Documents Wing, Steve 11 results

"Although the health sciences have investigated economic and social inequalities in morbidity and mortality for hundreds of years, health inequalities persist and are, by some measures, increasing. This is not simply a situation in which the knowledge exists but is not implemented. Rather, science in general and epidemiology in particular have focused on quantifying the effects of specific agents considered in isolation. This approach is powerful, but, in the absence of ecological concepts that connect parts and wholes, contributes to maintaining health inequalities. By joining movements for human rights and social justice, health scientists can identify research questions that are relevant to public health, develop methods that are appropriate to answering those questions, and contribute to efforts to reduce health inequalities."

"Corporations operating U.S. nuclear weapons plants for the federal government began tracking occupational exposures to ionizing radiation in 1943. However, workers, scholars, and policy makers have questioned the accuracy and completeness of radiation monitoring and its capacity to provide a basis for workers' compensation. We use interviews to explore the limitations of broad-scale, corporate epidemiological surveillance through worker accounts from the Savannah River Site nuclear weapons plant. Interviewees report inadequate monitoring, overbearing surveillance, limited venues to access medical support and exposure records, and administrative failure to report radiation and other exposures at the plant. The alienation of workers from their records and toil is relevant to worker compensation programs and the accuracy of radiation dose measurements used in epidemiologic studies of occupational radiation exposures at the Savannah River Site and other weapons plants."

"Environmental justice (EJ) research requires attention to consequences for research participants beyond those typically considered by institutional review boards. The imbalance of power between impacted communities and those who create and regulate pollution creates challenges for participation, yet research can also benefit those involved. Our community-academic partnership designed the Rural Air Pollutants and Children's Health (RAPCH) study to provide positive impacts while measuring health effects at three low-resource public middle schools near concentrated animal feeding operations (CAFOs) in North Carolina. We evaluated perceived benefits and challenges of study involvement by interviewing school staff and community liaisons who facilitated data collection. Reported benefits included enhancement of students' academic environment and increased community environmental awareness; challenges were associated mainly with some participants' immaturity. Leadership from a strong community-based organization was crucial to recruitment, yet our approach entailed minimal focus on EJ, which may have limited opportunities for community education or organizing for environmental health."

"The favorable health status of employed populations in comparison to that of the general population is often called the "healthy worker effect," and most researchers feel that it results from the selection of healthy individuals during the hiring process. However, other mechanisms may also contribute to the healthy worker effect. In particular, the healthy worker effect may reflect the selection, for epidemiologic study, of relatively advantaged workforces in terms of socioeconomic status and health. Evidence of differential health by socioeconomic status within the workforce is reviewed, and its possible role in the healthy worker effect is discussed."

"The U.S. government recently implemented rules for awarding compensation to individuals with cancer who were exposed to ionizing radiation while working in the nuclear weapons complex. Under these rules, chronic lymphocytic leukemia (CLL) is considered to be a nonradiogenic form of cancer. In other words, workers who develop CLL automatically have their compensation claim rejected because the compensation rules hold that the risk of radiation-induced CLL is zero. In this article we review molecular, clinical, and epidemiologic evidence regarding the radiogenicity of CLL. We note that current understanding of radiation-induced tumorigenesis and the etiology of lymphatic neoplasia provides a strong mechanistic basis for expecting that ionizing radiation exposure increases CLL risk. The clinical characteristics of CLL, including prolonged latency and morbidity periods and a low case fatality rate, make it relatively difficult to evaluate associations between ionizing radiation and CLL risk via epidemiologic methods. The epidemiologic evidence of association between external exposure to ionizing radiation and CLL is weak. However, epidemiologic findings are consistent with a hypothesis of elevated CLL mortality risk after a latency and morbidity period that spans several decades. Our findings in this review suggest that there is not a persuasive basis for the conclusion that CLL is a nonradiogenic form of cancer."

"Previous studies concluded that there was no evidence that the 1979 nuclear accident at Three Mile Island( TMI) affected cancer incidence in the surrounding area; however there were logical and methodological problems in earlier reports that led us to reconsider data previously collected.
A 10-mile area around TMI was divided into 69 study tracts, which were assigned radiation dose estimates based on radiation readings and models of atmospheric dispersion. Incident cancers from 1975 to 1985 were ascertained from hospital records and assigned to study tracts.
Associations between accident doses and incidence rates of leukemia, lung cancer, and all cancer were assessed using relative dose estimates calculated by the earlier investigators. Adjustments were made for age, sex, socioeconomic characteristics and preaccident variation in incidence.
Considering a 2-year latency, the estimated percent increase per dose unit +- standard error was 0.020 * 0.012 for all cancer, 0.082 +- 0.032 for lung cancer, and 0.116 * 0.067 for leukemia.
Adjustment for socioeconomic variables increased the estimates to 0.034+- 0.013, 0.103 +- 0.035, and 0.139 ? 0.073 for all cancer, lung cancer and leukaemia, respectively. Associations were generally larger considering a 5-year latency, but were based on smaller numbers of cases, results support the hypothesis that radiation doses are related to increased cancer incidence around TMI. The analysis avoids medical detection bias, but suffers from inaccurate dose classification; therefore, results may underestimate the magnitude of the association between radiation and cancer ncidence. These associations would not be expected, based on previous estimates of near background levels of radiation exposure following the accident."

"PURPOSE:
Reported elevations of multiple myeloma among nuclear workers exposed to external penetrating ionizing radiation, based on small numbers of cases, prompted this multi-facility study of workers at US Department of Energy facilities.
METHODS: Ninety-eight multiple myeloma deaths and 391 age-matched controls were selected from the combined roster of 115,143 workers hired before 1979 at Hanford, Los Alamos National Laboratory, Oak Ridge National Laboratory, and the Savannah River site. These workers were followed for vital status through 1990 (1986 for Hanford). Demographic, work history, and occupational exposure data were derived from personnel, occupational medicine, industrial hygiene, and health physics records. Exposure-disease associations were evaluated using conditional logistic regression.
RESULTS: Cases were disproportionately African American, male, and hired prior to 1948. Lifetime cumulative whole body ionizing radiation dose was not associated with multiple myeloma, however, there was a significant effect of age at exposure, with positive associations between multiple myeloma and doses received at older ages. Dose response associations increased in magnitude with exposure age (from 40 to 50) and lag assumption (from 5 to 15 years), while a likelihood ratio goodness of fit test reached the highest value for cumulative doses received at ages above 45 with a 5-year lag (X2=5.43,1 df; relative risk = 6.9% per 10 mSv). Dose response associations persisted with adjustment for potential confounders.
CONCLUSIONS: Multiple myeloma was associated with low level whole body penetrating ionizing radiation doses at older ages. The exposure age effect is at odds with interpretations of A-bomb survivor studies but in agreement with several studies of cancer among nuclear workers."

"Large-scale epidemiological studies of U.S. Department of Energy workers have been underway since the 1960s. Despite the increasing availability of information about long-term follow-up of badge-monitored nuclear workers, standard-setting bodies continue to rely on the Life Span Study (LSS) of A-bomb survivors as the primary epidemiological basis for making judgments about hazards of low-level radiation. Additionally, faith in the internal and external validity of studies of A-bomb survivors has influenced decisions about the design, analysis, and interpretation of many worker studies. A systematic comparison of the LSS and worker studies in terms of population characteristics, types of radiation exposures, selection factors, and dosimetry errors suggests that the priority given to dose response findings from the LSS is no longer warranted. Evidence from worker studies suggests that excess radiation-related cancer deaths occur at doses below the current occupational limits; low-dose effects have also been seen in studies of childhood cancers in relation to fetal irradiation. These findings should be considered in revising current radiation protection standards. "

Methods for evaluating age related differences in epidemiologic studies examining the effects of prolonged exposures were discussed. Subcohort analyses, use of weighting functions, and evaluating separate effects of cumulative exposure received at different age ranges (cross/classification analysis) were described. Subcohort analysis is usually done by distinguishing between individuals whose exposure histories begin at different ages or by using age at first exposure and age at last exposure in the analysis. Weighting functions can be used to discount exposures received before a certain age or to discount exposures not considered to be etiologically relevant. A variety of mathematical functions including step functions or linear, quadratic, or sigmoid weighting functions can be used for this purpose. Cross classification analysis can be used to separate the effects of cumulative exposure received at two different age ranges, thereby enabling trends in disease rates with increasing exposure received at one age period to be evaluated. The approaches were illustrated by application to a followup cohort study of the risk of cancer among employees at Oak Ridge National Laboratory (ORNL). The ORNL cohort consisted of 8,307 white males who had been hired between 1943 and 1972 and worked at the facility for at least 30 days. Subcohort analysis showed that an increase in cancer mortality occurred only in workers who received higher radiation exposures at ages of 45 years (yr) or greater. Workers in this age group showed an 8.55% increase in all cancer mortality per every 10 millisieverts (mSv) radiation exposure versus only a 3.02% increase in cancer mortality per 10mSv received before age 45yr. Cross classification analysis indicated that cumulative radiation doses received after age 45 were associated with a 5.46% increase in all cancer mortality per 10mSv exposure, whereas radiation doses received before age 45 were associated with only a 0.69% increase in cancer mortality per 10mSv. The weighting function approach also indicated that cancer mortality increased with age at exposure, the percentage increase per 10mSv varying from 2.28 to 6.49% depending on which particular function was used. The authors conclude that each method can contribute to the overall evaluation of age specific exposure effects in epidemiological studies.

"Legislation in North Carolina has mandated obtaining renewable energy from the incineration of poultry waste, resulting in proposals for three poultry-litter-fueled power plants statewide. This article summarizes environmental health and environmental justice issues associated with incineration of poultry waste for the generation of electric power. Emissions from poultry waste incineration include particulate matter, dioxins, arsenic, bioaerosols and other toxins; various components are associated with cardiovascular disease, cancer, respiratory illness, and other diseases. Industrial farm animal production tends to be concentrated in low-income, rural communities, where residents may be more vulnerable to air pollutants due to pre-existing diseases, other exposures and stressors, and poor access to medical services. These communities lack the political clout to prevent siting of polluting facilities or to pressure industry and government to follow and enforce regulations. Policies intended to reduce reliance on fossil fuels have the potential to increase environmental injustices and threats to environmental health. "