 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Dose estimation

Oak Ridge National Laboratory

Ostrouchov G, Frome EL, Kerr GD [1998]. Dose estimation from daily and weekly dosimetry data. Oak Ridge, TN: Oak Ridge National Laboratory.

Health effects of downsizing in the nuclear industry

Idaho National Engineering and Environmental Laboratory

Pepper L [2000]. The health effects of downsizing in the nuclear industry: findings at the Idaho National Engineering and Environmental Laboratory. Boston, MA: Boston University School of Public Health. Available from NIOSH/HERB, Cincinnati, OH; 129 pp.

Health effects of downsizing in the nuclear industry

Los Alamos National Laboratory

Pepper L [2000]. The health effects of downsizing in the nuclear industry: findings at the Los Alamos National Laboratory. Boston, MA: Boston University School of Public Health. Available from NIOSH/HERB, Cincinnati, OH; 135 pp.

Health effects of downsizing in the nuclear industry

Nevada Test Site

Pepper L [2000]. The health effects of downsizing in the nuclear industry: findings at the Nevada Test Site. Boston, MA: Boston University School of Public Health. Available from NIOSH/HERB, Cincinnati, OH; 125 pp.

Health effects of downsizing in the nuclear industry

Pantex

Pepper L [2000]. The health effects of downsizing in the nuclear industry: Pantex. Boston, MA: Boston University School of Public Health. Available from NIOSH/HERB, Cincinnati, OH; 133 pp.

Health effects of downsizing in the nuclear industry

Y-12 Plant, Oak Ridge

Pepper L [2000]. The health effects of downsizing in the nuclear industry: findings at the Y-12 Plant, Oak Ridge Reservation. Boston, MA: Boston University School of Public Health. Available from NIOSH/HERB, Cincinnati, OH; 129 pp.

Radon and cigarette smoking

Fernald

Pinney S [2004]. Radon and cigarette smoking assessment in Fernald workers. Cincinnati, OH: University of Cincinnati; 103 pp.

United Brotherhood of Carpenters Health and Safety Fund

 

Rosenman KD, Gardiner J, Cameron W, Anger KW [2000]. United Brotherhood of Carpenters Health and Safety Fund. Available from NIOSH/HERB, Cincinnati, Ohio; 76 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Chronic beryllium disease among beryllium-exposed workers

 

Rosenman KD, Hertzberg VS, Rice C, Rossman M. 2001. Final performance report: chronic beryllium disease among beryllium-exposed workers cooperative agreement; 25 pp.

Sentinel exposure event surveillance

 

Ruttenber AJ, LaMontagne AD, Van Dyke MV, Martyny JW [2004]. Final performance report: sentinel exposure event surveillance and evaluation for DOE sites. Denver, CO: University of Colorado Health Sciences Center; 5pp.

Epidemiological analyses of Rocky Flats production workers

Rocky Flats

Ruttenber AJ, Schonbeck M, Brown S, Wells T, McClure D, McCrea J, Popken D, Martyny J [2003]. Report of epidemiological analyses performed for Rocky Flats production workers employed between 1952-1989: Available from NIOSH/HERB, Cincinnati, OH; unpublished; 75 pp.

Epidemiological evaluation of childhood leukemia and paternal exposure to ionizing radiation

 

Sever LE, Gilbert ES, Tucker K, Greaves J, Greaves C, Buchanan J [1997]. Epidemiological evaluation of childhood leukemia and paternal exposure to ionizing radiation. Seattle, WA: Battelle Memorial Institute. Available from NIOSH/HERB, Cincinnati, OH; 51 pp.

Mortality among workers at Oak Ridge National Laboratory: follow-up through 1990

Oak Ridge National Laboratory

Shy C, Wing S [1994]. A report on mortality among workers at Oak Ridge National Laboratory: followup through 1990. Oak Ridge, TN: Oak Ridge Associated Universities, 21 pp.

Exposure assessment

Fernald

Stevens GW, Back DA [1996]. Hazardous waste, decontamination and decommissioning, and clean-up workers exposure assessment feasibility study at the Department of Energy’s Fernald site—Phase I: report; 156 pp.

Exposure assessment

Mound Plant

Stevens GW, Back DA [1997]. Remediation workers’ exposure assessment feasibility study at the Department of Energy’s Moundsite—Phase I: report; 218 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Measurement error methods

 

Stram DO [2001]. Measurement error methods for underground miner studies. Available from NIOSH/HERB, Cincinnati, OH; 4pp.b

Potential exposure profile system users’ guide

 

Tankersley WG [1997]. Potential exposure profile system (PEPS) users guide. Oak Ridge, TN: Oak Ridge Associated Universities; 34 pp.

Exposure assessment feasibility study

Savannah River site

Tankersley WG, West CM, Gray FE [1998]. Hazardous waste, decontamination and decommissioning and clean-up workers exposure assessment feasibility study at the Department of Energy’s Savannah River site.Cincinnati OH; 142 pp.

Exposure assessment feasibility study

Oak Ridge

Tankersley WG, West CM, Gray FE [1999]. Hazardous waste, deactivation, dismantlement, and cleanup workers exposure assessment feasibility study at the Department of Energy Oak Ridge reservation; 134 pp.

Mortality of 244 male workers exposed to plutonium

Los Alamos National Laboratory

Voelz GL, Johnson ER, Lawrence JNP [1993]. Mortality of 244 male workers exposed to plutonium. Los Alamos, NM: Los Alamos National Laboratory; unpublished; 16 pp.

Acute radiation syndrome in Russian nuclear workers

 

Wald N, Day R, Shekhter-Levin S, Vergona R, Aimin Z [2001]. Acute radiation syndrome in Russian nuclear workers. Pittsburgh, PA: University of Pittsburgh. Available from NIOSH/ HERB, Cincinnati, OH; 59 pp.

Time-related variables in occupational epidemiology studies

 

Watkins JP, Frome EL, Cragle DL [2004]. Evaluating time-related variables in occupational epidemiology studies. Final project report. Oak Ridge, TN: Oak Ridge Associated Universities; 57 pp. + 3 appendixes.

Estimating dose and chemical exposure

 

West CM, Rutherford BF, Tankersley WG [1997]. Current programs for estimating dose and chemical exposure: Volume I. Oak Ridge, TN: Oak Ridge Associated Universities; 124 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

Subject

Site if Applicable

Reference

Estimating dose and chemical exposure

 

West CM, Rutherford BF, Tankersley WG [1997]. Current programs for estimating dose and chemical exposure: Volume II. Oak Ridge, TN: Oak Ridge Associated Universities; 107 pp.

Mortality among female nuclear weapons workers

 

Wilkinson GS, Trieff, N, Graham, R [2000]. Final report: Study of mortality among female nuclear weapons workers. Buffalo, NY: State University of New York at Buffalo; 447 pp.

Time-related factors in radiation-cancer dose-response

 

Wing S, Richardson D [1997]. Time-related factors in radiation-cancer dose response. Chapel Hill, NC: University of North Carolina School of Public Health; 226 pp.

Ionizing radiation and mortality

Hanford site

Wing SB [1999]. Ionizing radiation and mortality among Hanford workers. Chapel Hill, NC: University of North Carolina School of Public Health; 1 p.

Case-control study of multiple myeloma among workers exposed to ionizing radiation and other physical and chemical agents

 

Wing SB, Wolf SH, Crawford-Brown D, Kotecki M, Mihlan GJ, Todd L, Emery J, Pompeii L, Wood JL, Olshan A, Shy CM [1997]. Case-control study of multiple myeloma among workers exposed to ionizing radiation and other physical and chemical agents. Chapel Hill, NC: University of North Carolina, School of Public Health; 203 pp.

Correcting for measurement errors in radiation exposure

 

Xue X [2002]. Correcting for measurement errors in radiation exposure. Available from NIOSH/HERB, Cincinnati, OH; 16 pp.

Remediation workers exposure assessment feasibility study

Hanford site

Zimmerman TD [1999]. Remediation workers exposure assessment feasibility study at the Department of Energy’s Hanford site—Phase I: Report; 204 pp.

Remediation workers exposure assessment feasibility study

INEEL

Zimmerman TD, Moore AM [2000]. Remediation workers exposure assessment feasibility study at the Department of Energy’s INEEL Site—Phase I: Report; 217 pp.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

NIOSH Health Hazard Evaluations (HHEs) Within the OERP

Hazard evaluation and technical assistance report

Idaho Falls, Idaho

NIOSH [1994]. Hazard evaluation and technical assistance report: Protection Technology Idaho Inc., Idaho Falls, Idaho. Cincinnati, OH: NIOSH Hazard Evaluation and Technical Assistance (HETA) Report No. 93-0740; 19 pp.

Hazard evaluation and technical assistance report

Lockheed Martin, Piketon, OH

NIOSH [1996]. Hazard evaluation and technical assistance report: Lockheed Martin Utility Services, Inc., Piketon, Ohio. Cincinnati, OH: NIOSH HETA Report No. 94-0077-2568; 41 pp.

Hazard evaluation and technical assistance report

LANL

NIOSH [1998]. Hazard evaluation and technical assistance report: Los Alamos National Laboratory, Los Alamos, NM. Cincinnati, OH: NIOSH HETA Report No. 98-0240; 6 pp.

Hazard evaluation and technical assistance report

Portsmouth Gaseous Diffusion Plant

NIOSH [2000]. Hazard evaluation and technical assistance report: Portsmouth Gaseous Diffusion Plant, Piketon, Ohio. Cincinnati, OH: NIOSH HETA Report No. 96-0198-2651.

aWhile NIOSH lists the 15-country as “Intramural” for NIOSH record-keeping purposes, the funding for the study came from multiple sources.

bDan Stram, a member of the authoring committee of the present report, conducted exposure measurement error analysis in the Colorado Plateau Uranium Miners cohort and the Hanford Thyroid Disease Study with extramural funding from NIOSH. That funding terminated prior to the inception of this study (end date 5/31/2002). Those studies were not a part of this review.

NOTE: Publications that acknowledge whole or partial funding by DOE through the NIOSH Occupational Energy Research Program. From this body of work the committee selected for review publications either directly related to its three sites (Hanford, ORNL, and LANL) or multisite studies that included data from at least one of the three sites. Excludes intramural proceedings, extended abstracts, and submitted publications not in press as of May 2006. Table is current as of information received May 9, 2006.

Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×

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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
×
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 71
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 72
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 73
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 74
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 75
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 76
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 77
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 78
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 79
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 80
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 81
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 82
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 83
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 84
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 85
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 86
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 87
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 88
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 89
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 90
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Page 91
Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Suggested Citation:"2 Scientific Program Assessment: National Institute for Occupational Safety and Health." National Research Council. 2006. Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services. Washington, DC: The National Academies Press. doi: 10.17226/11805.
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Ever since the United States began producing and testing nuclear weapons during World War II, the effects of ionizing radiation on human health and the environment have been a serious public concern. The Worker and Public Health Activities Program was established more than 20 years ago to study the consequences of exposure to ionizing radiation and other hazardous materials from Department of Energy operations to workers and members of the surrounding communities. In 2005, the National Academies convened an expert committee to conduct a review of the Worker and Public Health Activities Program, which is operated by the Department of Health and Human Services (HHS) at Department of Energy (DOE) nuclear facilities under a Memorandum of Understanding (MOU) with DOE.

Review of the Worker and Public Health Activities Program Administered by the Department of Energy and the Department of Health and Human Services concludes that the program has used sound research methods and generally has enhanced public understanding of the risks involved. However, the report recommends that more two-way communication between the agencies and workers and members of the public is needed. The report also explores the ways in which the agencies involved could develop a more coordinated, effective, and thorough evaluation of the public health concerns involved in cleanup and remediation activities at Department of Energy sites.

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