Follow-up on Spring Valley Health Study. Community Briefing July 24, 2013

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1 Follow-up on Spring Valley Health Study Community Briefing July 24, 2013

2 Johns Hopkins Study Team Mary Fox, PhD, MPH Beth Resnick, MPH, CPH Keeve Nachman, PhD, MHS Patti Truant, MPH Meghan McGinty, MBA, MPH Jennifer Le, MPH Thomas Burke, PhD, MPH 2

3 Agenda 2013 Follow-up Study Background and Objectives Summary of Findings Data and Results Community Health Assessment Community Survey Environment Assessment Discussion and Recommendations , Johns Hopkins University. All rights reserved.

4 2013 Study builds on 2007 Findings 2007 Health Findings: Community health is good compared to the nation Mortality rates low Cancer rates are lower than the nation; however, some arsenicrelated cancer rates are slightly higher in Spring Valley than Chevy Chase No association found between DC Cancer Registry cases and site-related contamination areas 2007 Environment Findings (Soil Sampling): Reflect dual nature of contamination Dispersed low-level contamination Disposal areas with higher levels of contamination , Johns Hopkins University. All rights reserved.

5 2013 Follow-up Study Components and Objectives Community Health Assessment Update community mortality and selected cancer statistics Extend 2007 study with literature search for data on other similar FUDS Community Survey and Outreach Gather and report health conditions and community concerns Maintain open communication and dialogue Environment Assessment Develop community environmental portraits Extend 2007 scoping study with assessment of site-related water sampling plans and data , Johns Hopkins University. All rights reserved.

6 Follow-up Study Approach Compare rates, trends and survey responses across geographic areas: Spring Valley, Chevy Chase, DC, US Consider findings from community health, environment, and survey components Offer public health recommendations, as indicated by findings , Johns Hopkins University. All rights reserved.

8 Summary of Findings Community health in the Spring Valley and Chevy Chase study areas continues to be very good. Mortality rates for the major causes of mortality are lower or similar to US rates Incidence and mortality rates for selected cancers are mostly lower than US rates Some cancer rate time trends were found to be increasing in the study areas Survey respondents reported better health overall than the national average Respondents across the study areas reported a common set of concerns about chronic health conditions, air and water quality, nutrition/obesity Respondents residing inside the FUDS area continue to be concerned about siterelated exposures Environment: overall air and water quality are good Air quality concerns are common to US cities No increased risk was estimated from contact with surface water on the site Although the methods and approaches being used in the site-related water study are appropriate, some aspects could be strengthened 8

10 Community Health Assessment Components Population demographics, US Census and American Community Survey Age-adjusted rates for Top 15 causes of mortality, Data from DC Department of Health (DCDOH), Division of Vital Records Age-adjusted rates for selected cancer incidence and mortality, Bladder, kidney & renal pelvis, liver & bile duct, lung & bronchus, leukemias, lymphomas, melanoma Data from DCDOH, Vital Records and Cancer Control Registry Literature search for other similar FUDS investigations Peer-reviewed literature databases, Agency for Toxic Substances and Disease Registry (ATSDR) reports , Johns Hopkins University. All rights reserved.

11 Demographic comparisons, Population Characteristics Spring Valley Chevy Chase D.C. U.S. Total Population 24,762 16, , ,591,917 % White % Black % Hispanic % Other Median Household Income $139,724 $132,773 $ 58,526 $ 51,914 % College Degree , Johns Hopkins University. All rights reserved.

13 Spring Valley and Chevy Chase Census Tracts ZIP Codes Census Tracts: Demographics Cancer Data Air Toxics Zip Codes: Mortality Survey Environmental Portrait , Johns Hopkins University. All rights reserved.

14 Top Causes of Death - #1 to 7, Age-Adjusted Rate per 100, * SV CC DC 2007 US W 2007 US * 0.00 Heart Disease Cancers Stroke Chronic Respiratory * Accidents * Diabetes Mellitus Influenza and Pneumonia *Statistical differences between Spring Valley and Chevy Chase areas , Johns Hopkins University. All rights reserved.

15 Top Causes of Death - #8 to 15, Age-adjusted Rate per 100, * SV CC DC 2007 US W 2007 US * *Statistical difference between Spring Valley and Chevy Chase areas , Johns Hopkins University. All rights reserved.

16 Selected cancers Incidence, Age-adjusted Rate per 100, * SV CC DC US 07 Whites US Bladder Kidney and Renal Pelvis Leukemias Liver and Intrahepatic Bile Duct Lung and Bronchus Lymphomas * Skin *Statistical difference between Spring Valley and Chevy Chase areas , Johns Hopkins University. All rights reserved.

17 Selected cancers Mortality, Age-adjusted Rate per 100, SV CC DC US W 2007 US All Bladder Kidney and Renal Pelvis Leukemias Liver and Intrahepatic Bile Duct Lung and Bronchus Lymphomas Skin , Johns Hopkins University. All rights reserved.

18 Cancer trends, Annual trends were examined for cancers where differences compared to US trends were observed in aggregated data and where numbers were adequate ( 1 case/year) Findings: Year by year rates are highly variable Spring Valley annual trends:» Small increasing trends found for bladder and lung and bronchus incidence, and lymphoma mortality;» Moderate, statistically significant increasing trend found for lung and bronchus mortality Chevy Chase annual trends:» Small increasing trends found for lung and bronchus and lymphoma mortality , Johns Hopkins University. All rights reserved.

19 Cancer trends, Incidence Lung and Bronchus Cancer Incidence Rate per 100, SV Lung and Bronchus CC Lung and Bronchus US Lung and Bronchus US: steady decreasing trend Spring Valley: small increasing trend Year Chevy Chase: small decreasing trend , Johns Hopkins University. All rights reserved.

20 Cancer trends, Lung and Bronchus Cancer Mortality Rate per 100, Mortality SV Lung and Bronchus CC Lung and Bronchus US Lung and Bronchus US: steady decreasing trend Spring Valley: moderate increasing trend Year Chevy Chase: small increasing trend , Johns Hopkins University. All rights reserved.

21 Lessons learned from other FUDS Little peer-reviewed literature on community health near other FUDS Only Former Camp Sibert in Alabama has contamination issues similar to Spring Valley. However, the exposure potential, population and community health are quite different. Not heavily residential, under development only in recent years Population not comparable to Spring Valley Lower income, lower educational attainment, more diverse ethnicity, older Poorer community health in Former Camp Sibert area than Spring Valley area Total mortality and cancer mortality rates higher than US rates , Johns Hopkins University. All rights reserved.

22 Community Health Assessment - Summary Community health in the Spring Valley and Chevy Chase, DC areas continues to be very good. Mortality rates for major causes of death are lower than US rates for most causes in both areas Cancer incidence and mortality rates for selected cancers are lower than US rates for most causes Increasing rate trends for bladder, lung and bronchus cancer incidence (Spring Valley) and lung and bronchus and lymphoma mortality (Spring Valley and Chevy Chase) , Johns Hopkins University. All rights reserved.

24 Survey Objectives Characterize residential, work & study history in 3 geographic areas: Inside FUDS Outside FUDS Describe overall health status Report specific health conditions Identify public health and community concerns Report other concerns and comments , Johns Hopkins University. All rights reserved.

25 Survey Implementation Survey available on-line and in hard copy for 9 weeks in Fall 2012 All current and former residents, students and workers in and Zip Code areas were eligible to complete the survey Participants could respond for members of their household (including children and former household members who live in other locations or are deceased) Outreach to news and social media, community listservs, distribution of flyers at polling stations and community venues 25

27 Community Survey Response 757 ever live, work or study in ~ 52% Inside FUDS ~ 35% Outside FUDS ~ 10% Inside and Outside FUDS ~ 2% Unsure Inside FUDS Outside FUDS Inside and Outside FUDS Unknown Ever live, work or study in , Johns Hopkins University. All rights reserved.

28 Survey Respondent Demographics All Survey Respondents (N=865) U.S Census Data combined for and Gender Male 393 (46%) 45% Female 467 (54%) 55% Ethnicity White/Caucasian 800 (92%) 83% Black/African-American 18 (2%) 7% Hispanic/Latino 18 (2%) 7% Asian 41 (5%) 5% Native American/Alaska Native 1 (0%) 0.2% Other 10 (1%) 2% Age Under (24%) 27% (17%) 27% (31%) 28% (23%) 15% 80 and older 32 (4%) 4% , Johns Hopkins University. All rights reserved.

29 Length of Residence Time Resided Inside FUDS n=403 Outside FUDS n= n=126 n (%) / Avg. Age n (%) / Avg. Age n (%) / Avg. Age 0 to 5 years 96 (24%) / (26%) / (32%) / 23 6 to 17 years 143 (35%) / (40%) / (37%) / or more years 164 (41%) / (34%) / (31%) / , Johns Hopkins University. All rights reserved.

30 Self-Reported Personal Health Status Survey respondents in all 3 geographic areas reported equal or better overall health status than the general U.S. population Only in the case of residents living in inside the FUDS for 18 or more years was the proportion of those reporting fair/poor health slightly higher (17%) than the national average (13%) , Johns Hopkins University. All rights reserved.

31 Self-Reported Health Conditions Caveats Self-reported (many respondents reported for other family members) Respondents asked if they (or family member) were ever diagnosed 31

32 Self-Reported Health Conditions Cancer Hypertension Skin Disease Respiratory Disease Thyroid Disease Heart Disease Learning Disability Mental Illness Peripheral Neuropathy Diabetes Kidney Disease Other (please specify) 32

33 Self-Reported Health Conditions Compared to US Most were reported at percentages below US national averages Some were reported at greater frequency than US statistics: Inside FUDS: Learning Disability, Thyroid Disease Outside FUDS: Learning Disability, Peripheral Neuropathy, Thyroid Disease 20015: Hypertension, Learning Disability, Heart Disease, Peripheral Neuropathy, Respiratory Disease, Thyroid Disease 33

34 Self-Reported Health Conditions Comparing Study Areas Only In all three geographic areas, reporting of health conditions increased with age and correspondingly length of residence, as long-term residents on average were older Patterns of higher reporting within study areas (over at least 2 residence durations) Inside FUDS: diabetes, learning disability, peripheral neuropathy Outside FUDS: had no consistent pattern of higher reporting 20015: hypertension, mental illness, respiratory disease, thyroid disease , Johns Hopkins University. All rights reserved.

35 Top 5 Reported Health Concerns Inside FUDS Outside FUDS n=403 n=259 n=126 mean age = 44.3 # % mean age = 39.4 # % mean age = 36.7 # % 1. Cancer 62 15% 1. Cancer 36 14% 1. Hypertension 20 16% 2. Hypertension 53 13% 2. Skin Dis % 2. Skin Dis % 3. Skin Dis % 3. Hypertension 28 11% 3. Cancer 17 13% 4. Thyroid Dis. 29 7% 4. Thyroid Dis. 20 8% 4. Resp. Dis % 5. Resp. Dis. 27 7% 5. Resp. Dis. 19 7% 5. Thyroid Dis. 11 9% 35

36 Public Health and Community Concerns Concerns Inside FUDS Outside FUDS Drinking Water Quality Chronic Conditions Nutrition/Obesity Outdoor Air Quality Site-related chemical contamination Causes of cancer 36

37 Survey Conclusions All three geographic areas are overall healthy compared to the nation Personal health status and most health conditions reported were better than or equal to the national average (similar to the findings from the community health assessment) There was consistency in concerns across all respondent groups on drinking water, chronic conditions, outdoor air quality and nutrition/obesity. Inside FUDS area respondents expressed additional concerns related to the FUDS, causes of cancer and possible environmental contamination , Johns Hopkins University. All rights reserved.

39 Environment Assessment Components Community environmental health portraits, Data from DDOE, EPA, Washington Aqueduct Exposure pathway evaluation, Spring Valley FUDS Data from EPA and Army Corps of Engineers reports Water monitoring plans and data evaluation, Spring Valley FUDS Includes available data from Army Corps of Engineers and URS, 2005 May , Johns Hopkins University. All rights reserved.

40 Environmental Portrait Industrial Facilities and Air and Water Quality ZIP Code has a greater density of facilities that report to EPA than Air quality in the D.C. area has improved over the past 10 years Ozone is the only criteria air pollutant found above national standards in the Washington, D.C. area Exposures and risks from air toxics in the study areas and DC overall are typical of US urban areas (higher than US average) Potential for adverse respiratory outcomes due to air toxics Both the and ZIP Codes are served by the public water system Water supply meets existing standards for arsenic and perchlorate , Johns Hopkins University. All rights reserved.

42 Exposure Analysis and Water Study Review Assessment of Site- Specific Exposure Pathways Completed exposure pathways identified by JHSPH and USACE were similar, with two exceptions: JHSPH included and evaluated a landscaper worker and residents particulate inhalation (2007 Scoping Study) No increased risks were indicated from incidental and recreational exposure to surface water evaluated for all contaminants detected in sampling Evaluation of water study plans The types of data and general approaches developed for the water study are adequate to address the stated objectives Gaps identified: rationale for well location, role of biogeochemical processes, potential for groundwater seepage to surfaces , Johns Hopkins University. All rights reserved.

43 Environment Assessment Summary Ambient Air Ozone concentrations are above national standards in DC area Air toxics concentrations in the study areas and DC overall are typical of other US cities Drinking water meets existing standards for arsenic and perchlorate No increased risks from exposure to surface water sampled on site US Army Corps of Engineers water study Methods adequate to address objectives Gaps identified: rationale for well location strategy, biogeochemical processes, groundwater seepage , Johns Hopkins University. All rights reserved.

45 2013 Study Key Findings (1) Community Health Community health in the Spring Valley and Chevy Chase areas continues to be very good Mortality rates are lower than US rates for most major causes Cancer incidence and mortality rates for most of the selected cancers are lower than US rates Some cancer rate trends are increasing in both study areas where US rates are decreasing , Johns Hopkins University. All rights reserved.

46 2013 Study Key Findings (2) Survey Reports of personal health status were better than or equal to the national average Most health conditions in all geographic areas were reported with less frequency than general US population statistics All respondent groups reported concerns about drinking water, chronic conditions, outdoor air quality and obesity Respondents inside the FUDS area expressed additional concerns related to the FUDS, causes of cancer and possible environmental contamination , Johns Hopkins University. All rights reserved.

47 2013 Study Key Findings (3) Environment Exposures and risks from air toxics in DC including the study areas are higher than the US average but typical of US urban areas Air quality in the Washington, D.C. area has improved over the past 10 years. Ozone is found above national standards in D.C. area. No increased risk was indicated from exposure to surface water on site Types of data and general approaches developed for the water study adequate to address the stated objectives Areas highlighted for further documentation/evaluation: well location strategy; role of biogeochemical processes; potential for groundwater seepage on surfaces , Johns Hopkins University. All rights reserved.

48 Integrated Findings Health Health Outcome Community Survey : inside & outside FUDS Community Health Assessment & Environment Assessment & Cancer Among top 5 concerns for all study areas Overall rates lower than national average, some rate trends increasing Air toxics cancer risks low Diabetes Inside FUDS had higher reporting than other study areas (but lower than US statistics) Mortality rates lower than US Hypertension had higher reporting than US and other study areas Mortality rates lower or on par with US Learning Disability Inside FUDS had higher reporting than US and other study areas Respiratory Disease had higher reporting than US and other study areas Mortality rates lower than US Ozone, air toxics typical of urban air, potential for increased respiratory disease risk , Johns Hopkins University. All rights reserved.

49 Integrated Findings - Environment Issue Air Quality Community Survey : inside & outside FUDS All respondent groups reported concerns about outdoor air quality Environment Assessment & Ambient ozone, air toxics typical of urban air Drinking Water Quality All respondent groups reported concerns about drinking water quality Meets national standards, perchlorate levels below existing standards Site-related Exposure Respondents of Inside the FUDS area expressed additional concerns related to the FUDS, causes of cancer and possible environmental contamination No increased risks estimated for surface water exposure , Johns Hopkins University. All rights reserved.

50 Community Health Recommendations Develop a complete profile of cancer incidence and mortality including rates and time trends for all major cancers, as well as cancers selected for site-related or other community concerns. Monitor health conditions that were reported more frequently than national average in the study areas: Heart Disease, Hypertension, Learning Disability, Peripheral Neuropathy, Respiratory Disease, Thyroid Disease , Johns Hopkins University. All rights reserved.

51 Community Outreach Recommendations Monitor and report environment and health status and trends Findings should be publicly available and disseminated on a regular basis in user-friendly formats, such as neighborhood profile reports and/or interactive websites. Maintain transparency and communication with the community regarding Spring Valley FUDS remediation activities and potential health risks, as well as FUDS related health concerns. Engage with the communities to identify opportunities for communication, education and evaluation of reported topics of concern (drinking water quality, chronic conditions, outdoor air quality and nutrition/obesity) , Johns Hopkins University. All rights reserved.

52 Water Study Recommendations US ACE water study methods and approaches were found to be adequate to achieve stated objectives Recommend further documentation and evaluation on: Strategy for well location Role of biogeochemical processes on contaminant fate and transport Potential for groundwater seepage onto surfaces , Johns Hopkins University. All rights reserved.

53 2013 Study Challenges and Strengths Challenges Time lag approaching 100 years since AUES activity Lack of exposure data Disease latency High mobility of population particularly in Strengths Integrated assessment considering Community input via survey Health data Environment data Consistency of health findings across 2007 and 2013 studies Strong agreement between community survey reporting and health data analysis findings 53

54 Conclusions We found that the study areas continue to have good health We recommend: Regular monitoring and reporting on health outcomes and environmental issues of concern Maintaining transparency and engagement with the community on Spring Valley FUDS activities, potential health risks, and health concerns , Johns Hopkins University. All rights reserved.

FOLLOW-UP ON SPRING VALLEY HEALTH STUDY SUMMARY REPORT JULY 2013

FOLLOW-UP ON SPRING VALLEY HEALTH STUDY SUMMARY REPORT JULY 2013 Prepared by the Johns Hopkins Bloomberg School of Public Health under contract with the District of Columbia Department of the Environment