### I.4 Report of Key Findings: In-depth Interviews with Experts About I-131 Exposure from the Nevada Test Site

**Prepared by:**

**Office of Cancer Communications**

**National Cancer Institute**

**31 Center Drive MSC-2580**

**Building 31, Room 10A03**

**Bethesda, MD 20892-2580**

**January 2000**

**I. INTRODUCTION AND METHOD**

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, NCI conducted 19 in-depth
interviews with individuals who have expertise in areas related to the
issue of nuclear fallout. The main objectives of this research were to
measure awareness level, concern, familiarity with, and evaluation of
the NCI Report and IOM recommendations about I-131 from the Nevada Test
Site, and to obtain recommendations about how to conduct a communication
campaign.

A working group consisting of NCI staff, CDC staff, and a panel of
community representatives generated a list of potential interviewees.
Individuals were suggested in a number of categories, including state
and local public health officials, community advocates (including
environmental, health, and pro-nuclear groups), scientific experts
(e.g., radiation scientists), health-oriented professional
organizations, veterans, health care providers (e.g., thyroid
specialists), and health educators.

The selection of interviewees was based on the following criteria: 1)
level of expertise; 2) an effort to obtain representation from all the
categories listed above; and 3) geographic diversity. The original
interviewee list was comprised of 29 contact names collectively agreed
upon by working group members. Interviews were completed with 19
interviewees. When an effort to contact a particular interviewee was not
successful, an alternate name was generally provided by working group
members. Alternates were selected from the same type of background as
the originally proposed interviewee.

In order to report the interview results in a way that incorporates the
contextual background of individuals, interviewees were separated into
three major reporting categories:

> **Public Health Officials:** Six government officials were interviewed
> in this category. Participants included those employed in public
> health departments in states with varying degrees of I-131 exposure
> from the Nevada Test Site and other representatives involved in
> radiation issues at the state level.
>
> **Advocacy Groups:** Seven individuals were interviewed in this
> category. Participants held a variety of positions in organizations
> dedicated to different issues associated with nuclear or radiation
> issues. Organizations were selected to represent a broad range of
> opinion. Included in this category were representatives of groups
> dedicated to radiation-exposed populations, the environment, and the
> advancement of nuclear science.
>
> **Scientific Experts:** Six individuals were interviewed in this
> category. Participants included both radiation and thyroid experts
> associated with a variety of institutions.

Interview questions were designed to measure awareness, concern and
opinions about what constitutes an appropriate outreach response (See
Attachment H-4-A for a copy of the interview instrument). It should be
noted that the interview guide was not followed verbatim, and language
was altered in some cases to be sensitive to the background and
expertise level of each respondent. Each interview lasted approximately
30 minutes.

It should also be noted that in-depth interviewing is a qualitative
research technique. Although the findings from this research can provide
useful detailed insights into the perceptions and views of different
organizations and experts involved with the I-131 fallout issue, they
cannot represent the views of all such groups or persons.

**II. KEY FINDINGS**

This section outlines the key/preliminary findings from the interviews.
Differences in responses between reporting groups are outlined
separately.

**A. Awareness and Concern**

-   **[For public health officials, the NCI report frames the boundaries
    of awareness.]{.underline}**

When asked what they knew about the potential health effects of the
Nevada Test Site, the majority of public health officials cited the NCI
study as their primary reference point. All agreed that thyroid cancer
or "the thyroid problem" was the main potential health outcome to be
concerned about. Although two officials mentioned other possible
conditions, like autoimmune illnesses and damage to other organs, they
qualified these statements indicating that the data and science were
only available on the thyroid cancer link. Only one official could name
other radioactive substances released from the site in addition to
I-131.

On a scale of one to ten, with one indicating "not at all severe" and
ten indicating "very severe," most officials gave the potential health
effects from the Nevada Test Site a fairly low severity rating of two or
three. Only one official gave it a relatively high rating of six.

None of the officials said their organization had a formal position on
I-131 exposure from the Nevada Test Site. One official, in a state with
some highly exposed counties, said they were "struggling" to determine
whether or not the potential risks justify a public outreach effort.

-   **[Advocacy groups have a far broader scope of
    concern.]{.underline}**

Fewer advocacy group participants mentioned the NCI report when asked
about their knowledge of the potential health effects of the Nevada Test
Site. Although most mentioned thyroid cancer and other non-cancerous
thyroid abnormalities as possible outcomes, a few participants also
mentioned leukemia. One representative said genetic mutations and birth
defects were also a possibility.

In addition to being concerned about more health effects, advocacy group
representatives were also more aware of other radioactive materials
emitted from the tests. The most frequently cited substances after I-131
were cesium, strontium, and plutonium. When asked which substances they
worried about the most, advocates said that all the substances posed
significant reasons for concern, but for different reasons. Some pointed
out the varying half-lives of the substances; several, for example,
talked about plutonium's ability to persist in the environment for long
periods of time. One representative took the opportunity to say that the
NCI report was "too narrowly and conveniently" focused on thyroid cancer
instead of on other more lethal cancers like leukemia, breast and bone
cancer that may be caused by other materials like strontium and cesium.

Advocates rated the severity of the health effects from the Nevada Test
Site much higher than did the public health officials. Most gave a
rating somewhere in the range of eight to ten. Only one respondent
thought differently. This participant, who refused to use the rating
scale, characterized the potential health effects from Nevada Test Site
exposure as 100 times more severe than an accident like Three Mile
Island or waste disposal sites, but much less severe than radiation
received from medical diagnostic tests.

All but two representatives said their organization had a position on
exposure from the Nevada Test Site. One representative said there needed
to be more education and research on the association between exposure
and non-thyroid disorders, particularly parathyroid disorders. Another
said the government needed to be more "forthright" and "conscientious"
in its efforts to inform the public. Others called for health care
provider education efforts and clinical screening and monitoring.
Although two representatives said their organization did not have a
formal or official position, they did say their organization generally
supports the cause of research and educational efforts conducted for the
benefit of exposed populations.

-   **[Concerns of scientific experts are defined by their evaluation of
    "the evidence."]{.underline}**

Scientific experts chose to focus primarily on the thyroid-cancer link
when asked what they knew about the health consequences of the Nevada
Test Site. Most made evaluative comments about the findings. The level
of detail provided about the relationship between I-131 and thyroid
cancer varied by the type of expert. Radiation experts provided much
more detailed information and critiques of the NCI data. One such expert
said, "I am aware that 10,000 to 75,000 new thyroid cancers will result
from these tests." Another radiation expert characterized the findings
as "statistically suggestive rather than significant." Strontium,
cesium, and plutonium were most frequently mentioned by radiation
experts as some of the other key radionuclides that were emitted from
the tests. One expert said I-131 should be paid the most attention
because it was the "main fallout product."

Thyroid experts had less detailed knowledge and seemed to retain only
the facts they felt were relevant to their concerns and practice areas.
These specialists were primarily concerned about the relationship
between I-131 and thyroid disorders and less interested in other health
effects. They were aware of the Nevada Test Site solely because of its
relationship to I-131 (an issue thyroid specialists are quite
knowledgeable about), since the site presents another potential avenue
of iodine exposure. These specialists expressed limited concern, stating
that exposure was found to be minimal for the most part and that thyroid
cancer is highly treatable.

Expert ratings of the severity of potential health effects were more
mixed than the other two interviewee groups. One radiation expert rated
the severity of the health effects as a one or a two, while another
rated it as an eight or nine. Many had difficulty providing unqualified
responses, probably due to their high knowledge levels. For example, one
radiation expert said the severity rating is dependent on geography,
giving a one for a person living in New York City and a four for a
person living in Utah. Thyroid specialists shared more commonality in
their ratings with most giving it a low rating of a one or two. One
specialist said the rating is dependent on age of exposure, giving it a
rating of five for a child and only a rating of one for an adult.

**B. Familiarity and Evaluation of NCI Report and IOM Action
Recommendations**

-   **[Public health officials are in agreement with findings and
    recommendations.]{.underline}**

All public health officials were quite familiar with the reports, and
most had a good working knowledge of risk factors and other specifics.
Officials in states with heavily exposed populations were more informed
than officials from states with less exposure. One official of a state
with areas of high exposure reported using the NCI data to conduct their
own state-level investigation. Two officials in less exposed states had
a more general level of knowledge about the NCI findings.

Overall, public health officials found the reports useful. Two officials
said the most useful information was the county-level exposure
information. Two others said the reports serve as good background pieces
about the relationship between I-131 and thyroid cancer and will be a
useful framework for thinking about other exposure sites throughout the
country. There were few suggestions for additional information. One
official said more definitive information on the risk associated with
I-131 exposure was needed to determine what the exposures really mean
from a health perspective. Another official thought information on the
relationship between I-131 exposure and non-cancerous thyroid disorders
would be important to have since there was a lot of "talk" about this
issue.

All officials agreed with the IOM position that screening would cause
more harm than good, due to the number of false positives. One
individual said screening was also not advisable because the exposure
findings were uncertain, and individuals would be better served if their
own doctor decided whether or not screening was appropriate for them.

Most public health officials thought the proposed strategy of educating
the general public and providing physicians with information to respond
to inquiries would be very effective. Some said this was important
because health care providers lack knowledge about the association
between iodine and thyroid disease. One individual said it would be
effective because people listen to and trust their doctors. Another
official thought that the strategy made sense but that the nature of the
information would be difficult for the public to understand.

-   **[Advocacy groups disagree more with findings and
    recommendations.]{.underline}**

Approximately two-thirds of the advocates said they were very familiar
with the NCI and IOM reports. The remaining one-third recalled major
pieces of information but without specifics. Advocacy group opinion
about the information in the reports was considerably more divided than
among public health officials. One representative said that some of the
exposure information was inaccurate and that there were more areas
listed as low-exposure areas than should be. Another representative held
the opposite view, saying that there were more high-exposure areas than
should be. A couple of representatives said the reports were useful in
the sense that there was an "admittance" of responsibility, and some
information was at least "out there." And another representative took
credit for pushing Congress to get the report "done in the first place."

Advocacy representatives were far less supportive of the IOM screening
recommendations than public health officials. Half thought screening for
thyroid cancer was necessary, and half agreed that it was not a
beneficial course of action. One individual supported the notion that
screening for thyroid cancer would result in too many false positives,
but felt screening for other disorders like hypothyroidism and
hyperparathyroidism should be conducted.

When asked how effective the IOM strategy of educating physicians and
the public would be, most advocates characterized the strategy as one
that would be "helpful." Two participants focused on the need to educate
physicians so patients will be "taken seriously" and will not have to
"educate their physicians." Only one participant felt the action would
be unnecessary and expressed doubt about the ability to educate
physicians who are "essentially lay people when it comes to nuclear and
radiation issues and lack technical knowledge and background."

-   **[Thyroid experts are in agreement, while radiation experts are
    more divided.]{.underline}**

While the radiation experts were very familiar with the NCI and IOM
reports and had examined them in detail, the thyroid specialists were
only vaguely familiar with the actual reports. Despite their uncertainty
about having read the reports, however, the thyroid specialists felt
certain that they understood the overall findings from other sources
like professional journals, newspapers, and presentations. In general,
they recalled that the exposure did not pose a very significant health
threat.

Those radiation experts who had read the reports found some information
useful and some not. While one expert said the reports were "most
inclusive and helpful," another said they were "inconclusive" because
the findings were "extrapolated from only 100 sites." Another expert
felt the information was useful, but needed to be translated in a way
that would make it possible for the lay public to understand. The lack
of "risk information" was "curiously avoided," according to another
expert.

The radiation experts were also divided on the issue of screening. One
agreed with the argument that "screening will do more harm than good."
Another agreed that it made no sense to screen the general population,
but did think the issue of screening high-risk populations needed to be
addressed. Another expressed agreement with not screening for thyroid
cancer, but thought looking into screening for other non-cancerous
thyroid disease was essential. The thyroid specialists were less
divided, all indicating that wide-scale screening for thyroid cancer
would result in too many false positives and could result in harm to the
patient in terms of unnecessary surgical procedures.

Most experts thought the action recommended by the IOM would be very
effective. Their reasons for thinking this strategy would be effective
were similar to those of the other groups. Explanations provided were
that physicians lack knowledge and have direct patient contact, while
patients for the most part feel comfortable with their doctors. One
expert said the strategy would be only "moderately effective" because
physicians may not take the time to review the information provided and
because not everyone has health insurance and/or is under the care of a
physician.

**C. Educational Efforts: What's Needed?**

-   **[Public health officials think risk factors should determine the
    focus and scope of the campaign.]{.underline}**

When asked if the entire U.S. needs to be the target of an educational
effort or if the effort should be confined only to those most heavily
exposed, officials answered in accordance with their understanding of
the risk factors and exposure patterns. One official thought the
campaign could be focused on those who were children at the time and
drank milk from a backyard goat or cow since these individuals were most
at risk. Another official thought everyone should be given information,
but the campaign should be more aggressively focused on those at higher
risk. Those who thought a campaign would need to target the whole
population grounded their opinions on the premise that it would be
difficult to "find" everyone at high risk due to factors like mobility
and storm and wind patterns.

By far, the most important information that officials thought needed to
be provided to people is a profile of the risk factors. One official
thought such a profile, along with an 800 number for those who need more
information, would be a good idea since it is so difficult to separate
out those who need to be concerned from those who don't.

-   **[Advocacy groups say a "right to know" argument
    prevails.]{.underline}**

A majority of advocates said a national campaign was needed because
citizens have "a right to know" about the actions of their government.
For example, one advocate said, "Everyone should know that this was done
without our knowledge" because "the government has no right to
contaminate us." Another said information should not be "denied to
people," but qualified the response by saying it would be difficult to
really get the information to everyone because a "large portion of the
public is apathetic," especially when something seems so "far away."
Some thought a general public information campaign was needed along with
a more targeted and aggressive effort to ensure that high-risk groups
are reached. Only one advocacy group representative thought that little
needed to be done; this individual expressed the view that something
"had to be done" because the issue had become "so political," but
thought that the campaign should be very targeted to those at highest
risk.

In addition to providing information on risk factors, advocates often
mentioned a need to translate the information into a format that people
can understand. One said people need to be provided with a listing of
symptoms that may signal a thyroid problem so they can ask their doctor
for a blood test or ultrasound. Another said people needed all the
information required to calculate their own dose.

-   **[Scientific experts propose solutions mixed with some worry about
    invoking "unnecessary" fear.]{.underline}**

Although solutions proposed by scientific experts varied, more
participants in this group than others expressed concern about the need
to present information in a way that does not provoke anxiety or panic
on the part of the public. The thyroid specialists frequently made this
argument and expressed a preference for a targeted "talk to your doctor"
type approach, especially aimed at those who were children at the time
of exposure. One specialist thought it would be important to assure
people that the NCI study was a "very carefully run study so they should
not be afraid."

Radiation experts were more divided. One expert thought the "right to
know" demanded a national campaign. This individual characterized the
notion of a targeted campaign as a scientific impossibility because it
would be too difficult to "find" the people most heavily affected.
Another felt the information was already "out there" for people who
needed to find it. He said that "the advocates do a good job of letting
people know who need to know" and any further effort will start a public
panic."

**D. Participant Recommendations for How to Conduct a Campaign**

-   **[The majority of participants are in consensus about campaign
    "how-to's."]{.underline}**

Although there was much disagreement about the appropriate scope and
focus of a potential educational information campaign, a high degree of
consensus emerged on how a campaign would be best implemented.

-   Most participants said that such a campaign would need to be
    conducted at a national level with significant use of mass media.
    Even many of those who thought more targeted campaigns were
    appropriate "back-tracked" a little here, realizing that a national
    effort may be needed in order to "find" everyone.

-   Providing information about exposure and risk was seen as important;
    dose information, as less so. A substantial amount of concern was
    expressed about the use of risk comparisons because they may tend to
    trivialize the issue.

-   By far, participants across all three groups thought a coalition of
    different types of organizations (government, advocacy groups, and
    non-profits) should implement the campaign.

-   The belief that a coalition was needed to counteract a lack of
    public trust in government and lend credibility to the campaign was
    expressed far more often by advocates than by public health
    officials and scientific experts.

-   State public health officials thought their departments could play
    valuable coordinating roles at the state and local levels.

-   In terms of federal government participation, there was little
    preference for which agency(ies) should lead the effort. It became
    apparent throughout many of the interviews, particularly with
    advocates, that individuals do not make distinctions between various
    federal agencies \-- for example, CDC, NCI, the Department of Energy
    (DOE), or the Environmental Protection Agency (EPA). Many think of
    the "government" as an all-encompassing entity. When participants
    did make agency recommendations, NCI and CDC were the most
    frequently mentioned.

-   Participants thought a variety of materials and resources would be
    helpful to their organizations: fact sheets, information kits,
    videos, in-person meetings, conferences and web-based materials.
    Web-based information was very appealing; videos and in-person
    meetings, somewhat less so.

Attachment I-4-A OMB #0925-0046

Exp. Date: 8/31/00

**INTERVIEW GUIDE FOR IN-DEPTH INTERVIEWS**

**ABOUT I-131 EXPOSURE FROM THE NEVADA TEST SITE**

**November 1999**

**I. INTRODUCTION (3 MINUTES)**

Hello, my name is \_\_\_\_\_\_\_\_\_\_ from Porter Novelli, and I'm
calling on behalf of the National Cancer Institute and the Centers for
Disease Control and Prevention. These organizations are currently
working to develop educational efforts to address health effects that
may be related to nuclear fallout from an atomic weapons testing program
conducted in Nevada in the 1950s and 1960s. Do you have approximately 30
minutes so that I can talk with you about health issues related to the
Nevada nuclear tests?

\[IF YES, CONTINUE. OTHERWISE, TRY TO RESCHEDULE FOR ANOTHER DAY AND
TIME.\]

If it is alright with you, I would like to audio-record this discussion
because everything you say is important. All of your comments will be
kept confidential, and your responses will never be connected to your
name or organization.

**IA. ORGANIZATIONAL DEMOGRAPHICS (4 MINUTES)**

First of all, I'd like to understand more about your organization.

1\. What is your organization's mission and goals?

2\. Who or what does your organization represent?

3\. Does your organization have membership? Approximately how many
members do you have?

4\. Does your organization have any other core audiences or
stakeholders?

5\. How do you typically communicate with your audiences?

**II. AWARENESS AND CONCERN (5-10 MINUTES)**

1\. What nuclear or radiation issues are you involved with or concerned
about?

> PROBE for both locations (e.g., Hanford, etc.) as well as different
> types of radiation.

2\. I'd like to talk specifically about the Nevada nuclear bomb tests
now. What knowledge do you have about the Nevada tests and their
consequences? What about health effects specifically?

> PROBE: Potential cancer-related health effects?
>
> Non-cancer-related effects?

3\. Overall, on a scale of 1 to 10 (with 1 meaning not severe at all and
10 meaning very severe), how severe do you think the possible health
effects of the Nevada nuclear bomb tests are? (INTERVIEWER NOTE: Collect
professional/organizational perspective rather than personal.)

4\. How would you rate the severity of these effects in relation to
other nuclear or radiation issues that you are concerned about on a
scale of 1 to 10? (INTERVIEWER NOTE: Collect professional/organizational
perspective rather than personal.)

5\. About 100 nuclear bomb tests were carried out in Nevada in the 1950s
and 1960s. These tests released different types of radioactive material
into the atmosphere. Which of these radioactive materials are you aware
of?

> IF AWARE OF MORE THAN ONE MATERIAL: Are you concerned about some of
> these radioactive substances more than others? Why?
>
> Before proceeding, I'd like to provide you with some additional
> background. One of the radioactive materials released from the Nevada
> tests was Iodine 131, commonly referred to as I-131. As you are
> probably aware, some epidemiological studies have found an association
> between exposure to I-131 and the risk of thyroid cancer. In addition,
> I-131 may also be related to other types of thyroid disease, such as
> hypothyroidism or an underactive thyroid gland, hyperparathyroidism, a
> condition in which the parathyroid glands located next to the thyroid
> become overactive, and noncancerous thyroid growths. While everyone in
> the United States experienced some exposure to the I-131 fallout,
> those in areas adjacent to the Nevada Test Site, downwind, and in
> other areas of the country where wind patterns served to increase
> fallout were most heavily exposed. These risks may be highest for
> young children who drank milk and lived in high fallout areas during
> the time of the tests.
>
> \[INTERVIEWER NOTE: Read high-exposure state list only if interview
> asks about the heavily affected region: Some adjacent states with high
> county exposure rates are Colorado, Idaho, Kansas, Minnesota,
> Missouri, Montana, Nebraska, Nevada, South Dakota, Utah.\]
>
> In 1997 and 1999, two documents regarding the Nevada tests were
> released to the public. The National Cancer Institute or NCI released
> results of a study that assessed U.S. residents' possible exposure to
> radioactive Iodine-131 fallout during and shortly after the nuclear
> bomb tests.
>
> In addition, the National Academy of Science's Institute of Medicine
> or IOM released a review of the NCI's methods and findings. This
> review also included recommendations on educating the general public
> about I-131 and advising physicians on how to approach patients who
> may have questions about I-131.

6\. How familiar are you with the NCI and IOM reports, if at all?

7\. If FAMILIAR: Do these reports provide your organization with the
information you need to communicate with your key audiences about this
issue?

> IF YES, PROBE: What information is useful?
>
> IF NO, PROBE: Why haven't the reports been useful?

8\. Aside from what is provided by the NCI and IOM reports, what else
does your organization know about this issue?

> PROBE: Where has your organization gotten that information?
>
> How has that information been useful?

9\. What additional information do you need to understand the issues
involved with I-131?

10\. Does your organization have a position on the issues surrounding
I-131 exposure from the Nevada Test Site?

> IF YES: What is that position?
>
> What specific concerns about I-131 exposure does your organization
> have?

**III. EDUCATIONAL EFFORTS (10-15 minutes)**

1\. Residents of the U.S. were not uniformly exposed to I-131 fallout.
In addition to factors such as geography and residential history, the
dose of radiation individuals may have received varies by other factors,
like age and dietary patterns.

> In your opinion, who needs to be informed about the possible risks of
> associated with the I-131 emitted by the nuclear tests? Should
> everyone in the U.S. be the focus, or should information be more
> targeted to those who may have been more heavily exposed?
>
> \[INTERVIEWER NOTE: Read high exposure state list only if interview
> asks about the heavily affected region: Some adjacent states with high
> county exposure levels are Colorado, Idaho, Kansas, Minnesota,
> Missouri, Montana, Nebraska, Nevada, South Dakota, Utah\]

2\. What information do you think people who were heavily exposed need
about I-131?

> IF THEY BELIEVE GENERAL PUBLIC SHOULD BE INFORMED: Which of these
> types of information do you think the general public should know?

3\. Now I'm going to read you a list of different types of educational
information that could be provided. Please rate how helpful each would
be on a scale from 1 to 5 with 1 meaning not helpful at all and 5
meaning very helpful.

> a\. Potential exposure levels based on factors like geography and age
>
> b\. Dose information, an estimate of the amount of radiation actually
> absorbed by the thyroid)
>
> c\. Risk information about potential health effects
>
> d\. Risk comparisons, which quantify risk levels in various contextual
> ways to aid understanding
>
> e\. Information about scientific uncertainties surrounding the
> estimates and associations between cause and effect

4\. What do you think would be the most effective way to reach these
populations?

> PROBE: Should education be conducted on a national, regional or local
> level?
>
> Why?

5\. The IOM report concludes that the available science does NOT warrant
routine clinical screening for thyroid cancer in the general population
or within subgroups of the population as an intervention strategy. Do
you think that the general population or any groups within the
population need to be screened? Why or Why not?

> The IOM report suggests that the general public be targeted with
> educational information about their possible exposure to I-131 from
> the nuclear bomb test fallout. It also suggests that information be
> provided to health care providers so they can answer any questions
> that members of the public may ask them about the fallout and
> potential health consequences such as thyroid cancer.

6\. How effective do you think this approach would be in educating the
general public about I-131 fallout from the nuclear tests at the Nevada
Test Site? Why?

7\. What else, if anything, do you think would need to be done to better
educate the general public about the issue of I-131 exposure?

8\. Overall, who do you think should implement these efforts? Who should
NOT conduct them?

> PROBE: Government agencies, non-profit organizations, or advocacy
> groups? National, regional, state, or local level?
>
> IF FEDERAL GOVERNMENT AGENCIES: Which government agencies do you think
> should implement the efforts? (PROBE: CDC, EPA, NCI, DOE)
>
> (INTERVIEWER NOTE: If regional, state, or local organizations are
> suggested, collect information that would be useful for future
> contact.)

9\. Would your organization want to play a role in efforts to educate
the public about possible I-131 exposure from nuclear tests conducted at
the Nevada Test Site?

> IF YES: Which publics or groups would your organization want to play a
> role in educating?
>
> What would that role be?
>
> How would that role fit in with your organization's mission, goals,
> values, and activities?

10\. Now, I'm going to read you a list of materials. Please indicate on
a scale from 1 to 5 how helpful each would be to your organization (with
1 meaning not helpful at all and 5 meaning very helpful).

> a\. Stand-alone materials such as brochures and fact sheets
>
> b\. Information kits
>
> c\. Videos
>
> d\. In-person meetings
>
> e\. Conferences/group meetings
>
> f\. Web-based materials
>
> g\. Would any other types of materials be helpful?

**IV. CLOSING (2 MINUTES)**

Thank you very much for speaking with me today. NCI and CDC are working
together on this project to provide information on this issue to the
public and health care providers. If you have any questions or if you
would like to receive materials about the Nevada tests and I-131
fallout, please call Kelli Marciel at the National Cancer Institute at
301-496-6667.