### I.5 Key Focus Group Findings on I-131 Exposure from the Nevada Test Site: Preliminary Findings from Public and Physician Groups

**Prepared by:**

**Office of Cancer Communications**

**National Cancer Institute**

**31 Center Drive MSC-2580**

**Building 31, Room 10A03**

**Bethesda, MD 20892-2580**

**January 2000**

**KEY FOCUS GROUP FINDINGS ON I-131 EXPOSURE FROM THE NEVADA TEST SITE:
PRELIMINARY FINDINGS FROM\
PUBLIC AND PHYSICIAN GROUPS**

**[Table of Contents]{.underline}**

> **[Page]{.underline}**

**I. INTRODUCTION** I-5-3

**II. METHODOLOGY** I-5-3

**III. KEY FINDINGS** I-5-6

A. Lower-Exposure Public I-5-7

B. Higher-Exposure Public I-5-11

C. Primary Care Physicians I-5-14

**IV. ATTACHMENTS** I-5-19

A. Participant Screening Questionnaires

B. Moderator's Topic Guides

**I. INTRODUCTION**

> The National Cancer Institute (NCI) and Centers for Disease Control
> and Prevention (CDC) are designing a national campaign to implement
> Institute of Medicine (IOM) recommendations to communicate to
> Americans the potential health effects of Iodine-131 (I-131) radiation
> released during atmospheric testing in Nevada during the 1950s and
> 1960s. To inform this effort, Office of Cancer Communication (OCC)
> conducted six focus groups during December 1999 with members of the
> higher-exposure public, the lower-exposure public, and primary care
> physicians. Primary objectives of this research were:

-   To gauge participants' awareness and knowledge of I-131 radiation
    fallout from the Nevada Test Site (NTS), as well as the potential
    risk for thyroid cancer and other non-cancerous thyroid conditions
    resulting from this exposure;

-   To determine whether participants perceive themselves or anyone else
    as being at-risk for health problems resulting from I-131 exposure
    and, if so, how concerned participants are about such risk;

-   To evaluate participants' reactions to IOM recommendations which
    discourage mass screening for thyroid cancer, but advocate for an
    educational campaign to communicate to Americans the potential
    health effects of I-131; and

-   To gain a better understanding of the information needs and wants of
    the general public and health care professionals.

> Preliminary findings from the focus groups are presented in this
> report. These findings will be used to help determine the direction
> and scope of further research for the campaign.

##### II. Methodology 

> **Audience Segments**
>
> A total of six focus groups were conducted with three audience
> segments, referred to as the "higher-exposure public," the
> "lower-exposure public," and "physicians." The higher-exposure public
> was defined as adults ages 39-64 who had lived in at least one of 18
> states exposed to high levels of I-131 for at least 5 years from birth
> to age 15.[^1] The lower-exposure public was defined as adults 34-64
> years of age who had NOT lived in one of the 18 higher-exposure states
> from birth to age 15. Conducting research with both the higher- and
> lower-exposure public was done to obtain a preliminary sense of how
> risk status might affect one's awareness, knowledge, and concerns
> about the Nevada Test Site and I-131 health implications.
>
> Physicians were defined as general practitioners, family physicians,
> or general internists who had been practicing medicine for at least
> three years in a high-exposure state. The three-year criterion ensured
> that physician participants had been in practice long enough to have
> some chance of seeing patients with radiation issues or health
> effects, and that they had been practicing in the surrounding area
> long enough to be familiar with their communities. Research was
> conducted with primary care physicians, because past research has
> shown that they are the most trusted source of both health care and
> health information.
>
> A total of 51 people participated in the focus groups: 33 were members
> of the higher-exposure or lower-exposure public and 18 were
> physicians. The six focus groups were structured as follows:

+----------------+-----------------+----------------+-----------------+
| ##### Location | **Date and      | **Audience     | **Number of     |
|                | Time**          | Segment**      | Participants**  |
+----------------+-----------------+----------------+-----------------+
| Philadelphia,  | December 7,     | Lower-exposure | 9               |
| PA             | 1999            | public         |                 |
|                |                 |                |                 |
|                | 6:00-7:30 PM    |                |                 |
+----------------+-----------------+----------------+-----------------+
| Philadelphia,  | December 7,     | Lower-exposure | 7               |
| PA             | 1999            | public         |                 |
|                |                 |                |                 |
|                | 8:00-9:30 PM    |                |                 |
+----------------+-----------------+----------------+-----------------+
| Omaha, NE      | December 13,    | H              | 9               |
|                | 1999            | igher-exposure |                 |
|                |                 | public         |                 |
|                | 5:30-7:00 PM    |                |                 |
+----------------+-----------------+----------------+-----------------+
| Omaha, NE      | December 13,    | Physicians     | 9               |
|                | 1999            |                |                 |
|                |                 |                |                 |
|                | 7:30-9:00 PM    |                |                 |
+----------------+-----------------+----------------+-----------------+
| Burlington, VT | December 14,    | H              | 8               |
|                | 1999            | igher-exposure |                 |
|                |                 | public         |                 |
|                | 5:30-7:00 PM    |                |                 |
+----------------+-----------------+----------------+-----------------+
| Burlington, VT | December 14,    | Physicians     | 9               |
|                | 1999            |                |                 |
|                |                 |                |                 |
|                | 7:30-9:00 PM    |                |                 |
+----------------+-----------------+----------------+-----------------+

> **Focus Group Sites**
>
> The higher-exposure public and physicians groups were conducted in two
> states exposed to higher levels of I-131 radiation. Omaha, NE, was
> chosen because of its close proximity to the Nevada Test Site, and
> Burlington, VT, was included because it is farther away from the site.
> These locations were selected to provide an initial reading of whether
> geographic proximity to the Nevada Test Site would affect focus group
> responses, particularly perceived risk to health problems due to I-131
> exposure. The lower-exposure public groups were held in Philadelphia,
> PA, a lower-exposure state.
>
> **Participant Recruiting Criteria**
>
> Higher-exposure and lower-exposure individuals were recruited in
> advance of the focus groups. The screening questionnaire was designed
> to separate out people with a personal history of thyroid cancer or
> disease, individuals having an immediate family member with a history
> of thyroid disease, or individuals who self-reported that they were
> familiar with the issue of radioactive fallout from nuclear testing.
> The reason for excluding these individuals was the desire to talk with
> people for whom the I-131 issue is not already salient because of
> personal knowledge or experience. Clearly, any information campaign
> which is developed will have to address those who are already
> concerned about the issue, but it will also need to address the
> concerns and information needs of a potentially much larger number of
> people who will become aware (through the campaign) they may have a
> health risk due to I-131 exposure. It is this latter group -- those
> not already knowledgeable or savvy about their potential risk -- that
> the focus groups sought to speak with[^2].
>
> In addition to the above criteria, the screening criteria ensured that
> the groups would contain a mix of women and men, a mix of races, and
> participants whose educational levels ranged from a high school
> graduate through college graduate. Copies of the recruitment screeners
> for the public and physician groups can be found in Attachment A.

+-------------------------------+------------+------------+------------+
|                               | **Number   | **Number   | **Number   |
|                               | of         | of         | of         |
|                               | Part       | Part       | Part       |
|                               | icipants** | icipants** | icipants** |
|                               |            |            |            |
|                               | *          | **(Lower-e | *          |
|                               | *(Higher-e | xposure)** | *(TOTAL)** |
|                               | xposure)** |            |            |
+-------------------------------+------------+------------+------------+
| ##### Gender                  |            |            |            |
+-------------------------------+------------+------------+------------+
| > Female                      | 8          | 9          | 17         |
+-------------------------------+------------+------------+------------+
| > Male                        | 9          | 7          | 16         |
+-------------------------------+------------+------------+------------+
| ##### Race or Ethnicity       |            |            |            |
+-------------------------------+------------+------------+------------+
| > White                       | 11         | 11         | 22         |
+-------------------------------+------------+------------+------------+
| > Black                       | 4          | 5          | 9          |
+-------------------------------+------------+------------+------------+
| > American Indian             | 2          | 0          | 2          |
+-------------------------------+------------+------------+------------+
| ##### Education               |            |            |            |
+-------------------------------+------------+------------+------------+
| > High school degree          | 3          | 5          | 8          |
+-------------------------------+------------+------------+------------+
| > Some college or technical   | 8          | 8          | 16         |
| > school                      |            |            |            |
+-------------------------------+------------+------------+------------+
| > College degree              | 5          | 3          | 8          |
+-------------------------------+------------+------------+------------+
| > Not specified               | 1          | 0          | 1          |
+-------------------------------+------------+------------+------------+

> **Topic Guide Development**
>
> The moderator's guides for the general public and physicians' groups
> were designed to: a) measure initial awareness, knowledge and concern
> about the Nevada nuclear testing in the 1950s and 1960s; b) assess
> reactions to information presented during the groups about the I-131
> exposure and its possible relationship to thyroid cancer and other
> non-cancerous thyroid disease; and c) gather opinions about the IOM
> screening recommendations as well as suggestions about implementing a
> communication campaign.
>
> After participants were asked about their general awareness, knowledge
> and concern, they were shown a newspaper article from the *Chicago
> Sun-Times* dated August 2, 1997, along with a fact sheet and map
> illustrating exposure patterns across the U.S. They were then asked
> questions to elicit their reaction to the information. The newspaper
> article was selected from a sample of press coverage appearing after
> the release of the NCI report, "Estimated Exposures and Thyroid Doses
> Received by the American Public from Iodine-131 in Fallout Following
> Nevada Atmospheric Nuclear Bomb Tests." Potential articles were judged
> on their objectivity in communicating basic facts about the I-131
> exposure and its potential relationship to thyroid cancer.
>
> Each focus group was two hours in length and was conducted by a male
> moderator in his forties. Participants were paid for their
> participation. A copy of the topic guide, as well as the stimulus
> materials, can be found in Appendices B and C.
>
> **Limitations**
>
> It should be noted that focus groups are a qualitative research
> technique which provide useful, detailed insights into the target
> audience's perceptions and motivations. Findings from qualitative
> research, however, cannot be projected to a larger audience. Rather,
> they are intended to provide guidance and direction in determining the
> best approach for communicating with key audiences about cancer risk
> research. In addition, findings from focus groups should be considered
> preliminary, laying the groundwork for further research with key
> target audiences.

##### III. KEY FINDINGS

> The remainder of this report presents the main findings from the focus
> groups. Findings related to the lower-exposure public, the
> higher-exposure public, and the physicians' groups are presented
> separately in order to give the reader an overall profile of each
> audience. However, it should be noted that there were many
> similarities across the three audience segments, particularly between
> the lower- and higher-exposure groups.
>
> **A. Lower-Exposure Public**
>
> [Awareness, Knowledge & Concern **Before** Reading Newspaper Article
> and Fact Sheet]{.underline}

-   Participants were concerned about a broad range of environmental
    concerns, including noise and water pollution, trash disposal, power
    plants, power lines, exhaust from vehicles, and "radiation" from
    computers.

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-   Participants were generally aware or had some vague recollection of
    the tests conducted at the Nevada Test site. The tests in Nevada
    were brought up by a few participants and then seemed to "ring a
    bell" for others who indicated a vague awareness of them.

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-   Several participants in each group knew the tests were conducted
    around the time of the 1950s or 1960s, but one thought tests had
    continued throughout the 1980s.

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-   Although participants were aware of the Nevada Test Site, they had
    little specific information about where their knowledge came from.
    No one knew about the NCI or IOM reports, or any other government
    reports on the issue. A couple of participants recalled seeing a
    movie about the Nevada Test Site called "Black Rain." Other
    participants mentioned television, and one got more specific and
    mentioned documentaries on programs like *Nova* and *60 Minutes*.

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-   None of the participants had specific knowledge of different types
    of radiation or radiation-induced health effects. Most expressed
    health concerns about "deformities" or "genetic alterations." One
    participant said the tests left people "crippled." Another said it
    could cause skin problems similar to those that resulted from "Agent
    Orange." Participants were particularly concerned about
    radiation-related illnesses being "passed through the genes."

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-   Participants felt little or no concern that they would suffer any
    negative health effects from the Nevada tests. Most did not consider
    themselves to be at risk and felt it was more of a concern for other
    people. One participant said, "If I lived out there I'd be
    concerned." Another said it was a problem for "those military people
    who were there at the time."

> [Concerns & Perceptions of Risk **After** Reading Newspaper Article
> and Fact Sheet]{.underline}

-   Participants were provided with a newspaper article and additional
    facts regarding the association between the Nevada tests and thyroid
    cancer, risk factors that increase the likelihood of exposure,
    examples of higher and lower exposure areas, and possible
    associations between I-131 and two other types of non-cancerous
    thyroid disease: hypothyroidism and hyperparathyroidism. Questions
    were then asked to gauge their level of concern, perceptions of
    risk, and opinions about actions that should be taken.

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-   The newspaper article and fact sheet raised levels of suspicion
    among many respondents. When asked about their initial reaction to
    the materials, many made comments like "there must be a big lawsuit
    coming" or referred to the newspaper article as a "scare tactic" no
    different from what they usually see in the news.

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-   Responses to the actual content of the material varied and included
    responses such as "frightening," surprise about the fact that
    "everyone was exposed" or the problem was so "widespread" and
    feelings of "sadness because children were affected." Others said
    the information was just "another thing to worry about."

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-   Even after reading the newspaper article and fact sheet,
    participants still did not feel a high level of personal concern
    about their risk of thyroid cancer or other non-cancerous thyroid
    disease from the Nevada Test Site 1-131 exposure. A few said there
    were more important health risks to worry about like stroke and
    heart attack. One respondent who stated that she has hypothyroidism
    said the information made her wonder about the possible connection
    to the Nevada Site, but even she did not seem overly concerned.
    Another said that the radiation had a "short half life" and no
    longer posed a risk because it was "long gone."

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-   When asked who is most at risk, participants thought the exposure
    posed a significant problem primarily to people living closer to the
    site. One said it was just not "plausible" that the radiation could
    cause problems in people thousands of miles away, and the rest of
    the group agreed. One person emphasized that she was still concerned
    about "other people being sacrificed."

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-   Few participants seemed to make the connection that *they* are the
    people who were children at the time of the tests and therefore at
    some level of risk. The length of time that has passed since the
    tests occurred and the aging of those who may be at greater risk
    seemed to make this a difficult concept for people to comprehend.

> [Actions Needed]{.underline}

-   While some participants said they would like more information about
    I-131 exposure from the Nevada Tests, few seemed to want it out of
    concern for their own health. Most wanted more information in order
    to clear up what they perceived as discrepancies in the newspaper
    article. More participants in the first group wanted additional
    information than did those in the second group. A few participants
    said they didn't want more information because the issue "does not
    affect me" or "it is someone else's problem." One participant said
    it was like "AIDS" in the sense that "sometimes you just don't want
    to know if you have a problem or not."

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-   Among the few who wanted more information, interest focused
    primarily on more conclusive information on the association between
    I-131 and development of thyroid cancer, why the study took 14
    years, and why it was still going to take more time to know whether
    people are "going to get cancer from the tests or not."

-   In general, thyroid screening and the false positives associated
    with screening were difficult concepts for people to understand.

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-   Reactions to the IOM recommendation not to conduct screening were
    mixed. Reasons for not supporting the IOM recommendation included
    statements like "If there is anything the government can do, it
    should be done" or "It sounds like the government is copping out."
    Participants who supported screening stressed the individual's right
    to choose, rather than concern about whether they themselves should
    (or might elect to) be screened.

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-   Proponents of the IOM recommendation expressed other views. One
    participant said screening would just cause a "panic." Another
    suggested screening in "limited areas." And one, who inaccurately
    thought cancer could be detected by a blood test, kept asserting
    that blood tests should be conducted because they would not cause
    anyone any harm.

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-   Regardless of whether or not they agreed with the IOM screening
    recommendation, many thought each individual should have the final
    say in whether or not to be screened.

> [Educational Effort: Who Should Conduct It?]{.underline}

-   Most participants thought government should be involved in an
    educational effort because the government was "responsible" for what
    happened. Many individuals thought the American Cancer Society would
    be appropriate. Other groups mentioned included the Red Cross,
    Greenpeace, local and city health centers and other medical groups.
    A few thought a combination of government and non-government groups
    would be best.

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-   When asked what organizations should not be involved, some said the
    federal government because it "caused the problem" and therefore
    would not be trusted. A few said that only the part of government
    which caused the problem (i.e., "the military") should not be
    involved. One participant expressed distrust of the Environmental
    Protection Agency (EPA) and said that agency should not take part.

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-   When probed about the appropriateness of the National Cancer
    Institute's involvement in an educational effort, participants said
    they had never heard of the institute. One participant said he
    thought the National Cancer Institute might be part of the National
    Institutes of Health, which may be associated with Johns Hopkins.
    Another participant then said the National Institutes of Health was
    a "research organization" that might be affiliated with that "group
    out of Atlanta," prompting another respondent to mention the "CDC."

> [Ethical Considerations]{.underline}

-   Participants were generally divided over whether there was good
    reason for conducting the Nevada bomb tests during the 1950s and
    1960s. Some said the tests were necessary to ensure the safety of
    Americans during the Cold War. Others said that it is "never right
    to sacrifice anyone" and that the nuclear testing "should not have
    been done because of the problems it caused." One participant also
    mentioned that the public could have been better protected from the
    radiation fallout at the time of the nuclear testing.

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-   Several participants expressed the opinion that "the government" (no
    agency specified) will always keep secrets and will never disclose
    the "full story" about nuclear testing pertaining to the past,
    present, or future.

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-   A couple of participants said that, in addition to being informed
    about the Nevada bomb testing and its resultant health effects, they
    would want assurance that nuclear testing would never happen again.
    Most of the other participants, however, took the viewpoint that the
    nuclear testing was over and that nothing could be done about it. In
    the words of one participant, "You can't right a wrong."

> **B. Higher-Exposure Public**
>
> [Awareness, Knowledge & Concern **Before** Reading Article and Fact
> Sheet]{.underline}

-   Participants expressed a broad range of general concerns about
    environmental hazards, from air and water pollution to lead paint,
    but provided few specifics. One participant said she was worried
    about "carcinogens\...that are just everywhere nowadays."

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-   Participants had little knowledge about nuclear testing in general
    or the Nevada Test Site in particular. A few participants could name
    locations in the U.S. where nuclear testing has been conducted,
    including "the Pacific," "the West," and the state of Nevada. A
    couple of these participants thought testing was still going on in
    these locations. Only a few recalled specific dates of the nuclear
    testing, expressing a vague recollection that "there was some
    nuclear testing that went on in the 1950s and 1960s." Participants
    had no specific knowledge of different types of radiation or
    radiation-induced health effects from the Nevada Test Site. Several
    expressed the view that the government has kept secrets about
    nuclear testing.

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-   Most participants could not recall the source of their information
    about the Nevada nuclear tests. A few vaguely recalled hearing
    something in "the news" or through "a documentary." One participant,
    for example, recalled seeing a program on the History Channel that
    "had something to do with radiation exposure and military men."
    Another said she thought the Discovery Channel might have run a
    documentary about the issue in the not too distant past. Another
    participant remembered some media coverage happening "when people
    were invited to watch some above-ground testing with special
    glasses." Although she couldn't recall the specifics, she
    characterized the event as "a real big deal."

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-   Participants initially expressed little concern about suffering any
    negative health effects from the Nevada tests. One participant,
    describing the tests as "underground tests," said he hoped the
    people conducting the tests now were protecting the environment to
    avoid any "contamination of the atmosphere or water supply." Another
    participant responded by saying it was more important to be
    concerned about the effects of such tests on people and animals than
    the environment. Another emphasized that people should worry more
    about the present than the past. One Vermont participant expressed
    little concern because of living far away from the Nevada Test Site
    (Note: this perception later changed when participants saw a map
    illustrating that radiation fallout had been carried from the West
    to the East).

> [Perceptions of Personal Risks & Concerns **After** Reading Article
> and Fact Sheet]{.underline}

-   Prior to seeing the article and fact sheet, participants were asked
    whether they remembered hearing anything in the news about two years
    ago. None remembered anything too specific. A couple of participants
    said they remembered hearing something, but they either could not
    recount the details or mentioned other events such as the nuclear
    testing in India and Pakistan.

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-   The newspaper article and fact sheet initially evoked an emotional
    reaction from some participants. Some Nebraska and Vermont
    participants said they were "shocked" and that the information made
    them feel "unsafe." However, these emotional reactions dissipated
    quickly after the first few minutes of conversation.

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-   When asked who in the population is most at risk, most participants
    in Nebraska and Vermont immediately noted that people living in
    their own geographical areas were exposed, often referring to the
    color map of exposure levels. Comments like, "We are in the red" or
    "It is right over us" were fairly frequent during the course of the
    groups. Few participants, however, fully comprehended that they
    might also be at risk because they were children at the time of
    testing and may have consumed contaminated milk.

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-   Despite some initial surprise over seeing the "red spots," personal
    concern about developing cancer or non-cancerous thyroid disease was
    minimal. Most participants said they were not too concerned because:

-   They cannot change the past

-   They need to focus on the future

-   They question the credibility of some of the information in the
    article

-   They need more information to determine their true risk

-   It would be difficult to prove that any thyroid occurrence is
    actually caused by I-131 exposure

-   They have other more immediate health concerns such as heart
    disease, high blood pressure, prostate cancer, and breast cancer

-   They have other (non-health) concerns such as neighborhood violence

-   Thyroid problems have not surfaced thus far after routine checkups

-   The chances of getting thyroid cancer are small

> As one participant explained, "I'm sure we probably read about these
> nuclear tests at one time but then forgot about them. It's not the
> 'here and now.' The only reason we are thinking about it now is
> because you are making us think about it."

-   The issue of whether or not their children or spouses could be
    affected resonated more with participants than their own personal
    risk. A few asked questions about whether or not the effects of the
    exposure could be "passed down." Another said, "If we were affected,
    that means someone in our family could be affected. How are
    offspring affected?" One person was worried that the exposure could
    have caused "a flaw in the \[genetic\] system that will keep getting
    passed down." Another participant, still misunderstanding the time
    period of exposure, said she was glad her children don't drink milk.

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-   A couple of participants said they would worry more about getting
    other types of cancers from the tests as opposed to developing
    thyroid problems. One participant asked, "Why does all this focus on
    the thyroid?" Another participant said he thought skin and bone
    cancer might be more likely problems based on what happened to the
    people who were bombed in Japan.

> [Actions Needed]{.underline}

-   Throughout the discussions, participants raised more questions than
    personal concerns about the tests. Questions that have not already
    been mentioned include:

> \-- Were all the tests underground?
>
> \-- How long does the I-131 fallout last? What is the half-life?
>
> \-- Can radiation sink into the ground? If so, can it rise back above
> the surface of the ground?
>
> \-- Was the information on the fact sheet compiled during the time of
> the testing or now?
>
> \-- Weren't the tests conducted in the desert so they wouldn't harm
> any people, plants or animals?

-   The majority of participants agreed that a public information
    campaign would be appropriate. One participant said, "The more
    people know, the better." However, a couple individuals in the
    groups noted that it would be important to conduct the campaign
    carefully so people don't panic needlessly.

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-   The majority of participants were not supportive of the IOM
    recommendation against screening. Most thought people should have
    the option to decide whether or not they needed to be screened. As
    one participant put it, "If they think it is relevant for them and
    they want to have it done, this should override the recommendation."

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-   Several participants requested more information about how to get
    tested for thyroid disease, including where to go and what the test
    involves. One respondent suggested providing information about how
    to check one's own thyroid gland for lumps or problems.

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-   A couple of participants were concerned that mandatory screening
    might cause a panic. This prompted one participant to suggest a
    campaign to inform doctors, so doctors could then decide whether or
    not a patient needed screening. A few others agreed with this
    recommendation.

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-   A few participants focused on compensation issues related to
    screening. One thought the government needed to pay for the
    screening, particularly for people with no insurance, since it was
    the government that caused the problem. Another participant
    questioned the motive behind the IOM recommendation, saying
    insurance companies and medical doctors were probably trying to get
    out of paying for the screening. One participant said those who were
    hurt should get "a big check" from the government and then laughed.

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-   A few participants thought that additional research was needed to
    develop a less-invasive screening test for thyroid cancer so more
    people can get screened without being harmed. Several also wanted
    more conclusive evidence showing that I-131 does cause health
    problems.

> [Educational Effort: Who Should Conduct It?]{.underline}

-   Participants had few suggestions about who should conduct an
    educational effort. When probed, a few said the federal government
    should head the effort since it was responsible for the exposure;
    several specifically said the Public Health Service and Centers for
    Disease Control and Prevention. In addition, a few participants
    indicated that their local governments should be responsible.
    Another participant said that "public health organizations that do
    things like vaccines" would be appropriate. Other organizations
    mentioned were Blue Cross, EPA, and the American Cancer Society.

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-   A few participants thought that people would be best educated by
    their own personal doctor. One participant suggested using an
    article in a medical society journal to educate physicians.

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-   When asked if the federal government needed to stay out of the
    effort, only a few participants commented. One said yes because
    "they lied once and they'll do it again." Another participant
    thought it was okay for the government to conduct the effort
    "because the people in government today are not the same people as
    40 years ago." Some participants felt that local government would be
    better, explaining that local government is more personal and less
    likely to withhold information.

> [Ethical Considerations]{.underline}:

-   Ethical issues related to the Cold War were brought up at two
    different points during the focus groups \-- at the very beginning
    when participants were asked for their concerns about consequences
    from the Nevada tests and then again after reading the article. A
    few participants said testing needed to be conducted for the U.S. to
    maintain the "balance of power."

```{=html}
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```
-   Only a couple of individuals commented when asked why it was or why
    it was not important to educate the public about what happened. One
    participant said it was important because people were "exposed
    without their knowledge." Another participant was unsure whether an
    educational effort was justified because "there was no real thyroid
    cancer outbreak."

> **C. Primary Care Physicians**
>
> [Awareness, Knowledge & Concern **Before** Reading Article and Fact
> Sheet]{.underline}

-   In general, physicians had vague memories but little actual
    knowledge about nuclear weapons tests conducted in the United
    States. A couple of participants said they had heard something about
    the issue in the last few years, but could not provide specifics.
    One participant said he remembered hearing that the government
    admitted to exposing people to radiation from some tests that were
    conducted in the 1950s and 1960s. Another said the government also
    admitted that workers at a test site in the 1950s were exposed to
    radiation. In addition, one participant recalled that soldiers were
    affected by tests conducted "when the atomic bombs were developed."
    Another physician recounted his father warning him as a child to
    refrain from eating snow, though he did not understand why. Only one
    participant in Vermont knew specific details about the Nevada
    testing, recalling that fallout resulted from tests conducted around
    1946-1955, that one type of fallout was strontium 90, and that
    weather patterns carried fallout across the US.

```{=html}
<!-- -->
```
-   Participants mentioned the western United States, Nevada, Utah and
    New Mexico when asked about nuclear testing locations.

```{=html}
<!-- -->
```
-   Most participants could provide no details about specific types of
    radiation emitted from the tests or about specific health or
    non-health related consequences.

```{=html}
<!-- -->
```
-   Participants could not recall where they received information about
    the Nevada nuclear tests. One participant thought there might have
    been a program about the issue on the Discovery Channel at one time.
    Another recalled seeing a person on television who recounted
    watching atomic bomb tests and suffering health effects afterward.

```{=html}
<!-- -->
```
-   Participants expressed little concern about their patients having
    negative health consequences as a result of the Nevada Test Site
    exposures. One participant said, "I have no day-to-day concerns. It
    was many years ago." Another participant thought that any serious
    consequences "would have shown up by now."

```{=html}
<!-- -->
```
-   Only a few participants recalled having any patients ask them about
    negative health effects from exposure to nuclear fallout. One
    physician said that only a few of his patients have expressed
    concern, and he told them how to "watch for lumps on their thyroid
    and other symptoms." Another participant said he had one patient
    with leukemia ask him if it might be related to the tests, but he
    couldn't give the patient an answer. Another mentioned a patient
    with a brain tumor who once asked about the possible connection to
    radiation fallout. Other participants said their patients are
    concerned about and ask questions about cancer, but they don't tend
    to relate it to the environment.

```{=html}
<!-- -->
```
-   Participants offered some explanations for why their patients are
    not concerned about radiation from the Nevada Test Site. One
    participant said patients are more concerned about negative health
    effects from nuclear power plants or disposal sites. A couple other
    participants said cellular telephones have recently become a big
    issue. Another physician noted that a majority of the population of
    Omaha, Nebraska, moved there from someplace else, thereby diluting
    the level of concern. Another said, "The testing was so long ago
    that people have forgotten about it; that's what the government
    wants."

> [Awareness, Knowledge & Concern **After** Reading Article and Fact
> Sheet]{.underline}

-   When asked about their initial reaction to the news article and fact
    sheet, participants responded with questions such as:

-   How did they determine radiation exposure for various areas of the
    country?

-   How was the data on dosage collected?

-   How can there be areas in the Central US where there was no exposure
    in between areas in the West and East where there was high exposure?

-   Do thyroid cancer rates map out similar to the radiation dosages
    displayed on the fact sheet?

-   What type of thyroid cancer might result from exposure to I-131?

-   Is there any scientific evidence that shows a direct link between
    I-131 exposure and thyroid diseases of any kind?

-   What's happening in Canada?

```{=html}
<!-- -->
```
-   Physicians repeatedly expressed a desire for sound scientific data
    about radiation dosage and links to negative health effects. Some
    even questioned the validity of the data that currently exists. One
    participant said he remembered a talk given by a lecturer at the
    National Cancer Institute who said the NCI exposure data was
    inaccurate and excluded some people who had higher-exposure because
    they drank milk from cattle. Another participant said she assumed
    any exposure information provided by the government would be wrong.

```{=html}
<!-- -->
```
-   The majority of participants said they would only be concerned for
    their patients if they received appropriate risk information
    indicating that there is a substantial increase in thyroid cancer.
    One participant said physicians would need to know if there was some
    type of evidence pointing to a "10% to 15% increase in thyroid
    cancer." Another asked, "Is this a hypothetical or a *true* risk?"

```{=html}
<!-- -->
```
-   The majority of participants agreed that they would not change the
    way they practice medicine based on the information they had just
    received and the ensuing discussion. Reasons for not changing their
    practice were as follows:

-   Thyroid cancer is rare (particularly in Nebraska and Vermont). One
    participant said she has only seen one case of thyroid cancer in
    twelve years.

-   Thyroid cancer is very survivable.

-   Most patients have other, more pressing health concerns such as
    breast cancer.

-   People are already "dying off from something else" by the time they
    get thyroid cancer.

-   The issue of I-131 has "fallen off the radar screen."

-   There is not enough scientific evidence to warrant a high degree of
    concern.

-   They do not want to unnecessarily alarm their patients with
    information that, to date is scientifically unfounded.

-   They already routinely check for cancerous and non-cancerous thyroid
    problems during regular physical exams.

> [Actions Needed]{.underline}

-   When asked what should be done to address I-131 exposure from the
    Nevada bomb testing, participants mentioned that the environment
    (air, water, and soil) should be tested and that nuclear testing
    should be permanently banned.

```{=html}
<!-- -->
```
-   Most participants thought an educational campaign targeting the
    public would be unnecessary and would only serve to cause undue
    public alarm. One participant said, "Too many things have been done
    in medicine before all the facts are in; we often put education
    before science." Others agreed that nothing should be done until a
    meaningful increase in actual risk is demonstrated. A couple of
    participants said a public education campaign would cause "a mess."
    Another stated that physicians are sometimes pressured by media
    coverage to do things just to put their patients' concerns to rest.

```{=html}
<!-- -->
```
-   Nearly all participants agreed that a medical education campaign
    targeted at physicians would not be beneficial because, again, the
    information would not change the way they practice medicine. One
    participant thought some very basic information provided to
    physicians in higher-exposure areas may be useful just to put them
    "on alert."

```{=html}
<!-- -->
```
-   All participants agreed with the IOM recommendation that screening
    at this time is unwarranted. All agreed that thyroid cancer is rare,
    very survivable and that false positives would result in more harm
    than good being done to patients. A couple of participants said they
    were also uncertain about the real benefits associated with early
    detection of thyroid cancer. One participant stated that checking
    everyone's thyroid would be a "logistical public health nightmare."

> [Educational Effort: Who Should Conduct It?]{.underline}

-   If any educational effort were to be conducted, some participants
    thought the National Cancer Institute or the National Institute of
    Health would be the most appropriate sponsor because they are
    science-oriented. Others mentioned medical societies like the
    American Medical Association or their professional membership
    organizations such as the American Association of Family Physicians
    (AAFP).

```{=html}
<!-- -->
```
-   A couple of participants expressed concerns about sponsorship by
    advocacy organizations because they are not research-based and could
    be motivated by self-interests. Some participants said the American
    Cancer Society should not be involved for this reason. When the
    Vermont participants were asked about the Society of Physicians for
    Responsible Medicine, all of them laughed and immediately
    discredited the group as being too politically extreme.

> [Ethical Considerations]{.underline}

-   Ethical issues regarding why the nuclear tests were conducted and
    about individuals' right to know triggered little interest among
    physician participants.

```{=html}
<!-- -->
```
-   Most physicians thought it would be unethical to launch any type of
    educational effort before there is scientific data to support the
    necessity of such an effort. One participant said, "It would not be
    a public service announcement, it would be a public disservice
    announcement."

> **I-5 ATTACHMENTS**
>
> **I-5-A. Participant Screening Questionnaires**
>
> **I-5-B. Moderator's Topic Guides**

**ATTACHMENT I-5-A**

**OMB# 0925-0046**

**Exp. Date 8/31/00**

**Screener for Health Focus Groups with Public**

**Name**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Street Address**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**City**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Zip
Code**: \_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

**Home Phone**: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Work
Phone**: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+---+-------------+------------------+-------------+------+----------+
|   | **City**    | **Group**        | *           | **Da | **Time** |
|   |             |                  | *Facility** | te** |          |
+---+-------------+------------------+-------------+------+----------+
| - | Ph          | Lower risk       | Focus       | Dec. | 6:00 PM  |
|   | iladelphia, |                  | Pointe      | 7    |          |
|   | PA          |                  |             |      |          |
|   |             |                  |             |      |          |
+---+-------------+------------------+-------------+------+----------+
| - | Ph          | Lower risk       | Focus       | Dec. | 8:00 PM  |
|   | iladelphia, |                  | Pointe      | 7    |          |
|   | PA          |                  |             |      |          |
|   |             |                  |             |      |          |
+---+-------------+------------------+-------------+------+----------+
|   |             |                  |             |      |          |
+---+-------------+------------------+-------------+------+----------+
| - | Omaha, NE   | Higher risk      | Midwest     | Dec. | 5:30 PM  |
|   |             |                  | Survey      | 13   |          |
|   |             |                  |             |      |          |
|   |             |                  |             |      |          |
+---+-------------+------------------+-------------+------+----------+
| - | Burlington, | Higher risk      | Action      | Dec. | 5:30 PM  |
|   | VT          |                  | Research    | 14   |          |
|   |             |                  |             |      |          |
|   |             |                  |             |      |          |
+---+-------------+------------------+-------------+------+----------+

##### INTRODUCTION

Hello, my name is \_\_\_\_\_\_\_\_\_\_\_, and I'm calling on behalf of a
national, non-profit organization concerned about the health and
well-being of Americans. We're talking to people to learn their opinions
about some important environmental and health issues.\
I want to assure you that we're not selling anything and that your
responses will be kept confidential.\
\
May I speak to an adult in the household? (ONCE SPEAKING TO ADULT,
REPEAT INTRODUCTION IF NECESSARY AND ASK:) Would you be willing to
answer a few questions?

-   Yes (CONTINUE)

-   No (THANK AND TERMINATE)

1.  What is your exact age? (RECORD EXACT RESPONSE AND CODE IN
    APPROPRIATE AGE SUBGROUP.)

> **Age**: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   Younger than 39 (THANK AND TERMINATE)

-   39-47 (RECRUIT 4)

-   48-56 (RECRUIT 4)

-   57-64 (RECRUIT 4)

-   65 or older (THANK AND TERMINATE)

2.  I'm going to read you a list of statements. For each one, please
    tell me whether you agree, neither agree nor disagree, or disagree
    with that statement. (READ.)

+---------------------+-----------+-----------+-----------+-----------+
|                     | **Agree** | **Neither | **D       | **Don't   |
|                     |           | Agree nor | isagree** | Know/\    |
|                     |           | D         |           | Refused** |
|                     |           | isagree** |           |           |
+---------------------+-----------+-----------+-----------+-----------+
| To protect the      | 1         | 2\        | 3\        | 9         |
| environment, people |           | (         | (         |           |
| need to make big    | (         | CONTINUE) | CONTINUE) | (         |
| changes in the way  | CONTINUE) |           |           | CONTINUE) |
| they live.          |           |           |           |           |
+---------------------+-----------+-----------+-----------+-----------+
| I am concerned      | 1         | 2\        | 3\        | 9         |
| about the           |           | (         | (         |           |
| environment because | (         | CONTINUE) | CONTINUE) | (         |
| of the potential    | CONTINUE) |           |           | CONTINUE) |
| harm to myself and  |           |           |           |           |
| my family.          |           |           |           |           |
+---------------------+-----------+-----------+-----------+-----------+

3.  Different areas of the country are more or less concerned about
    environmental issues. Thus, where we have lived can affect our
    opinions about the environment.

```{=html}
<!-- -->
```
a.  I'm going to read you a list of states, and please tell me if you
    lived in any of these states between the time you were born and
    age 15. (READ STATES IN COLUMN "a" AND CHECK ANY STATES WHERE
    RESPONDENT LIVED BETWEEN THE AGES OF 0-15. MULTIPLE RESPONSES
    ACCEPTED.\
    \
    IF NO CHECKS ARE MADE IN COLUMN "a," CLASSIFY AS "[LOWER
    RISK]{.underline}" AND SKIP TO Q3.\
    \
    IF ONE ORE MORE STATES ARE CHECKED, ASK Q2b FOR EACH STATE
    MENTIONED.)

b.  Did you live in \[STATE\] for at least 5 years? (USE COLUMN "b" TO
    CHECK ANY STATE(S) WHERE RESPONDENT LIVED AT LEAST 5 YEARS.\
    \
    CLASSIFY AS "[HIGHER RISK]{.underline}" ANY RESPONDENT WHO HAS LIVED
    IN AT LEAST ONE OF THE LISTED STATES FOR AT LEAST 5 YEARS BETWEEN
    THE AGES OF 0-15.)

+-----------------------+------------------+--------------------------+
|                       | **a. Lived in    | **b. At least 5 years\   |
|                       | state from age   | (ASK HIGHER RISK ONLY)** |
|                       | 0-15**           |                          |
+-----------------------+------------------+--------------------------+
| (1) Arkansas          | -                | -                        |
+-----------------------+------------------+--------------------------+
| (2) Colorado          | -                | -                        |
+-----------------------+------------------+--------------------------+
| (3) Idaho             | -                | -                        |
+-----------------------+------------------+--------------------------+
| (4) Illinois          | -                | -                        |
+-----------------------+------------------+--------------------------+
| (5) Iowa              | -                | -                        |
+-----------------------+------------------+--------------------------+
| (6) Kansas            | -                | -                        |
+-----------------------+------------------+--------------------------+
| (7) Minnesota         | -                | -                        |
+-----------------------+------------------+--------------------------+
| (8) Missouri          | -                | -                        |
+-----------------------+------------------+--------------------------+
| (9) Montana           | -                | -                        |
+-----------------------+------------------+--------------------------+
| (10) Nebraska         | -                | -                        |
+-----------------------+------------------+--------------------------+
| (11) Nevada           | -                | -                        |
+-----------------------+------------------+--------------------------+
| (12) North Dakota     | -                | -                        |
+-----------------------+------------------+--------------------------+
| (13) Oklahoma         | -                | -                        |
+-----------------------+------------------+--------------------------+
| (14) South Dakota     | -                | -                        |
+-----------------------+------------------+--------------------------+
| (15) Utah             | -                | -                        |
+-----------------------+------------------+--------------------------+
| (16) Vermont          | -                | -                        |
+-----------------------+------------------+--------------------------+
| (17) Wisconsin        | -                | -                        |
+-----------------------+------------------+--------------------------+
| (18) Wyoming          | -                | -                        |
+-----------------------+------------------+--------------------------+

4.  Currently there are many issues about the environment under public
    debate, and different people are more or less familiar with them.
    I'm going to read you a list of specific environmental issues. For
    each one, please tell me whether you are "familiar," "neither
    familiar nor unfamiliar," or "not at all familiar" with that issue.

+--------------------+------------+-----------+-----------+-----------+
|                    | **         | Neither   | **Not at  | **Don't   |
|                    | Familiar** | Familiar  | All       | Know/\    |
|                    |            | Nor       | F         | Refused** |
|                    |            | U         | amiliar** |           |
|                    |            | nfamiliar |           |           |
+--------------------+------------+-----------+-----------+-----------+
| Liquid waste from  | 1          | 2\        | 3\        | 9         |
| chemical plants.   |            | (         | (         |           |
|                    | (CONTINUE) | CONTINUE) | CONTINUE) | (         |
|                    |            |           |           | CONTINUE) |
+--------------------+------------+-----------+-----------+-----------+
| Residual           | 1          | 2\        | 3\        | 9         |
| pesticides in the  |            | (         | (         |           |
| water supply.      | (CONTINUE) | CONTINUE) | CONTINUE) | (         |
|                    |            |           |           | CONTINUE) |
+--------------------+------------+-----------+-----------+-----------+
| Radioactive        | 1          | 2\        | 3         | 9         |
| fallout from       |            | (         |           |           |
| nuclear testing.   | (THANK AND | CONTINUE) | (         | (         |
|                    | TERMINATE) |           | CONTINUE) | CONTINUE) |
+--------------------+------------+-----------+-----------+-----------+
| Toxic air          | 1          | 2\        | 3\        | 9         |
| emissions from     |            | (         | (         |           |
| coal plants used   | (CONTINUE) | CONTINUE) | CONTINUE) | (         |
| to generate        |            |           |           | CONTINUE) |
| electricity.       |            |           |           |           |
+--------------------+------------+-----------+-----------+-----------+

5.  Since this study is also about health, I'm going to ask you some
    health related questions. Have you have ever been diagnosed with any
    of the following diseases ... (READ. DO **NOT** RECRUIT PARTICIPANTS
    WHO HAVE HAD THYROID DISEASE OR CANCER.)

-   Respiratory disease (CONTINUE)

-   Heart disease (CONTINUE)

-   Thyroid disease (THANK AND TERMINATE)

-   Cancer of any kind (THANK AND TERMINATE)

6.  Have any of your immediate family members, that is, your parents,
    brothers or sisters, partner, or children, ever been diagnosed with
    any of the following diseases ... (READ. DO **NOT** RECRUIT
    PARTICIPANTS WHO HAVE HAD IMMEDIATE FAMILY MEMBER DIAGNOSED WITH
    THYROID DISEASE.)

-   Respiratory disease (CONTINUE)

-   Heart disease (CONTINUE)

-   Thyroid disease of any kind, including thyroid cancer (THANK AND
    TERMINATE)

-   Cancer of any other kind (CONTINUE)

7.  I have a few more questions to ask for classification purposes.
    Which of the following best describes your race? (READ. RECRUIT 8
    WHITE AND 4 NON-WHITE. NEBRASKA FACILITY MUST RECRUIT AT LEAST 2
    AMERICAN INDIAN/ALASKA NATIVE.)

-   White

-   Black or African American

-   Hispanic or Latino

-   Asian

-   Native Hawaiian/Other Pacific Islander

-   American Indian /Alaska Native

8.  Which of the following best describes your highest level of
    education? (READ.)

-   Less than high school degree (THANK AND TERMINATE)

-   High school degree (RECRUIT AT LEAST 3)

-   Some college/technical school/associates degree (RECRUIT AT LEAST 3)

-   4-year college degree (RECRUIT NO MORE THAN 3)

-   Some graduate school or more (THANK AND TERMINATE)

9.  (NOTE GENDER:)

-   Male (RECRUIT 6)

-   Female (RECRUIT 6)

10. Have you ever been employed in any of the following settings?

  --------------------------- -------------- ------------- ----------------
                              **Yes**        No            **Don't
                                                           Know/Refused**

  Medical or health setting   (THANK AND     (CONTINUE)    (THANK AND
                              TERMINATE)                   TERMINATE)

  Advertising or market       (THANK AND     (CONTINUE)    (THANK AND
  research setting            TERMINATE)                   TERMINATE)
  --------------------------- -------------- ------------- ----------------

11. Have you ever participated in a focus group discussion or been paid
    to be part of a discussion group?

-   Yes (CONTINUE)

-   No (SKIP TO INVITATION)

12. How recently did you participate in the focus group?

-   6 months ago or less (THANK AND TERMINATE)

-   More than 6 months ago (CONTINUE)

13. What did you talk about during the groups? (RECORD VERBATIM. DO NOT
    RECRUIT IF TOPICS WERE ABOUT THE ENVIRONMENT, ATOMIC BOMBS, NUCLEAR
    RADIATION, THYROID DISEASE, OR CANCER.)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
\
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
\
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### INVITATION

Thank you for answering our questions. We'd like to invite you to take
part in a focus group discussion of 8-10 people. We're talking to adults
across the U.S. so that we can better plan for a national program
focusing on the environment and the health of Americans. Your
participation is very important to us. The focus group will take place
\[FACILITY, DATE, TIME\] and will last about 2 hours. Participants will
be paid \$\_\_\_\_\_ in cash for their time to take part. We'll also
serve refreshments. Will you take part?

-   Yes (CONTINUE)

-   No (THANK AND TERMINATE)

Thanks for accepting our invitation. For contact purposes, may I get
your name, address, and daytime and evening phone numbers? (RECORD
INFORMATION ON FIRST PAGE)

We will send you a packet with a confirmation letter three to five days
before the focus group is held. It will include directions to the
location where the discussion will take place. It is very important that
you arrive on time. If you need glasses for reading, please bring them
to the discussion. If you have any questions or find out that you cannot
attend the focus group, please call \_\_\_\_\_\_\_\_\_\_\_ at
\_\_\_\_\_\_\_\_\_\_ so that we can find someone to take your place.
Thank you for agreeing to take part in our study. We look forward to
meeting you. Goodbye.

(NOTE TO RECRUITER: If respondents have any questions or concerns about
the focus group topic, please contact Memi Miscally at Porter Novelli at
202-973-5845. Do NOT give her name to respondents.)

**Recruited by**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Date**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Confirmed by**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Date**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

OMB# 0925-0046

Exp. Date 8/31/00

Screener for Health Focus Groups with Physicians

##### Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Street Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
**

**City: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Zip Code: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
**

**Home Phone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Work Phone:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

+---+----------------+---------------+-------------+------+----------+
|   | **City**       | **Group**     | *           | **Da | **Time** |
|   |                |               | *Facility** | te** |          |
+---+----------------+---------------+-------------+------+----------+
| - | Omaha, NE      | Physicians    | Midwest     | Dec. | 7:30 PM  |
|   |                |               | Survey      | 13   |          |
|   |                |               |             |      |          |
|   |                |               |             |      |          |
+---+----------------+---------------+-------------+------+----------+
| - | Burlington, VT | Physicians    | Action      | Dec. | 7:30 PM  |
|   |                |               | Research    | 14   |          |
|   |                |               |             |      |          |
|   |                |               |             |      |          |
+---+----------------+---------------+-------------+------+----------+

##### INTRODUCTION

Hello, my name is \_\_\_\_\_\_\_\_\_\_\_, and I'm calling on behalf of a
national, non-profit organization concerned about the health and
well-being of Americans. We're talking to physicians to learn their
opinions about some important health issues. I want to assure you that
we're not selling anything and that your responses will be kept
confidential. May I speak to a physician? (ONCE SPEAKING TO PHYSICIAN,
REPEAT INTRODUCTION IF NECESSARY AND ASK:) Would you be willing to
answer a few questions?

-   Yes (CONTINUE)

-   No (THANK AND TERMINATE)

1.  Which of the following best describes the kind of medicine you
    practice? (READ.)

```{=html}
<!-- -->
```
a.  General practice (CONTINUE)

b.  Family practice (CONTINUE)

c.  General internist (CONTINUE)

d.  Other (THANK AND TERMINATE)

```{=html}
<!-- -->
```
2.  Are you a practicing physician---that is, do you see patients on a
    regular basis?

> a\. Yes (CONTINUE)
>
> b\. No (THANK AND TERMINATE)

3.  Which of the following best describes how old the majority of your
    patients are? Are they ... (READ.)

```{=html}
<!-- -->
```
a.  Younger than 18 (THANK AND TERMINATE)

b.  18-64 (CONTINUE)

c.  65 or older (THANK AND TERMINATE)

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4.  Do you see approximately equal numbers of males and females?

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a.  Yes (CONTINUE)

b.  No (THANK AND TERMINATE)

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5.  How many years have you been practicing medicine?

> a\. Less than 5 years (THANK AND TERMINATE)
>
> b\. 5 years or more (CONTINUE)

6.  How long have you been practicing in the state of Nebraska/Vermont?

> a\. Less than 3 years (THANK AND TERMINATE)
>
> b\. 3 years or more (CONTINUE)

7.  Are you employed full-time by a managed care company such as Kaiser
    Permanente or Aetna?

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a.  Yes (RECRUIT NO MORE THAN 2)

b.  No (CONTINUE)

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8.  Have you ever been employed in an advertising or market research
    setting?

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a.  Yes (THANK AND TERMINATE)

b.  No (CONTINUE)

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9.  Have you ever participated in a focus group discussion or been paid
    to be part of a discussion group?

-   Yes (CONTINUE)

-   No (SKIP TO INVITATION)

10. How recently did you participate in the focus group?

-   6 months ago or less (THANK AND TERMINATE)

-   More than 6 months ago (CONTINUE)

11. What did you talk about during the groups? (RECORD VERBATIM. DO NOT
    RECRUIT IF TOPICS WERE ABOUT THE ENVIRONMENT, ATOMIC BOMBS, NUCLEAR
    RADIATION, THYROID DISEASE, OR CANCER.)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
\
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\
\
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

##### INVITATION

Thank you for answering our questions. We'd like to invite you to take
part in a focus group discussion of 8-10 people. We're talking to
physicians across the U.S. so that we can better plan for a national
program focusing on the health of Americans. Your participation is very
important to us. The focus group will take place \[FACILITY, DATE,
TIME\] and will last about 2 hours. Participants will be paid
\$\_\_\_\_\_ in cash for their time to take part. We'll also serve
refreshments. Will you take part?

-   Yes (CONTINUE)

-   No (THANK AND TERMINATE)

Thanks for accepting our invitation. For contact purposes, may I get
your name, address, and daytime and evening phone numbers? (RECORD
INFORMATION ON FIRST PAGE)

We will send you a packet with a confirmation letter three to five days
before the focus group is held. It will include directions to the
location where the discussion will take place. It is very important that
you arrive on time. If you need glasses for reading, please bring them
to the discussion. If you have any questions or find out that you cannot
attend the focus group, please call \_\_\_\_\_\_\_\_\_\_\_ at
\_\_\_\_\_\_\_\_\_\_ so that we can find someone to take your place.
Thank you for agreeing to take part in our study. We look forward to
meeting you. Goodbye.

(NOTE TO RECRUITER: If respondents have any questions or concerns about
the focus group topic, please contact Memi Miscally at Porter Novelli at
202-973-5845. Do NOT give her name to respondents.)

**Recruited by**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Date**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Confirmed by**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Date**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**ATTACHMENT I-5-B**

OMB# 0925-0046

Exp. Date 8/31/00

**[Moderator's Guide for I-131 Focus Groups with the General
Public]{.underline}**

**I. EXPLANATION AND INTRODUCTIONS** (10 minutes)

1.  **Thanks** for coming today. Your participation is very important to
    us; your insights will help us develop a national public health
    program.

2.  My name is \_\_\_\_\_\_ and I work for \_\_\_\_\_\_, an independent
    research company. I do not work with the sponsor of these groups, so
    please feel that you can give me your **honest**
    opinions---**positive and negative**.

3.  What we're doing today is called a focus group. You may have guessed
    that all of you **live in the Philadelphia/Omaha/Burlington area**,
    and for the next 2 hours, we're going to talk about the
    **environment and your** **health**.

4.  I'm interested in all of your ideas, comments, and suggestions.
    There are **no right or wrong answers**. It's important that I hear
    what everyone thinks, so please speak up, especially if your view is
    different from something someone else says.

5.  We'll **audio-tape** and **video-tape** this discussion. In
    addition, program planners sitting behind this mirror will
    **observe**. We're taking these steps because everything you say is
    important to us, and we want to make sure we don't miss any
    comments.

6.  Please **talk one at a time** and in a voice at least as **loud** as
    mine so that the recording equipment can pick up everything that is
    said.

7.  Later, we'll go through all of your comments and use them to write a
    report. Remember that all of your comments are **confidential**.
    Your name will not be used in the report.

8.  If you need to use the bathroom, please go **one at a time**.

9.  Please turn off any **beepers, pagers, or cell phones** that you may
    have.

10. Before we begin the discussion, please **introduce** yourself.
    Please tell us your:

-   First name

-   Number of years you've been living in the
    Philadelphia/Omaha/Burlington area

**II. GENERAL AWARENESS, KNOWLEDGE, AND CONCERN** (25 minutes)

1.  What are some of the environmental issues that you've heard about,
    if any at all? Where does nuclear radiation fit into the list of
    issues? (SPEND ONLY A MINUTE AND THEN MOVE ON)

2.  What words, images, or feelings come to mind when I say the word
    nuclear radiation?

3.  What, if anything, have you heard about nuclear weapons tests
    conducted in the United States? (TRY TO OBTAIN PLACES AND DATES OF
    ATOMIC BOMB TESTING AND TYPES OF NUCLEAR RADIATION RELEASED)

About 100 atomic bomb tests were conducted in the state of Nevada during
the 1950s and 1960s. These tests released different types of radioactive
material into the atmosphere. The rest of this discussion will pertain
to these tests and the nuclear radiation fallout.

4.  Have you heard anything about these tests? IF YES: What have you
    heard about these tests?

PROBE: Types of radiation released?

IF AWARE OF MORE THAN ONE MATERIAL: Are you concerned about some of the
radioactive substances more than others? What makes you more concerned?

5.  What, if any, questions do you have about these tests and the
    nuclear radiation released?

PROBE: How about health related consequences?

How about any non-health related consequences?

6.  What, if any, concerns do you have about these tests and the nuclear
    radiation released?

PROBE: How about health-related consequences?

How about any non-health-related consequences?

7.  From what sources have you gotten any information you might have? IF
    MEDIA: From what sources did the media get their information? For
    example, do you remember any specific individuals, experts or
    organizations that the media quoted or mentioned? (PROBE FOR
    AWARENESS OF NCI AND IOM REPORTS)

**III. REACTIONS AFTER SEEING ARTICLE** (30 minutes)

Now, I'm going to give you a newspaper article (or fact sheet) to read
about the Nevada nuclear bomb tests. Some of this information you may
already know. Please read all the information carefully as we will be
discussing this material in detail next.

1.  What are your initial reactions to this article and the additional
    information I've given you? (LEAVE OPEN DISCUSSION AROUND
    EMOTIONS/FEELINGS OR THE INFORMATION ITSELF)

2.  When might people living in the U.S. have been affected by I-131?
    During the 1950s and 1960s when the tests were conducted? Now, in
    the 1990s? In the future, when it's 2000 and beyond?

You may or may not have a thorough understanding of thyroid cancer. To
ensure that all of us have the information we need to get through
tonight's discussion, I'd like to give you some information about
thyroid cancer. (SHOW BOARD)

3.  Based on the information provided, who do you think is at risk for
    thyroid cancer from the Nevada tests? What are the major factors
    that make someone more at risk?

PROBE: Different geographical areas

> Age
>
> Milk consumption

4.  How concerned are you personally about your risk for developing
    thyroid cancer as a result of these tests and exposure to the
    fallout? What makes you particularly concerned?

5.  How concerned are you personally about your risk of developing any
    of the non-cancerous thyroid diseases I mentioned as a result of the
    Nevada tests? What makes you concerned?

6.  In comparison to other types of health risks like heart disease or
    stroke, how concerned are you about getting thyroid cancer? How
    about non-cancerous thyroid diseases?

7.  Is the information I provided you with confusing or clear? What
    would need to be done to make it easier to understand?

8\. Would you like more information to determine how important a health
issue the I-131 fallout from the Nevada tests is for you? Why or why
not? What information?

**IV. EDUCATIONAL CAMPAIGN** (40 minutes)

1\. What, if anything, do you think should be done about I-131 and any
potential health risks?

PROBE: Public Education

Screening

Compensation for Medical Expenses

2.  Who should be responsible? (IF GOVERNMENT: PROBE FOR LOCAL, STATE OR
    FEDERAL, IF FEDERAL PROBE FOR AGENCIES) What about these entities
    makes them responsible?

3\. What are your opinions about this recommendation?

Do you think there is a need for a public information campaign to
educate people about their possible exposure to I-131 and the potential
risks associated with that exposure?

4\. In your opinion, who needs to be informed about the possible risks
associated with the I-131 emitted from the nuclear tests? Should
everyone in the U.S. be the focus, or should information be targeted to
those who may have been more exposed? Why?

5.  IF GENERAL PUBLIC: What information do you think the general public
    needs to get? IF THOSE MORE EXPOSED: What information do you think
    people who were heavily exposed need to get?

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```
6.  What information do you think you personally need about the I-131
    emitted from the Nevada tests and its possible health effects?

7.  What do you think would be the most effective ways to get this
    information to people?

PROBE: Television/radio

Newspapers/magazines

Conferences/meetings

Interpersonal communication

Brochures

Internet

8.  What health care professionals, if any, do you think should be
    involved in reaching out to people? What about these people makes
    them important?

9.  If an educational effort is to be launched, some organization or
    organizations need to be responsible for implementing the effort.
    Are there any organizations or types of organizations that you
    particularly trust to implement these efforts? What about those
    organizations makes you trust them?

(PROBE: Government agencies, non-profit organizations or advocacy
groups?)

10. Are there any organizations or types of organizations that should
    NOT be involved in implementing these efforts? What makes them
    untrustworthy?

11. Do you think people will trust a public education campaign that is
    conducted by the federal government? Would it matter what specific
    federal agencies are involved? Why?

**V. ADDITIONAL CONSIDERATIONS** (10 minutes)

1.  In your opinion, what are the **main** reasons why the public should
    be informed about the Nevada Test Site, I-131 exposure, and any
    potential health problems?

IF NECESSARY, PROBE: Some people think the government has an obligation
to let people know about the exposure from the Nevada Test Site
primarily because some people could have been harmed by the fallout.
Other people think that regardless of the level of harm people
experienced, the government has an obligation to inform the public
because the public has a right to know about its government's actions.
Which of these best represents your views? Why?

2.  Based on everything you know now, what if anything, would justify
    the Nevada atomic bomb testing?

IF NECESSARY, PROBE: People were exposed to radioactive material while
nuclear weapons were being tested for the purpose of defending our
country. What do you think about this?

3.  Do you think the government would have intentionally exposed people
    to radioactive material or do you think the government probably
    didn't know about the negative health effects that may be associated
    with the exposures until after the tests were already conducted?

4.  What else do you think needs to be done to address the issue of
    I-131 fallout from the Nevada Test Site that we have not talked
    about?

5.  How do these ethical considerations impact your trust in the
    government as a whole and different government agencies?

6.  Is there anything else that you think needs to be done to address
    the issue of I-131 fallout from the Nevada Test Site that we have
    not talked about?

**VI. CLOSING** (5 minutes)

1.  CHECK WITH OBSERVERS FOR ADDITIONAL QUESTIONS.

2.  Those are all of the questions I have. Do you have any final
    comments?

3.  Thanks for your participation today. I have some bookmarks that can
    provide you with current information about what we've discussed this
    evening. Feel free to take one before you leave.

**OMB# 0925-0046**

**Exp. Date 8/31/00**

**[Moderator's Guide for I-131 Focus Groups with
Physicians]{.underline}**

**I. EXPLANATION AND INTRODUCTIONS** (10 minutes)

1.  **Thanks** for coming today. Your participation is very important to
    us; your insights will help us develop a national public health
    program.

2.  My name is \_\_\_\_\_\_ and I work for \_\_\_\_\_\_, an independent
    research company. I do not work with the sponsor of these groups, so
    please feel that you can give me your **honest** opinions --
    **positive and negative.**

3.  What we're doing today is called a focus group. You may have guessed
    that all of you are **primary care** **physicians**, and for the
    next 2 hours, we're going to talk about the **environment and the**
    **health of your patients**.

4.  I'm interested in all of your ideas, comments, and suggestions.
    There are **no right or wrong answers**. It's important that I hear
    what everyone thinks, so please speak up, especially if your view is
    different from something someone else says.

5.  We'll **audio-tape** and **video-tape** this discussion. In
    addition, program planners sitting behind this mirror will
    **observe**. We're taking these steps because everything you say is
    important to us, and we want to make sure we don't miss any
    comments.

6.  Please **talk one at a time** and in a voice at least as **loud** as
    mine so that the recording equipment can pick up everything that is
    said.

7.  Later, we'll go through all of your comments and use them to write a
    report. Remember that all of your comments are **confidential**.
    Your name will not be used in the report.

8.  If you need to use the bathroom, please go **one at a time**.

9.  Please turn off any **beepers, pagers, or cell phones** that you may
    have.

10. Before we begin the discussion, please **introduce** yourself.
    Please tell us your:

-   First name

-   Number of years you've been practicing in the Omaha/Burlington area

**II GENERAL AWARENESS, KNOWLEDGE, AND CONCERN** (25 minutes)

1.  What are some of the environmental issues that you've heard about,
    if any at all? Where does nuclear radiation fit into the list of
    issues? (SPEND ONLY A MINUTE AND THEN MOVE ON)

2.  What words, images, or feelings come to mind when I say the word
    nuclear radiation?

3.  What, if anything, have you heard about nuclear weapons tests
    conducted in the United States? (TRY TO OBTAIN PLACES AND DATES OF
    ATOMIC BOMB TESTING AND TYPES OF NUCLEAR RADIATION RELEASED)

About 100 atomic bomb tests were conducted in the state of Nevada during
the 1950s and 1960s. These tests released different types of radioactive
material into the atmosphere. The rest of this discussion will pertain
to these tests and the nuclear radiation fallout.

4.  What, if anything, have you heard about these Nevada bomb tests
    conducted during the 1950s and 1960s and the resulting nuclear
    radiation fallout?

PROBE: Types of radiation released?

> IF AWARE OF MORE THAN ONE MATERIAL: Are you concerned about some of
> the radioactive substances more than others? What makes you more
> concerned?

5.  What, if any, questions do you have about these tests and the
    nuclear radiation released?

6.  What, if any, concerns do you have about these tests and the nuclear
    radiation released?

> PROBE: Any concerns about health or non-health related consequences?

7.  Have you and your patients discussed the Nevada bomb tests and
    health problems resulting from the I-131 fallout radiation? If so,
    how often? What have you talked about? Who typically initiates the
    conversation---you or your patients?

8.  Relative to their other health concerns, how concerned are your
    patients about experiencing health problems as a result of being
    exposed to I-131?

9.  How concerned about I-131 health effects is your community in
    general?

10. From what sources have you gotten any information you might have? IF
    MEDIA: From what sources did the media get their information? For
    example, do you remember any specific individuals, experts or
    organizations that the media quoted or mentioned? (PROBE FOR
    AWARENESS OF NCI AND IOM REPORTS)

**III REACTIONS AFTER SEEING ARTICLE** (30 minutes)

Now, I'm going to give you a newspaper article and fact sheet to read
about the Nevada nuclear bomb tests. The article actually appeared in
newspapers across the country, perhaps even in your area. Some of this
information you may already know. Please read all the information
carefully as we will be discussing this material in detail next. (SHOW
ARTICLE)

1.  What are your initial reactions to this article and the additional
    information I've given you? (LEAVE OPEN DISCUSSION AROUND
    EMOTIONS/FEELINGS OR THE INFORMATION ITSELF)

2.  When might people living in the U.S. have been affected by I-131?
    During the 1950s and 1960s when the tests were conducted? Now, in
    the 1990s? In the future, when it's 200 and beyond?

You may or may not have a thorough understanding of thyroid cancer. To
ensure that all of us have the information we need to get through
tonight's discussion, I'd like to give you some information about
thyroid cancer. (SHOW BOARD)

3.  Who do you perceive to be most at-risk for thyroid cancer based upon
    the risk factors presented in the article? Which factors are most
    central?

PROBE: Different geographical areas

> Age\
> Milk consumption

4.  Given the identified risk factors, how concerned are you that any of
    your current patients may be at risk of developing thyroid cancer?

5.  Do you believe these concerns about non-cancerous thyroid conditions
    are warranted by available information on I-131 and its effects on
    human health? Or are these concerns needlessly raised?

6.  Additional research into the non-cancerous thyroid conditions due to
    I-131 exposure is being conducted. How worthwhile do you think this
    effort is?

7.  How concerned are you about your patients' risk of developing any of
    the non-cancerous thyroid disease I mentioned as a result of the
    Nevada tests? What makes you concerned?

8.  In comparison to other types of health risks, how concerned are you
    about your patients' risk for thyroid cancer as a result of I-131
    exposure? Non-cancerous thyroid diseases? (DETERMINE WHETHER
    PARTICIPANTS ARE MORE CONCERNED ABOUT THYROID CANCER OR
    NON-CANCEROUS THYROID DISEASES)

9.  What other information would you need to make a good determination
    of whether you have patients that are at heightened risk for I-131
    related problems?

**IV. EDUCATION CAMPAIGN** (45 minutes)

1.  What, if anything, do you think should be done to educate the public
    about I-131 and potential health risks?

PROBE: Public education

Screening

> Compensation for medical expenses (RESERVE ANY DISCUSSION AROUND
> ADDITIONAL TYPES OF COMPENSATION FOR SECTION V)

2.  Who should be responsible for implementing these efforts? (IF
    GOVERNMENT: PROBE FOR LOCAL, STATE OR FEDERAL, IF FEDERAL PROBE FOR
    AGENCIES) What about these entities makes them responsible?

In 1999, the Institute of Medicine (IOM), a panel of experts from the
National Academy of Scientists congressionally mandated to advise the
federal government on medical issues, released medical screening
recommendations for people who may have been exposed to I-131 released
from the Nevada Tests. The panel concluded that the available science
does NOT warrant medical screening tests within the general population
or within any subgroups of the population.

The reasoning behind this recommendation is that very few people get
thyroid and those that do are very likely to be cured. In addition, the
current method of thyroid cancer screening can produce false positives,
meaning that people may be inaccurately diagnosed with thyroid cancer
and consequently subjected to unnecessary fear, medication and surgery.

For these reasons, the IOM felt that the evidence suggests that more
harm than good to the public would be done with screening.

3.  What are your opinions about this recommendation? How important is
    it to educate the public about I-131 and the potential health risks?

4.  In your opinion, who needs to be informed about the possible risks
    associated with the I-131 emitted from the nuclear tests? Should
    everyone in the U.S. be the focus, or should information be targeted
    to those who may have been more exposed? Why?

5.  IF GENERAL PUBLIC: What information do you think the general public
    needs to get?

> IF THOSE MORE EXPOSED: What information do you think people who were
> heavily exposed need to get?

6.  What role, if any, should physicians play in a campaign to educate
    the public about I-131 health implications?

7.  Based on what you know now, is it important for you to inform your
    patients? Why or why not?

8.  What barriers might you encounter? What support might you need?

PROBE: Time

Money

Tips on how to talk to patients

Materials (What types?)

Further information

9.  What other types of health care professionals should be involved in
    an educational effort?

10. If an educational effort is to be launched, some organization or
    organizations need to be responsible for implementing the effort.
    What organizations or types of organizations would you particularly
    trust to implement these efforts? What about those organizations
    makes you trust them?

PROBE: Government agencies

Non-profit organizations

Advocacy groups

Medical associations

11. What organizations or types of organizations should NOT be involved
    in implementing these efforts? What makes them untrustworthy?

12. How much do you think people will trust a public education campaign
    that is conducted by the federal government? What specific federal
    agencies should be involved? Why?

**V. ADDITIONAL CONSIDERATIONS** (5 minutes)

1.  In your opinion, what are the **main** reasons why the public should
    be informed about the Nevada Test Site, I-131 exposure, and any
    potential health problems?

> IF NECESSARY, PROBE: Some people think the government has an
> obligation to let people know about the exposure from the Nevada Test
> Site primarily because some people could have been harmed by the
> fallout. Other people think that regardless of the level of harm
> people experienced the government has an obligation to inform the
> public because the public has a right to know about its government's
> actions. Which of these best represents your views? Why?

2.  Based on everything you know now, what if anything, would justify
    the Nevada atomic bomb testing?

IF NECESSARY, PROBE: People were exposed to radioactive material while
nuclear weapons were being tested for the purpose of defending our
country. What do you think about this?

3.  Do you think the government would have intentionally exposed people
    to radioactive material or do you think the government probably
    didn't know about the negative health effects that may be associated
    with the exposures until after the tests were already conducted?

4.  What else do you think needs to be done to address the issue of
    I-131 fallout from the Nevada Test Site that we have not talked
    about?

**VI. CLOSING** (5 minutes)

1\. CHECK WITH OBSERVERS FOR ADDITIONAL QUESTIONS.

2\. Those are all of the questions I have. Do you have any final
comments?

3.  Thanks for your participation today. I have some bookmarks that can
    provide you with current information about what we've discussed this
    evening. Feel free to take one before you leave.

**Additional Facts**

-   Thyroid cancer accounts for 1% of all cancers.

-   Some areas near the Nevada Test Site were highly exposed to I-131
    radiation. Other areas farther from Nevada also were highly exposed
    because weather patterns carried the radiation north and east of
    Nevada.

Study Estimating Thyroid Doses of I-131 Received by Americans from
Nevada Atmospheric Nuclear Bomb Tests

**Figure 1**

**Per capita thyroid doses resulting from all exposure routes from all
tests**

![](media/image1.png){width="6.125in" height="4.659722222222222in"}

### 

[^1]: The higher-exposure and lower exposure public definitions were
    extracted from NCI's report, "Estimated Exposures and Thyroid Doses
    Received by the American People from Iodine-131 in Fallout Following
    Nevada Atmospheric Nuclear Bomb Tests: A Report from the National
    Cancer Institute" (NIH Pub #97-4264), which outlined the key risk
    factors due to I-131 exposure. Participants had to be ages 39 to 64
    because that is the present age of the individuals who were ages 0
    to 15 during the time of the Nevada testing. The 18 states
    designated as high exposure by the report were: Arkansas, Colorado,
    Idaho, Illinois, Iowa, Kansas, Minnesota, Missouri, Montana,
    Nebraska, Nevada, North Dakota, Oklahoma, South Dakota, Utah,
    Vermont, Wisconsin, and Wyoming.

[^2]: It should be noted that earlier research, in the form of in-depth
    interviews, was conducted in November 1999 with advocates,
    scientific experts, and public health experts to obtain the
    viewpoint of those more cognizant of the I-131 health issue.