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

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Learning objectives

Risk Communication Strategiesin the DiNEH ProjectNavajo Nation Human Research Review Board ConferenceNovember 16, 2011Window Rock, AZChris Shuey, Glenn Stark, Sandy RamoneDiné Network for Environmental Health ProjectJohnnye Lewis, PI

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

Learning objectives
Learning Objectives

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

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

  • Outline methods to evaluate these communication methods

Principles of risk communication adapted for din communities
Principles* of Risk Communication Adapted for Diné Communities

  • Never forget: Communities are partners!

  • Use Navajo language

  • Integrate iterative research models

  • Use pictures, graphics; Navajo is descriptive

  • Speak clearly, mix in some humor

  • Develop community trust through frequent contacts

  • Listen carefully, listen some more

  • Understand that on Navajo, uranium impacts are historic

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

Column charts show survey statistics
Column charts show survey statistics Communities

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

  • Data from survey responses

  • Self-reported health problems

  • Self-reported exposures to uranium wastes

  • Chapter responses compared with “All Chapters” responses

  • Percentages likened to fractions of one dollar

  • Compare prevalences with other study results

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

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

  • Proximity by itself consistently predicts increased risk of disease

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


About 1 in 4 participants reported 1 or more environmental exposures

What’s a “surrogate”? We say “substitute” in Navajo



*Environmental legacy exposures are activities that bring people close to or in contact with uranium wastes, over their lifetimes:

(A) Lived near abandoned mines

(B) herded livestock near mines

(C) sheltered livestock in mines

(D) played on or near mines, mills

(E) used mine materials in home

(F) drank or contacted mine water



Learning objectives
“Heat” maps show increased health risksincreasing health risk (with increasing distance to mine features and legacy exposures)

Red areas represent doubling of risk of high blood pressure, all other risk factors being equal (Odds Ratio = 2.0)

1 exposure 2 exposures

Maps by Glenn Stark

Communicating risk to avoid risk
Communicating Risk to increased health risksAvoid Risk

  • DiNEH results, which apply to the entire study population, can be used to reduce individual risk

  • Red areas in map below, derived from soil sampling, have known contamination and should be avoided

2007 Map by Jamie deLemos, PhD.

This can be prevented!

Know where the abandoned mines are in your community. Visit http://www.epa.gov/region09/superfund/navajo-nation/index.html to learn mine locations on the Navajo Nation.

Learning objectives

Locations of Abandoned Uranium Mines in Mariano Lake area increased health risks

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


Avoid contact with uranium mine sites!

Learning objectives

DiNEH water testing program increased health risks

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

Learning objectives

Water Sources in Mariano Lake Area increased health risks

Mariano Residence Well

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


Rocky Canyon Windmill

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


16K-528 Mariano Lake Chapter Well (inoperative)



(no sample)


  • 16T-519

Documentation and educational materials provided to chapters
Documentation and educational materials provided to Chapters increased health risks

  • DiNEH Project binder for each chapter

  • In collaboration with NNEPA and USEPA, produced:

    • Safe water-hauling guides

    • Contaminated well posters (for chapters having contaminated water sources

    • Agency posters (maps, contaminated wells)

Evaluation increased health risks

  • Obtaining feedback from Chapters

    • Are binders available?

    • Are warning posters publicly visible?

    • What are materials used for?

    • How can they be improved?

  • Binder present in about half of 12 chapters

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

Warnings about drinking from unregulated water sources
Warnings About Drinking Nationfrom Unregulated Water Sources

  • Contaminated well posters for 5 agencies

    • Arsenic, Uranium most frequent contaminants exceeding MCLs

  • Bacteriological contamination

    • Total coliforms found in 72% of unregulated water sources

    • more harmful E. Coli were present in about 23% of water sources in Central Navajo region.

  • Basis for recommendation not to drink from unregulated wells

Using geospatial data to predict potential health risks
Using geospatial data to predict potential health risks Nation

  • Knowing the locations of uranium wastes, we can predict areas of greatest potential risk

  • Helps target outreach for Navajo Birth Cohort Study

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

Learning objectives

1940s-60s: Uranium Mining Nation

“Comprehensive” Health Studies?



Miners & Millers Studies

Contaminated Structures

1980s-present: UMTRA/AML

2012: Navajo Birth Cohort Study

Community health?

2010-11: DiNEH blood & urine study


Church Rock Spill

Health Research on Navajo Uranium Legacy

Navajo land use & health?

Tailings covers

2010-12 CUE-JTH: medical monitoring

1980s: Birth Defects Study

  • Other diseases?

  • Biological reasons?

  • Critical exposure ages?

  • Other contamination?

  • Early indicators?

Uranium mining, or other exposures?

Uranium worker families

2007: Waxman Hearing

2001: DiNEH Project 1st Integrated Health Study

1990s-2000s: Community Actions for Environmental Health

Mid-80s: Limited Livestock Studies (NM)

2003-2007: CRUMP

Identification of health risks


NIEHS, EPA and UNM for financial support Nation

Community Advisory Board

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

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

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

Crownpoint Service Unit, I H S

Virgil Davis

Navajo Area IHS

Lisa Allee, CNM; John Hubbard; Ryan Johnson, MD; Doug Peter, MD

UT-Houston Nephrology

Donald Molony, MD

Southwest Research Information Center

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


Jamie deLemos, PhD – Tufts Univ.

Christine George – Stanford Univ.

Tommy Rock, MA, UNM Health Policy Student

Christine Samuel-Nakamura, PhD Candidate, UCLA


Ben Bostick, PhD

University of Arizona Cancer Center & Northern Arizona University, NACRP

Jani Ingram, PhD, Margaret Briehl, PhD


Harry Allen, Rich Bauer, Clancy Tenley

State of New Mexico Diagnostic Laboratory

Navajo Nation EPA Air Quality Division, Public Water Supply Supervision Program, Superfund Program

Navajo Nation Division of Health

Former Contributors:

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

Thanks to the many others who’ve contributed