Type of Survey

Information is obtained by a personal interview with an in-
formed respondent, preferably the housewife, in each household from
which information will be obtained. The interview should be con-
ducted by a person specifically trained for the purpose. Current
employees of health agencies, persons with experience in conducting
interviews on other subjects, and interested volunteers are some
of the candidates for training. The material provided here may be

used for orientation and training interviewers.

Seclection of Families for Interview

The information is obtained from an entire family or house-
hold unit. (A household unit is all persons residing permanently
in a dwelling unit.) Members of the household may reside in a
single-family dwelling or occupy one of several units in an apart-
ment house. In any event, the information obtained relates to
only the persons that comprise the family or household unit.

Information is desirable from all families in communities
consisting of about 200 families or less. In larger communities,
the resources and time available may necessitate sampling only a
portion of the community. There are several procedures that may
be used to identify a representative sample of respondents in the
community. One that has proved useful in health surveys is “Attri-
bute Sampling Methods for Local Health Departments”, Public Health
Services Publication No. 1230, available from the Government Print-
ing Office.

Since the primary concerns here are health effects in rapidly

-57-


=)

APPLICATIONS OF INFORMATION

The information obtained by the methods outlined in the pre-
vious sections will enable you to identify health problems and de-
velop plans to prevent, alleviate, or eliminate them. Because
needs are obvious, or appear so, in many instances questions may
be raised as to the necessity of more precise quantitation or
identification of underlying problems and remedial measures. There
are, however, substantial reasons for making the evaluations by
the procedures outlined. In addition to providing accurate, up to
date information, this process enables the orderly development of
priorities and also supplies the data required to obtain support
from various granting agencies where such assistance is needed.
Underlying health problems may be apparent -- in addition to other
ways -- because of the overt occurrence of disease, recognized
deficiencies in the scope or adequacy of available health services,
insufficient personnel to provide health services, and the inade-
quacy of health facilities, or by combinations of these, Data
compliled or collected by the procedures described and consolidated,
analyzed, and interpreted indicate and quantify such problems. The
brief explanation and examples provided below suggest some appli-

cations of data resulting from the evaluation described.

~121-


Table 3-3

Projected Average Daily Requirements for Future Use of Domestic Water
1976-1981

(Community)

Projected Daily Use (gal. x 1,000/day)

Year Residential Business Industry All Users

1976

1977

1978

1979

1980

1981 1

-23-


pe ype

=)

8" EPA-908/4-77-012

PROCEDURES FOR EVALUATING

HEALTH IMPACTS RESULTING FROM
DEVELOPMENT OF ENERGY RESOURCES

Prepared for

ENVIRONMENTAL PROTECTION AGENCY
REGION VIII
OFFICE OF ENERGY ACTIVITY
Under Contract No. 68-01-1949
/

By

COPLEY INTERNATIONAL CORPORATION
7817 Herschel Avenue
La Jolla, California 92037
Telephone 714/454-0391

Revised
November 1, 1977


\CILITIES:

1 = Postoperative recovery room
2 - Intensive cardiac care unit

3 - Intensive care unit

4 - Open-heart surgery facilities

5 - Pharmacy with FT registered pharmactet
6 - Pharmacy with PT registered pharmacist

7 - X-ray therapy

8 - Cobalt therapy

9 - Radium therapy

10 - Diagnostic radioisotope facility

11 - Therapeutic radioisotope facility

12 - Histopathology laboratory

13 - Organ bank

14 ~ Blood bank

15 - Electroencephalography

16 - Inhalation therapy department

17 - Premature nursery

18 - Self-care unit

19 - Extended care or long-term nursing
care unit

20 - Inpatient renal dialysis

21 - Outpatient renal dialysis

22 - Burn care unit

23 - Physical therapy department

24 - Occupational therapy department

25 - Rehabilitation inpatient unit

26 - Rehabilitation outpatient unit

27 - Paychiatric inpatient unit

28 - Psychiatric outpatient unit

29 - Psychiatric partial hospitalization
program

30 - Psychiatric emergency services

31 - Psychiatric foster and/or home care

32 - Psychiatric consultation and
education services

33 - Clinical psychologist services

34 - Organized outpatient department

35 - Emergency department

36 = Soctal work department

37 - Family planning service

38 - Genetic counseling service

39 - Abortion service (inpatient)

40 - Abortion service (outpatient)

41 - Home care department

42 - Dental services

43 - Podiatrist services

44 - Speech therapist services

45 - Hospital auxiliary

46 - Volunteer services department

Codes from:

HOSPITAL CODES
(For Use With Table 6-5)

CONTROL

Government, nowcderal
12- State

13 - County
14 - City

15 - City-county

16 - Hospital district or authority

Nongovernment not-for-profit
21 - Church operated

23 - Other

Investor-owned (for profit)
31 - Individual

32 - Partnership

33 - Corporation

Govern ent, federal

41 - Air Force

42 - Army

43 - Navy

44 - Public Health Service
other than 47

45 - Veterans Administration

46 - Federal other than 41-45,
47-48

47 - Public Health Servicd
Indian Service

48 - Department of Justice

Osteopathic
61 - Church operated

63 - Other not-for-profit
64 - Other

71 - Individual for-profit
72 - Partnership for-profit
73 - Corporation for-profit

SERVICE

10 - General medical and surgical
11 - Hospital unit of an institution
(prison hospital, college

infirmary, etc.)

12 - Hospital unit within a mental
retardation school

22 - Psychiatric

33 - Tuberculosis and other
resplratory discases

American Hospital Association

"Guide to the Health Care Field"

1975 Edition
American Hospital Association

840 North Lake Shore Drive
Chicago, Dlinols 60611

-117-

42 - Narcotle addiction
44 - Maternity
45 - Eye, ear nose, and
throat
46 - Rehabilitation
47 - Orthopedic
48 - Chronic disease
49 - Other specialty*
50 - Children’s general
51 - Children's hospital
unit of an institution
52 - Children's psychiatric
53 - Children’s tuberculosis
and other respiratory
diseases
55 - Children's eye, ear,
nose, and throat
$6 - Children's rehabilitation
57 - Children's orthopedic
58 - Children's chronic disease
59 - Children's other spectalty*
62 - Institution for mental
» retardation
82 - Alcoholism

*When a hospital restricts its
service to a specialty not defined
by a specific code, it is coded
49 (59 if a children's hospital)
and the specialty is indicated in
parentheses following the name
of the hospital.

STAY

S - Short-term -- average length
of stay for all patients in less
than 30 days or over 50 percent
of all patients are admitted to
units where average length of
stay is less than 30 days.

L - Lone-term -- average length
of stay for all patients is 30 days
or more or over 50 percent of all
putients are admitted to units
where average length of stay J¢
30 days or more.


Has (READ NAMB) been (Immunized for » Tested for

IMMUNIZATIONS, TESTS, PHYSICAL EXAMINATIONS

, Had a Chest X-Ray or Physical Examination) ?

Source
of Physical Exam
Polio Vaccine Immuni- T.B. Skin Test Date | ~
No. of doses) DPT {| TDor T {M-M-R Vaccine Other zation Source Chest X-Ray of {Sov
Oral [Injection] (Date) (Date) (Code) { (Date) Type Year | (Code) | (Date)! Results |(Code)_ | (Date) (Code) | Neverj Last [(Cr
*
iZ {

Page 5

-66-


COPIES OF CARDS TO BE HANDED TO RESPONDENTS

Diet

(1) Has a proper diet

(2) Particular about eating, and does not eat properly
(3) Has frequent snacks between meals

(4) Frequently eats candy

(5) Drinks about | soft drinks a day

(6) Is ona diet prescribed by

because of

Smoking

()
(2)
(3)
(4)
(5)

Never has smoked

Smokes packs of cigarettes a day
Smokes a pipe or cigars

Formerly smoked, but stopped___ months ago
Other

(7) Other:

-77-



Suggested Outline for Developing Physical and Demographic Profile

of the Community

Historical Background

Summary of origin and settlement of the community.

Political and economic history.
. Exploration and development of energy resources. .
. Other factors pertinent to development of the community

and its natural resources.

Physical Characteristics

Prominent topographic features - description and location
with respect to distance from the community and site of en-

ergy development.
Features associated with precipitous or hazardous events

such as flooding, torrential rains, tornadoes, persistent
winds, exposures conducive to blowing dust.

Climate

Characteristic climatic features
Seasonal temperature ranges

Types and amounts of precipitation
Prevailing winds

Land Use and Economy

Agriculture and industry before and after initiation of
energy development

Relative social and economic significance of various types
of employment and commercial developments

. Recent or anticipated changes caused by energy developments

Cultural and Social Characteristics

Ethnic background and composition of the community
Customs and preferences with respect to development of nat-

ural resources, health services, education, economic growth
industrical developments, and related factors.

Population

- Long-term trends in population before energy developments
were intiated.

. Recent or anticipated trends as results of energy develop-

-13-


availability of health services is by determining the driving time
required to reach the various types of services. To accomplish
this, the different types of services must be classified according
to the urgency of access or the requirement of convenience. For
example, the life-saving emergency medical and surgical services
must be readily accessible in the smaller communities, but immedi-
ate availability of elective surgical procedures is not essential,
Similarly, certain public health services, immunization for exam-
ple, must be convenient or they will not be used,

For purposes of evaluation and planning the various types of

health services may be considered as follows:

Primary Health Services

These include the health service first sought when medical
care is needed and the preventive and other types of health ser-
vices that should be easily accessible for frequent use. Prefera-
bly, they should be within 20 minutes driving time, Specific
examples of types of primary health services are:

First-aid and limited emergency service

Diagnostic and screening services

Preventive health services

Limited prescription medication

Non-prescription medication

Counseling on health problems and sources of appropriate
services

Transportation

District Health Services

These services are broader in scope and generally are not re-
quired as often, need not be as convenient to assure use, or be

accessible as quickly as primary services. They can be at some

-126-


(COLORADO CONT'D)

Lee Woolsey, Director INDUSTRIAL ECONOMICS DIVISION
1 Region 13 - Lake, Chaffee, Fremont, and Custer Counties Denver Research Insticute
University of Denver
_ Upper Arkansas Area Council of Governments Denver, Colorado 80210
ch an fason, Box Teleph . 303/753-3376
Canon City, Colorado 81212 ereprone
Telephone: 303/275-8350, Dr. Alma Lantz, Research Psychologist
L Frank Cervi, Director COOPERATIVE EXTENSION SERVICE
HEALTH PLANNING AND DEVELOPMENT AGENCY Colorado Extension Service

‘ Ft. Collins, Colorado 80523
Colorado Department of Health
4210 East Eleventh Street
- Denver, Colorado 80220
Telephone: 303/368-6111

Anthony Robbins, M.D., Director

Michael K. Schonbrun, Assistant Director
- Office of Medical Care Regulation and Development
Extension 356

HEALTH SYSTEMS AGENCIES

Area IT
Central-Northeast Colorado Health Systems Agency, Inc
7290 Samuel Drive, Suite 316

. Denver, Colorado 80222

Telephone: 303/427-8460

~ June H. Twinam, Executive Director

Area II
Southeastern Colorado Health Systems Agency, Inc.
Pikes Peak Center
1715 Monterey Road
Colorado Springs, Corlorado 81501
Telephone: 303/475-9395

Frank Armstrong, Executive Director

~ Area IIT

Western Colorado Health Systems Agency, Inc.
i 2525 NorthSeventh Street

Grand Junction, Colorado 81501
' Telephone: 303/245-3590

David Meyer, Executive Director
\ OFFICE OF ENERGY CONSERVATION
~ Office of Energy Conservation
1313 Sherman, Room 718

| Denver, Colorado 80203
Telephone: 303/839-2507

Buie Seawell
SOURCE OF DEMOGRAPHIC DATA

1 Colorado Department of Local Affairs
Division of Planning

~ 1313 Sherman, Room 520
Denver, Colorado 80203
Telephone: 303/829-2351

Kenneth D. Prince
STATE CARTUGRAPKER

Louis F. Campbell

Division of Planning

Department of Local Affairs
~ 1313 Sherman Street, Room 520

Denver, Colorado 80203

Telephone: 303/839-2351

-132-


ILLNESS WITHIN PREVIOUS TWO WEEKS OR INJURY WITHIN PREVIOUS YEAR

Has (NAME) been ill in the past 2 weeks or been injured in the past 12 months?

Iliness Name

Injury

Name

Accident
Place (Code)

Duration

Physician Consulted

Hospitalized

Yes

No

Name

Yes|

No

Where

How Loi

-T?2-_


environmental survey, If maps are not available from these sources,
satisfactory ones can be prepared with the use of an accurate, hand-

held compass and automobile odometer.

Identification of Blocks

The block in the community should be identified by consecutive
numbers beginning at the northwest extent of the area. Blocks to
the east are numbered sequentially until the community limit is
reached. The series of numbers is continued with the second tier
and subsequent tiers of blocks. The numbers for each tier begin
at the western limit, and consecutive numbers are assigned to the
blocks eastward.

In larger communities, or when otherwise convenient, the com-
munity may first be subdivided into sectors delineated by natural
or cultural features, e.g., rivers, railroad tracks, highways or
other major thoroughfares, parks, business districts, or obvious.
socioeconomic areas. If this is done, a letter is assigned to
each sector and blocks within the sectors are numbered, as outlined
above. In this case, block would be designated by both a letter
and a number, e.g., A-1, A-2, B-1, B-2, etc. This system is useful
in distinguishing sections, or neighborhoods, of the community
that obviously have homogenous characteristics, e.g., a mobile
home community, a "tent city," or a grossly deteriorated area.

Census tracts are designated for few impacted communities.

If they are available, however, use them by all means rather than

devise another system.

-30-


Both provide the content for a report of findings from the survey.

The following are examples of the types of tables required:

Characteristics of the survey sample

- Distribution of the sample by neighborhood or sector,
number and percent of blocks surveyed, number and per-
cent of interviews completed. (See Table 5-2.)

Populations impression of health and sanitation services

- Reported priorities of health and sanitation needs by
neighborhood or sector.

- Awareness and use of available public health services
by neighborhood or sector.

Extent of use of preventive health services

- Number and percent of persons reported having a skin
test for tuberculosis by neighborhood or sector, by

age.

- Number and percent of persons reporting a visit to a
physician or dentist by neighborhood or sector, by age

- Number and percent of persons reporting immunization
against communicable diseases by type of disease, by
age, by neighborhood or sector. .

Experience with disease and injury

- Number of recent illnesses reported by neighborhood
or sector, by age.

- Number of recent accidents reported by type of acci-
dent, by place of occurrence, by age, by neighborhood
or sector.

- Number and type of frequent or recurrent health pro-
blems by neighborhood or sector, by age.

- Number of reported respiratory diseases by neighbor-

hood or sector, by type of disease, by occupation, by
length of exposure.

Design of Tables
The form of the Health Index Survey suggests some possible for-

mats for organization of tables. Table 5-3 through Table 5-6

-101-


The following general suggestions are offered for preparation
of the maps listed above. In determining the types of maps to be
prepared, consideration should be given to the possibility of en-
hancing their usefulness by depicting combinations of factors on
the same map. For example, condition of the physical structures
and sanitary conditions often can be illustrated together to ad-
vantage. The quality and condition of housing is correlated with
well-maintained environs and presence of adequate community envi-
ronmental services. Local circumstances will suggest when such
combination of illustrations is desirable. For clarity and con-
venience, each of the principal types of maps are considered se-
parately in these suggestions.

Land Use. Illustrations of land use may be prepared from the
data in Table 4-3. Unless there are indications otherwise, the
mininum number of categories should be depicted in the initial pre-
sentation. In many instances, residential and non-residential use
may suffice. In communities where population is growing rapidly,
categories that distinguish between temporary, mobile, and per-
manent dwellings may be desirable. Locations of vacant areas and
recreational areas are useful in planning for community growth.
The information accumulated, as outlined in Parts 1 through 3
will be useful in determining the categories to be included in
the initial illustration of land use.

Difficulty is seldom encountered in determining whether a
given block is primarily residential or non-residential. A vi-
sual comparison of the data in the total columns of Table 4-3 is

usually adequate without a separate tabulation and calculation.

-37-


ANSWER CODES FOR USE ON PAGE 3

Reasons for Not Using Service

(1) Did not know about service

(2) Not needed

(3) Not convenient

(4) Did not like the service provided

(5) Other

-62-


1. A determination is made as to whether or not the use is
residential or non-residential.

2. I£ residential, the type of dwelling unit it identified
and recorded.

3. If non-residential, the type of use is observed and re-
corded.

4. The condition of the principal structure is determined and
recorded.

The method of solid waste storage is observed and recorded.
The type of sewage disposal is observed and recorded.

The source of domestic water is determined and recorded.

on DOD wu

The condition of the premises is observed, and specific
deficiencies are noted and recorded.

The appropriate symbols are always recorded on the form in
the same sequence. The first is recorded at the place on the form
depicting the front (streetside) of the property being inspected.
The other symbols are recorded sequentially, in the order indicated
above, toward the place on the form indicating the back of the pre-

mises. An example of a completed form is illustrated in Figure 4-2.

Code for Land Use and Environmental Conditions

Table 4-1 lists the symbols used for recording land use and
environmental conditions observed during the inspection. The in-
spector should become familiar with these symbols so that constant
reference to the list is not necessary. It will be noted that
the letters used for each symbol usually suggest the factors and
conditions to be evaluated. In instances when this is not done,
other letters will be necessary to avoid repetition. Table 4-1
should be duplicated and kept on the clipboard with the Environ-

mental Survey Forms. For specific local needs, additions or mod-

-33-


ANSWER CODES FOR USE ON PAGE 5

M-M-R

Measles single

Rubella single

Mumps single

M-R (measles-rubella)

M-M-R (mumps-measles-rubella)
Do not know

-65-

Q)
(2)
(3)
(4)
(5)
(6)
(7)

Place of Service

Private physician's office
Health Department
School

Hospital

Military

X-Rav Mobile Van

Other


indicate representative types suitable for presenting these data.
Selected reports from the accompanying list of references should
also be examined for ideas concerning forms of presentations, as
should the vital statistics summary prepared by the state department
of health.

After a preliminary decision is reached concerning the layout
of the tables, procedures for transcribing data from the Health
Index Survey form should be developed. Obviously the table format
and procedures for transcription should be developed to accommodate
all data, for which a need can be foreseen, from the survey form
before transcription is begun. In this way inconsistencies and

redundancies between the tables can be detected and adjusted.

-102-


ment of information from these data to assure conformance with
pertinent regulation and procedure for developing applications for
assistance should this be necessary,

Needs, demands, or expectations of availability of public
health services will be derived from the health index survey, Some
information will result from analysis of disease problems, as out-
lined above, and other will be obtained from direct responses of
persons interviewed. This will indicate the extent of use and
adequacy of the scope of existing services as well as the respon-
dents' impressions of what additional services are desirable. As-
sistance should be sought from the state and local health depart-
ments and health planning agencies in evaluating these data and in

formulating plans for modifying or adding services.

PERSONNEL TO PROVIDE HEALTH SERVICES

The inventory of resources for health services (Part 6 in
Methods and Procedures) provides the data for determining the ade-
quacy of numbers and types of existing personnel and for defining
additional needs, This analysis must take into account the re-
quirement for health services determined in other phases of the
evaluation and, most importantly, constraints to developing logis-
tics imposed by characteristics of the community.

It is obvious that every conceivable health service cannot
be provided to afford maximum convenience and accessibility to
everyone who needs services. A minimum number of potential users
is necessary to warrant, for example, the development of a hospi-

tal, or to attract a physician or dentist to locate in a specific

-124-


uating programs and provide the means for easy reassessment of

conditions.
When the maps depicting land use and condition of housing

are prepared, several prominent characteristics of the community
become apparent that may not have been as evident or as well defined
For example, the various socioeconomic sectors -- industrial, com-
mercial, and residential areas ~- will be clearly delineated.

The other prominent types of land use also will be evident.

Areas that should be selected for early or intensive attention

will be apparent, as will be parts of the community where specific

problems are less significant.

Tabular Compilations

The data consolidated in Table 4-3, 4-4, and 4-5 also provide
the basis for tabular presentations of statistical information.
These are necessary for quantitation of conditions and are essen-
tial to complement the illustrative information on the maps. Both
the maps and the tabular material are needed for effective analy-
sis.

The tables are generally organized to enable comparisons of
conditions in various sectors or neighborhoods, for various types
of housing, and other factors. Some examples of general forms of
arrangements are illustrated in Tables 4-6, 4-7, and 4-8. Local
requirements and conditions will suggest the factors to be consi-
dered and the appropriate arrangement of numerical information.
The following are some examples:

. Distribution of residential units, by type, by socioeco-

-43-


Yes

No

Don't
Know

16

Does any family member show behavior problems, such as
using drugs, getting in trouble or being delinquent, running
away from home or school, or being too agressive (fighting,
beating wife or children, etc .)?

How many such members?

Are there serious problems in the marriage?

Has any member of the household had psychiatric treatment
or help for nervous or mental trouble in the past two years?
How many have?

Has anyone from this household been admitted to a mental
hospital in the past two years?
How many?

Are there any mentally retarded members of the household?
How many?

Has anyone from the home been admitted to a home for
retarded children?.
How many?

Does anybody in the family wish for help - or wish that another
family member would get help - for nervous or emotional
trouble, worries, or for the way he acts sometimes?

How many should get help?

Is the family on welfare?
Does the family get any other kind of financial assistance?

Is the head of the family unemployed?
For how long?

Is anyone else in the household unemployed, who is of age
and really should be working?
How many?

Please name the two greatest problems for you, or the family as a whole, or for other
family members; those problem which you would most like to get taken care of.

1.

2.

Thank you very much for your help.

-85-


the information you already have. This initial contact will give
you the opportunity to meet the industry's representative who has
been designated to work with the community. If a person has not
been appointed, you can request that a responsible offical be named
as the community contact.

As indicated above, the information for Table 1-1 usually
is available from state or regional offices. These are the best
focal points for information concerning all the developments that
may affect your community. If you do have to collect the infor-
mation locally, it is best to do so by personal contacts. The use
of a questionnaire is indesirable, especially if requests for the
information are made by correspondence. Table 1-1 is for you to
complete by using data obtained from various sources, It is not

designed to be sent to someone to "fill out".


ments were made by many users, including the authors of this Manual.
The origin of particular procedures and the developers of specific
formats cannot be identified for individual acknowledgment. Special
mention should be made of the leadership of the Center for Disease
Control, Public Health Service, U.S. Department of Health, Education,

and Welfare in formulating procedures for evaluating conditions of

health and sanitation in communities.

iv


erally is preferable to apply the appropriate indicator, color or
shading pattern, to entire block. Multiple indicators can be used,
as mentioned in connection with the other maps. Also, the condi-
tion of one or a few units that differ from that of the others

on the block may be shown by superimposing a symbol or another
indicator of appropriate size at the proper location on the indi-
cator that depicts the prevalent conditions on the block.

The number of categories used to describe conditions of hous-
ing will be determined by the extent of detail needed in the com-
munity. Generally, three categories are sufficient: good, fair,
and poor. The classification of "new" and "good repair" used in
Table 4-4 would be placed in the "good" category, "minor repairs"
in the "fair" category, and "extensive repairs" and "dilapidated"
in "poor". Good conditions should be depicted by a blue color or
light shading pattern, fair by yellow or an intermediate shading
pattern, and poor by red or a heavy shading pattern.

Domestic Water. Sources of domestic water may be effectively
illustrated on a map that also indicates the municipal water dis-
tribution system(s). Data for preparation of this suap will be
available from the work outlined in Part 3 and from those re-
corded in Table 4-5. By illustrating these two sets of data to-
gether, the possibility of making connections to the existing
system, or extending the system to unserved residences, can easily
be visualized.

Symbols used on the map should be selected to reflect the

municipal water supply as the best situation and an open well as

-40-


ANSWER CODES FOR USE ON PAGE 8

Place of Accident

()
(2)
(3)
(4)
(5)
(6)
(7)

At home or adjacent premises

Street and highway

Farm

Industry

School

Place of recreation and sports (except school)

Other, including business, church, progessional office, etc.

-71-


HAZARDS: This card describes the types of

hazards that face some people.
Which of these would apply to
(NAME) and please complete
the description. (Code as
many as apply.)

INDCOR ENVIRONMENT: This card describes the various types of

indoor conditions that face some people
Which of these would apply to (NAME) ?
(Code as many as apply.)

1 2 3 4 1 2 3 4 5 6 7 8
HS W HS W HS W HS Wl HS W{HS W HS W HS W HS W

Page 12

-80-


United States EPA-908/4-77-012
Environmental Protection

Agency

PROCEDURES FOR EVALUATING HEALTH IMPACTS
RESULTING FROM DEVELOPMENT OF ENERGY
RESOURCES

Region 8 March 1978
Denver , Colorado


Table 5-4

Health Index Survey

( Community)

Occurrence of Chronic Diseases

Sector

Number of
Persons

Percent of Persons With Chronic Disease

Allergy

Asthma

Bronchitis

Emphysema

Any Chronic
Disease

-106-



=)

APPENDIX

SOURCES OF INFORMATION AND ASSISTANCE
FOR
COMMUNITIES IMPACTED BY ENERGY DEVELOPMENTS

129-


=)

PREFACE

This Manual is a compilation of formats, protocols, and proce-
dures that may be used by communities and state agencies to evaluate
health impacts resulting from the development of energy resources.
The Manual also considers ways of using these evaluations to deve-
lop plans for coping with health impacts. The Manual is an outgrowth
of a study of health problems experienced by impacted communities
in Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming.
Many communities, especially small ones, found that such problems
required actions by both elected officials and the general public
that were new to the community. There was, and is, a need for guide-
lines and procedures to do the jobs that have to be done.

Impacted communities have used a variety of approaches in deal-
ing with undesirable health effects. But accounts of these experieces
and comparisons of their effectiveness are not easily available to
commumities that need to know about them. In some instances, there
was uncertainty about assistance that might be available and where
‘to get it. This Manual was developed to make such information easier
to obtain and to suggest ways that a community may assemble informa-
tion and organize to avoid or overcome undesirable health impacts
from rapid growth.

The material in this Manual was adapted from many: sources,

The procedures outlined have evolved over a long period and refine-

iii


Table 5-5

Health Index Survey

(Community)

Occurrence of Recent Illness

Percent of Persons Ill Within 2 Previous Weeks

Upper Asthma
Number of Respiratory or Eye Any
Sector Persons Infection Cough Allergy Diarrhea Irritation IUlness

-107-



Table 3-7

Current and Projected Trends in Production of Solid Waste

1950-1981

(Community)

Year*

Population

Tons/Day (_x 1,000 )

1950

1960

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

19 80

1981

*Years for which the population is estimated,

-28-

indicate with an asterisk.


which of the entire list of services is known to be available. The
entire list of services should be read without reference to the
interviewer's knowledge of their availability. The respondent's an-
swers should be recorded by placing a check in the appropriate
column in area "A" of the form.

The respondent then should be asked which of the available
services are used by any household member. The list of services
identified by checks in the "Available" column should be read and
the respondent's answer recorded for each in the "B" area of the
form. If a "no" answer is given, inquiry should be made to deter-
mine why the service is not used. The response given should be
recorded in the "No" column using the appropriate number from the
code.

The respondent then should be asked whether or not the ser-
vices on the list which are not presently provided in the community
would be used if they were available. Read the entire list of
services that were not previously checked as being available. Re-
cord the responses in the "C'' area of the form. If a "no" answer
is given, ask why the services would not be used, The response
should be recorded in the "No" column using the appropriate code,

Page 4. Information About Indoor and Outdoor Environmental

Conditions and Community Services That Affect Health. Information

from the questions on Page 4 will give the informant's impression
about selected environmental conditions and community services. The
"A" list concerns nuisances that may occur in or near the dwelling
unit. The "B" list concerns community services related to health

and safety. Each one of the itmes should be mentioned separately

-87-


Family Name

Address
Phone No.
Relationship
Name to Head of i
sex ltonccnon Ethnic Group (observe) Code [J (A)
First Middle Last* Age {M|F Residence:
Length of time in this community: years, months
1 Anticipated length of stay in this community: indefinitely or for.
= Length of time in this residence: years, months
2 Dwelling Uni
Type of dwelling unit Code [[—] (8)
Number of rooms Number of rooms used only for bedrooms
3 Apparent condition of dwelling unit Code [——] (c)
- Type of space heating Code [____] (D)
Type of space cooling Code [—__] (E)
4.

Sanitary Facilities:
Type of sewage facilities Code [__] (F)
5 Type of water facilities Code [__](G)

- Type of solid waste disposal Code [—_](H)

6. Dogs:
Number
Number vaccinated against rabies:
7. Employment:
Education of Household head CodeL__K)
8 Occupation of household head:
4 Where employed:
5 Mature Child Other (Specify)
5 Respondent: Household Head Spouse (18 or over) (18 or over)
10n

*Last name only if different from family name. Page 13 -82-


Table 1-1
(cont'd)

2. Other sources (available): Yes No

Title Date Source

-10-


of

Page

Table 4-4

Community

Summary
Environmental Survey

State

Inspector

and

Physical Condition of Structure

Sector

Sanitary Condition of Premises

Sanitary Condition
Number of Premises

aqeuon

Kelqo 79MO

seornos

luornyqjod ary

sMoD

sasioyH

suaxoty

sep
- s80q

MOTJIIAQ,
ondes

Taye
Surpueis

aserogiey

quapoy

SPd9M

UMOIBIIAQ

sunt 70

swloq odie]

sSuTptinqino
payeprderid

aday
TIM.

Physical Condition
Number of Structures

queoe,;

poweprdeyiq

siteday

SATSUSIXY

sateday
oul

ireday
poop

MON

Block
‘amber

-52-


The location where the service was received should be entered
in the "where" column using the code for “Location of Physician
and Dentist.“

Page 10. Stay in Hospital or Institution in the Past Year.

The information obtained from the questions on Page 10 indicates
the frequency and purpose for use of selected health-related in-
stitutions. Where combined with data from other sources, for ex-
ample those obtained from Page 9, the information is useful in
planning the appropriate type and location of facilities to meet
the needs of the community.

Information is recorded for each current member of the family,
Information should not be recorded for members who have died.
Inquiry should be made for each member by name and the number of
times during the past year that each person was in a health-related
institution should be recorded in the "Number of Times" column.

The codes should be used to identify the type of facility,
the reason for admission, length of stay, and outcome. The appro-
priate number should be recorded in the proper column. Length of
stay should be recorded in days. If a family member is a per-
manent occupant of an institution or a long-term occupancy is an-
ticipated, “L" should be entered in the “Length of Stay" colum,
Space is provided for complete recording of two episodes. If more
than two occurred during the year, complete data should be recorded
only for the two most recent ones.

Page 11 and 12. Habits and Behavior. The information obtained

by the questions on Page 11 and Page 12 relates to the possible

occurrence of health hazards and to some of the habits of family

-94-


ANSWER CODES FOR USE ON PAGE 9

Reason for Physician Visit

qd)
.@)
(3)
(4)
(5)
(6)

Diagnosis or Treatment

Pre or Post-Natal Care
General Check-Up
Immunization or Vaccination
Eye Examination (glasses)
Other

Location of Physician and Dentist

(1) Local private physician or dentist
(2) Private physician or dentist in another County
(3) Private physician or dentist out of state

(4)
(5)

Military Medical Care
V.A. Medical Care

q)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

Reason for Dentist Visit

Fillings

Extractions or other surgery
Straightening (Orthodontia)
Treatment of gums

Cleaning teeth

Examination

Denture work

Other

-73-


ifications to the code may be desirable to measure factors or con-
ditions not anticipated. Duplication of symbols already used in
the code should be avoided when making changes or additions. In-
formation concerning observations or impressions not considered
in the code should be noted on the form when desirable for clari-
fication or to provide more detail. Procedures for use of the

code in recording observations are given in Table 4-2.

Consolidation of Data

The data obtained from individual premises is consolidated
to characterize conditions for each block. This should first be
done on the Environmental Survey Form by entering the totals for
the block in the spaces provided at the bottom of the forms.
The data for each block then should be transferred to summary forms
Tables 4-3, 4-4, and 4-5 illustrate forms useful for this purpose.
Preferably, the field data should be transferred to these forms
by the inspector the same day or the day following the survey.
This facilitates recall of abbreviations and permits repeat visits,
if required, while the survey is in progress in nearby areas. It
should be emphasized that completion of these forms is an inter-
mediate step in analysis of data. Their usefulness in reports

and for public display is limited.

Display of Information

When the data are consolidated, the information developed
from them should be displayed on maps of suitable size and scale.

The maps used for the enumeration of blocks may be adaptable for

~34-


LAND USE

Table 4-2

Directions for Recording Observations

This information is needed to determine the principal purpose for which

each block of the community is being used in order that the adequacy of community

sanitation services can be determined and data obtained for planning additional

services where needed.

Residential Units - any type of dwelling unit used for shelter by the population. A
distinction is made between units attached to integral foundations and those
which can be moved without dismantling or disturbing the structural inte-
grity of the unit.

Units Attached to Integral Foundations

R-1

R-2

Single residence intended for occupancy by one household group.

Double residence - a duplex or other unit, such as an apartment in
a private residence, intended for occupancy by two household groups.

Multiple residence - intended for occupancy by three or more house-
hold units. No special efforts should be made to determine the precise
number of units,but if an estimate is possible, indicate the estimated
number by R-3 (6), R-3 (14), etc.

Motel - indicate known or estimated number of units by M-12, M-25,
etc.

Hotel - indicate known or estimated number of rooms by H-10, H-23,
etc.

Units Not Attached to Integral Foundations

MH

Mobile home - a movable unit not designed for frequent relocation,
Often has awnings attached or is located adjacent to a sheltered con-
crete slab. Usually provided with electrical, water, and sewer
connections and solid waste is collected.

-46-


Table 6-3

Inventory of Resources for Health Services

(Community)

Number and Type of Medical Specialists in Accessible Communities with More Than Five Practitioners

Average Driving General Family Internal Obstetrics and Surgery, Other (Code)
Name of Community Time Practice Practice Medicine Gynecology Pediatrics General
MD | DO MD {DO MD | DO MD | DO MDI DO MD {DO Mb{ DO | MD| DO | MD
Fields of Practice

1, Administrative Medicine 16. Laryngology 31. Pediatrics, Allergy 46. Rhinology
2. Aerospace Medicine 17. Legal Medicine 32. Pediatrics, Cardiology 47. Surgery, Abdominal
3. Allergy 18, Neoplastic Diseases 33. Pharmacology, Clinical 48. Surgery, Cardiovascular
4. Anesthesiology 19, Nephrology 34. Physical Med. & Rehabilitation 49. Surgery, Colon and Rectal
5. Broncho-Esophagology 20, Neurology 35. Psychiatry 50. Surgery, Hand
6. Cardiovascular Diseases 21, Neu-ology, Child 36. Psychiatry, Child 51. Surgery, Head and Neck
7. Dermatology 22. Nuclear Medicine 37. Psychoanalysis 52. Surgery, Neurological
8. Diabetes 23. Nutrition 38. Psychosomatic Medicine 53. Surgery, Orthopedic
9, Endocrinology 24. Occupational Medicine 39, Public Health 54. Surgery, Pediatric
10. Gastroenterology 25. Ophthalmology 40. Pulmonary Diseases 5S. Surgery, Plastic
11. General Preventive Medicine 26. Otoloty 41. Radiology 56. Surgery, Thoracic
12, Geriatrics 27. Otorhinolaryngology 42, Radiology, Diagnostic 57. Surgery, Traumatic
13, Hematology 28. Pathology 43. Radiology, Pediatric 58. Surgery, Urological
14. Hypnosis 29, Pathology, Clinical 44. Radiology, Therapeutic
15, Infectious Diseases 30. Pathology, Forensic 45. Rheumatology

-115-



of

Page

Table 4-3

Community.

Summary

Environmental Survey

State.

of Land Use

Inspector

Sector

Total
all
Premises

Multiple
Use

Non-Residential

TeI0L,

adh exes tpuy
-79190

wary 10
2077 WeOeA

ely
Teuopeer90%

uoTMFASUy

Anima
rand

‘Surpring
920.

‘DFUBBIO ION
Axsnpuy

Des
Axsnpuy

‘DFUeSIO ION
ssaursng

OpesIO
{ ssoutsng

Residential

TROL

adky, a3eorpuy
-z9MO

woTeLL
asnoy

SUIO]T
aren

« T230H

» T10yy

4. D0UapISay
aTSn INA,

IN UL NUINU

aouspIsSay
aqqnog

Bouaprsay
arsurs

Block
Number

*Enter number of structures (N) and number of units (U), if determined.

-S51-


(NORTH DAKOTA CONT'D)

HEALTH SYSTEMS AGENCIES

Western North Dakota Health Systems Agency
209 North Seventh Street, Suite No. 2
Bismarck, North Dakoca 58501

Telephone: 701/223-8085

Barry Halm, Executive Director

Agassiz Health Systems Agency
123 DeMers Avenue

st Grand Forks, MN 56721
Telephone: 218/773-2471

Don DeMers, Executive Director

Min-Dak Health Systems Agency
811 South léth

Post Office Box 915
Moorhead, MN 56560
Telephone: 218/236-2746

Bruce T. Briggs, Executive Director
DISTRICT HEALTH UNITS

Custer District Health Unit

210 Second Avenue Northwest

Post Office Box 185

Mandan, North Dakota 58554
Telephone: 701/663-4243, Ext. 46

Frank E. Gilchrist, Area Public Health Administrator

First District Health Unit
801 11th Avenue Southwest
Post Office Box 1268
Minot, North Dakota 58701
Telephone: 701/852~1376

0.8. Uthus, M.D., Executive Director

Southwestern District Health Unit
Pulver Hall, Dickinson College
Post Office Box 1208

Dickinson, North Dakota 58601
Telephone: 701/227-0171

John E. Fields, Area Public Health Administrator

Upper Missouri District Health Unit
206 Firse avenue East
Post Office Box 756

Williston, North Dakota 58801
Telephone: 701/572-3763

Frank L. Onufray, Acea Public Health Administrator

Lake Region District Health Unit
Ramsey County Court House

Post Office Box 844

Devils Lake, North Dakota 58301
Telephone: 701/662-4931

Norman Septon, Area Public Health Administrator
STATE ENERGY OFFICE

Governor's Office

Capitol Building

Bismarck, North Dakota 58501
Telephone: 701/224-2200

Dr. Charles Metzger, Fnergy Advisor for
Governor Arthur A. Link

SOURCES OF DEMOGRAPHIC INFORMATION

State Board for Vocational Education
State Office Building

900 East Boulevard

Bismarck, North Dakota 58501
Telephone: 701/224-3187

Social Science Research Institute
University of North Dakota
University Station

Grand Forks, North Daketa 58201

-136-

Regtonal Environmental Assessment Program (KEAP)
316 North Fifth Street ,Room 521

Bismarck, North Dakota 58505

Telephone: 701/224-3700

Dr. A. William Johnson, Director
COOPERATIVE EXTENSION SERVICE
North Dakota State University
State University Station
Fargo, North Dakota 58102

Dr. Norbert A. Dorow, Economist
Public Affairs

North Dakota State University
Pulber Hall
Dickinson, North Dakota 58601

Harry Hecht, District Director
County Extension Office
Weshburn, North Dakota 58577
Telephone: 701/462-3532

Don H. Peterson, Area Resource Development
Agent

SOCIAL SICENCE RESEARCH INSTITUTE

University of North Dakota
Grand Forks, North Dakota 58201

Dr. Richard L. Ludtke, Director
BUREAU OF BUSINESS AND ECONOMIC RESEARCH

University of North Dakota
286 Gamble Hall
Grand Forks, North Dakota 58201

INDUSTRIES

ANG Coal Gasification Company
304 East Rosser

Bismarck, North Dakota 58501
Telephone: 701/258-7440

John Clement

Basin Electric Power Cooperative
1717 East Interstate Avenue
Bismarck, North Dakota 58501
Telephone: 701/223-0441

Robert L. Valeu, Coordinator
Impact Planning


HT

OM

If located on a single lot, evaluate as a separate residence.

If a mobile home community, sketch boundaries on survey form;
indicate number of units by MH-6, MH-20, etc.; and evaluate com-
munity as a single premise.

Indicate the numbez of vacant spaces if apparent, e.g. 6-V.

House trailer - (include Motor Homes in this category) distinguished
from a mobile home by ease of transportation and anticipated greater
frequency of relocation. Often provided with electrical, water, and
sewage connection at parking site and, additionally, has self-contained
water reservoir and sewage holding tank.

If located on a separate lot, evaluate as a single residence. Indicate
by -L if apparently Las been parked for more than two weeks.

If located in a trailer park, sketch park boundaries on survey form;
indicate number of units by HT-10, HT-13, HT-25, etc., and evaluate
park as a single premise. Indicate the number of vacant spaces if
apparent, e.g. 5-V.

Other mobile or easily movable residential units, such as tents,
motor homes, or campers. If located on a separate lot, indicate
type and evaluate as a separate premise. This type of unit usually
will be included in evaluation of trailer parks.

Non-residential Units

BO

BN

IO

Business establishments where any type of organic refuse is produced.
This category includes restaurants, food stores, flower shops, and
other businesses that discard putrescible materia]

Business establishments where organic refuse is not produced. Ex-
amples are service stations, offices, theaters, garages, machine
shops, parking lots, warehouses, etc.

Industrial establishments where any type of organic waste is pro-
duced. For example, canning plants, meat processing plants, fruit
and vegetable packing sheds,

Industrial establishments where organic wastes are not produced.
This category includes manufacturing and processing operations.

-47-


STAY IN HOSPITAL OR INSTITUTION IN THE PAST YEAR

Has (NAME) ever been a patient in a hospital or other health related institution within the past year?

Type of Type of
Number of Facilities Outcome Facilities! Outcome
Never Times (Code) Reason Length of Stay (Code) (Code) Reason Length of Stay (Code)

-76-


Health Index Survey forms before the forms are taken in the field
to conduct interviews. A record should be made of each attempt to
conduct an interview and the ultimate outcome of these efforts
should be recorded.

Page 2. Informant's General Impressions of Health and Sanita-

tion Services, The information requested on Page 2 of the Health
Index Survey form is designed to obtain the informant's own impres-
sion about health and sanitation services in the community without
specific or leading questions from the interviewer. The questions
on Page 2 should be asked exactly as written but in a conversational
manner rather than as a list of interrogations. The introduction
and explanation can be continued to pose these questions but dis-~
cussion of problems or conditions in the community prior to begin-
ning the interview is not desirable. The interviewer should be
completely neutral with regard to problems and conditions and nei-
ther agree or disagree about them. The respondent should not be
able to anticipate the answers that the interviewer may expect.

Page 3, Awareness and Use of Community Health Services, The

information from the questions on Page 3 will indicate the respon-
dent's awareness of need and availability of some important health
and social services in the community and whether or not the family
uses them, Names of additional services may be added to this list
as appropriate for specific communities.

Before undertaking the survey, it should be determined which
of the services listed are available in the community. A check
should be made in the "Available" column indicating these.

In conducting the interview, the respondent should be asked

_-86-


the least desirable, A well with a pump should be indicated as
an intermediate condition.

Sewage Disposal. Illustration of methods of sewage disposal
and the sewage collecting system also may be illustrated advanta-
geously on the same map. The sources of data are Part 3 and
Table 4-5, The methods of display should be essentially the same
as for the sources of water. Usually, only three categories are
required. Indoor plumbing should be depicted as the best condi-
tion, no facilities for sewage disposal as the worst, and privy
or frostproof toilet as the intermediate condition. Local cir-
cumstances and requirements may, of course, necessitate other
categories,

Solid Wastes. In communities where collection, disposal,
or storage of solid wastes is a significant problem, methods of
refuse storage on premises should be illustrated on a separate
map. In other circumstances, these data may be included on the
same map illustrating other environmental conditions. Three. cate-
gories usually are adequate. The best situation is covered con-
tainers of satisfactory construction, the worst is unconfined litter
or burning, and any inadequate container is intermediate, Data
are obtained from Table 4-5.

Environmental Conditions. The illustration of environmental

conditions from the data in Table 4-4 may be simple or detailed,
depending on local requirements. It seldom is necessary to depict
the category of "well-kept" on the map. In some cases. only an
indication of blocks with any objectionable sanitary conditions

may be adequate without specifically identifying the types of con-

~41-


greater distance, but preferably should be within 45 to 60 minutes
driving time. The following types of services are included:

: Consultation and support for providers of primary services
. Ambulatory medical and surgical procedures
. Basic emergency services
. General dental services
: Basic clinical laboratory services
. Basic radiography
. General pharmacy services
Transportation

Regional Health Services

Regional services are more specialized than district services
but are required less frequently. The services generally should be
accessible within 90 minutes driving time. The following types of
services are included:

. Consultation and support for primary and district services

. Specialized medical and surgical services

. Complete emergency services

: Clinical laboratory services

. Radiological services including isotope diagnosis and
therapy

+ Opthalmic services

General hospital services

Complete pharmacy services

Rehabilitation services

Chronic care and long-stay institutional services

Transportation

To complete the description, state health services centers provide
services associated with a regional medical center -- for example,
the state medical center -- administration of public health and
sanitation, and planning. Organizational arrangements vary from
state to state.

The data from the inventory should be analyzed to determine
the location and adequacy of personnel to provide the various types
of services in each of these groups -- primary, district, and re-

gional. This will reveal any deficiencies that may exist for the
- \

-127-


city, types of services, and extent of use of available hospitals.

Table 6-6 should be used for similar data relating to nursing homes.

Sources of Information

Essentially all of the data needed for the health resources
inventory are readily available. Information should first be sought
from your Health Systems Agency and the State Health Planning and
Development Agency (see Appendix). Most states, and many local
agencies, have conducted health manpower surveys that provide data
concerning personnel. State plans for health facilities usually
are prepared annually to determine adequacy and projected needs
for health facilities in designated service areas, These reports
provide information relating to estimated population projections,
current capacity and extent of use of various types of health facil-
ities, and other factors that can be extracted directly for the in-
ventory.

State and local professional societies and state licensing
boards can provide data concerning the number and location of prac-
titioners for which licenses are required, The stats and county
departments can provide information relating to pubsic health per-
sonnel and probably other health personnel.

Information relating to hospitals can be obtained directly
from "Guides to the Health Care Field" published annually by the
American Hospital Association. Most hospitals have a copy, referred
‘to as the "Guide Issue," which should be available for use. The
data concerning hospitals in Table 6-4 and all of the data in

Table 6-5 can be obtained from the "Guide Issue."

-111-


Table 6-6

Inventory of Resources for Health Services

(Community)

Number, Capacity, and Occupancy of Accessible Nursing Homes

Community

Control
Name of Nursing Home (Code) Beds Admissions

Census

Occupancy
(percent)

-120-



community. Certain highly specialized services, such as burn and
trauma units, can be supported adequately only in large centers

of population. However, everyone who needs health services, in-
cluding residents of small communities, should have timely access
to appropriate service in a system that provides for prompt refer-
ral to the proper provider and facility.

In evaluating the adequacy of health services or in planning
health services for a specific population or a community, both
the needs for service and frequency of use of the services must be
taken into account, Frequency of use depends on the type of ser-
vice, the number of people to whom the service is accessible, and
the number of persons by whom the service is needed. The idea that
the national average ratio of providers to population (for example,
one physician to 1,200 persons) can be achieved for every community
regardless of size is untenable. Ways must be sought, however, to
make adequate health services available to everyone regardless of
the place of residence.

The first step in this direction is the determination of the
availability of health services to residents of the community be-
ing evaluated, The data obtained by the inventory of resources
for health services (Part 6 of Methods and Procedures) should be
used for this purpose, The criteria of availability is that an
appropriate provider, as well as other resources, must be accessi-
ble within a reasonable access time. "Reasonable" relates to both
convenience and the urgency of need for which the service is sought.
Some services must be close by and others can be at locations that

require greater access time, Thus, an appropriate way to evaluate

-125-


DISCLAIMER

This report has been reviewed by the Office of Energy Activities,
Region VIII, U. S. Environmental Protection Agency, and approved for
publication. Mention of trade names or commercial products does not
constitute endorsement or recommendation for use.

Document is available to the public through the National T. i
Information Service, Springfield, Virginia 22161. onal Technical

di


INSTRUCTIONS

1, REPORT NUMBER ; ;
Insert the EPA report number as it appears on the cover of the publication.

2. LEAVE BLANK

3. RECIPIENTS ACCESSION NUMBER:
Reserved for use by each report recipient.

4, TITLE AND SUBTITLE , - a :
Title should indicate clearly and briefly the subject coverage of the report, and be displayed prominently. Set subtitle, if used, in smaller

type or otherwise subordinate it to main title, When a report is prepared in more than one volume, repeat the primary title, add volume
number and include subtitle for the specific title.

5. REPORT DATE a ;
Each report shall carry a date indicating at least month and year. Indicate the basis on which it was selected (e.g., date of issue, date of
approval, date of preparation, etc.}.

6. PERFORMING ORGANIZATION CODE
Leave blank.

7. AUTHOR(S) - a | ;
Give name(s) in conventional order (John R. Doe, J. Robert Doe, etc.). List author's affiliation if it differs from the performing organi-
zation.

8. PERFORMING ORGANIZATION REPORT NUMBER .
Insert if performing organization wishes to assign this number.

9. PERFORMING ORGANIZATION NAME AND ADDRESS oo
Give name, street, city, state, and ZIP code. List no more than two levels of an organizational hirearchy.

10. PROGRAM ELEMENT NUMBER .
Use the program element number under which the report was prepared, Subordinate numbers may be included in parentheses.

11. CONTRACT/GRANT NUMBER
Insert contract or grant number under which report was prepared.

SPONSORING AGENCY NAME AND ADDRESS
Include ZIP code.

13. TYPE OF REPORT AND PERIOD COVERED
Indicate interim final, etc., and if applicable, dates covered.

SPONSORING AGENCY CODE
Insert appropriate code.
15. SUPPLEMENTARY NOTES

Enter information not included elsewhere but useful, such as: Prepared in cooperation with, Translation of, Presented’at conference of,
To be published in, Supersedes, Supplements, etc.

12.

14,

16. ABSTRACT
Include a brief (200 words or less) factual summary of the most significant information contained in the report. If the report contains a
significant bibliography or literature survey, mention it here.

17. KEY WORDS AND DOCUMENT ANALYSIS
(a) DESCRIPTORS - Select from the Thesaurus of Engineering and Scientific Terms the proper authorized terms that identify the major
concept of the research and are sufficiently specific and precise to be used as index entries for cataloging.

(b) IDENTIFIERS AND OPEN-ENDED TERMS - Use identifiers for project names, code names, equipment designators, etc. Use open-
ended terms written in descriptor form for those subjects for which no descriptor exists.

(©) COSATI FIELD GROUP - Field and group assignments are to be taken from the 1965 COSATI Subject Category List. Since the ma-
jority of documents are multidisciplinary in nature, the Primary Field/Group assignment(s) will be specific discipline, area of human
endeavor, or type of physical object. The application(s) will be cross-referenced with secondary Field/Group assignments that will follow
the primary posting(s).

18. DISTRIBUTION STATEMENT
Denote releasability to the public of limitation for reasons other than security for example ‘‘Release Unlimited.” Cite any availability to
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Insert the total number of pages, including this one and unnumbered pages, but exclude distribution list, if any.

22. PRICE
Insert the price set by the National Technical Information Service or the Government Printing Office, if known.

‘EPA Form 2220-1 (Rev. 4-77) (Reverse)


Table 5-2

Health Index Survey

(Community)

Age Composition of Population Surveyed

Sector

Number of
Households

Number of Persons in Age Groups (Age in Years)

v1 1-4 5-14 15-24 25-39 40-64 65+

All ages

Persons per
Household

-104-



A. Indoor Conditions

IMPRESSIONS ABOUT ENVIRONMENTAL CONDITIONS AND COMMUNITY SERVICES THAT AFFECT HEALTH

Have you noticed or been bothered by any of the following things in or near
your home in the past 12 months?

Mosquitoes
Flies
Cockroaches

Other Insects (SPECIFY)

B. Community Services

How would you rate the sollowing community services,
would you say_ was satisfactory or unsatisfactory?

Yes

No

Do not kiow or have not been bothered

jlype of Service

Satistactory

Unsatisfactory

No Opinion]

Mice
Rats

Other (SPECIFY)

[Trash collection

ICarbage collection

[Street lighting

Street maintenance

[Police protection

Fire protection

Public transportation

[Are there any other services

that you would like to com~
fment about?

For the remaining questions I need to know the names of al! the family members, (Also the names of other persons living in the household who are
not members of the family.)

Page 4

-64-


OG

RH

st

DC

CH

co

PI

GA

oo

Overgrown weeds ~ the yard or lot is covered or partially so by
uncontrolled growth of vegetation.

Rodent harborage - rubble or other debris, unstacked lumber, or
other material observed that could provide harborage for mice
and rats.

Standing water - indicate permanent or semi-permanent that could
provide breeding places for mosquitoes. Do not record casual
water resulting from recent rain unless the place of accumulation
appears likely to persist.

Septic tank overflow - usually can be identified by evidence of flow
from beneath surface.

Dogs or cats - indicate which or both by circling appropriate letter
or both letters. Indicate number observed.

Chickens ox other domestic fowl - indicate number observed and
whether in coop or loose by -C or -L.

Horses - indicate number observed.
Cows - indicate number observed.
Pigs

Goats

Air pollution ~- any activities such as burning that are sources of
air pollution.

Other - any other objectional conditions observed.

~50-


that the data collected could be consolidated by hand tabulation.
The arrangement of the forms does permit, however, easy adaptation
to mechanical handling if the necessary resources are available
and the volume of data warrants machine processing. In commuities
where the latter methods will be employed, the requisite special-
ists will be available for adapting the forms and processing pro-
cedures to the locally available system and equipment. The sug-
gestions provided here anticipate hand tabulation and the use of a
conventional adding machine or office calculator.

Consolidation of data should be done as surveys are completed
for previously defined areas. Generally, this will be done for
each block and the resulting data aggregated for the neighborhoods
or sectors that were delineated in selecting the sample for sur-
veying. Compilation of data by block provides flexibility in ag-
gregating information by various combinations of block according
to the homogeneity of the environmental and other variable to be
compared with health information,

Before considering procedures for consolidation of data, at-
tention must be given to the form in which data are desired and the

means of extracting and transcribing them from the curvey forms.

Transcription of Data

Columnar analysis forms, available in pads from office supply
outlets, should be used to record data transcribed from the survey
forms. This usually is done more efficiently by two people working
together, one reading from the survey form and the other recording

on the analysis form. Data from the survey form is recorded for

-99-


Solid Waste Disposal

Provide interpretative narrative for data in Table 3-6
and Table 3-7.

Describe services available for collecting garbage and re-
fuse from residential and commercial premises;

- number, type, and capacity of collecting vehicles

- number of collections per week

Describe suitability of existing methods of disposal--land
fill, dump, or others--from an environmental standpoint.

Evaluation of adequacy of existing systems to meet current
and future requirements including:
- number of residences where garbage and refuse collec-
tions are made
- number of residences where garbage and refuse collec-
tions are not made
- number of vacant building lots on route where refuse
and garbage collections are made
- current and projected adequacy of disposal site(s)

Indicate methods of solid waste disposal used where collec-
tions are not made through an organized system.

Current or potential problems with land fill or dump, such
as, drainage, ground water contaimination, odor, and smoke.

Availability of additional land, limitations to use.

Air Pollution

Indicate current standards applicable to the community.

Describe location of air monitoring stations that reflect
conditions in the community.

Discuss relations of applicable measurements to standards.

~24-


Sewage and Waste Water Treatment

. Provide interpretative narrative for data in Table 3-4 and
Table 3-5.

. Description of the types of systems used in the community,
number of each type, whether community is completely or
partially sewered, use of septic tanks, means of effluent
disposal, and acceptability of the methods from an envi-
ronmental standpoint.

. Describe annual trends in average sewage flows and seasonal
variations.

. Outline means for increasing capacity, if needed.

Describe adequacy of sewage collecting systems including:

- number of residences to which the collecting systems
are providing services

- number of residences to which the collecting systems
are not accessible

- number of residences that have access to the collect-
ing systems but are not served by it

- number of vacant building lots to which the collecting
systems are accessible.

Describe methods of sewage disposal used by premises not
served by collecting systems.

. Use of septic tanks, percolation rates, number of systems,
current or anticipated problems such as bad soil conditions
and close ground water.


Table 5-1

Health Index Survey

(Community)

Distribution of Population Interviewed

Sector or
Socioeconomic Areas

Percent
Number of Blocks of Blocks Number of Interviews
Total Surveyed Surveyed Possible Completed

Percent of
Interviews
Completed

Established Areas

New Housing Areas

Mobile Home Areas

Temporary Housing Areas

All Areas

-103-



pared. If the area is homogenous, the number of housing units

may be noted and the area evaluated as a whole.

Use of the Environmental Survey Form

Observations are recorded on the form illustrated in Figure
4-1. The block number and name of the intersecting streets at the
northwest corner, where observations commence, are entered first
on the form. The name of the other boundary streets are noted as
they are observed. Names are entered from the community map if
there are no street signs. During the course of the inspection,
variations in the shape of the block, streams, alleys, and other
features are noted. A rough approximation of the apparent property
lines of individual lots is recorded on the form during the inspec~
tion. The purpose is not to identify boundaries as much as to in-
dicate the premises to which the symbols pertain. This assures
assigning the code symbols to the correct location when data are
transferred to summary forms or illustrations, Each lot is num-
bered consecutively from the start of survey of each block. The
lot on the northwest corner is number 1, the next number 2, and so
on. If house numbers are visible they should be recorded, as well.
No particular effort should be made, however, to ascertain the spe-
cific addresses for houses on which numbers are not displayed,

If is advisable to follow the same pattern in recording the
code symbols on the survey form. Both recording and transcription
are facilitated if observations are made and recorded in the same
sequence for each premise. The arrangement shown in Table 4-1 sug-

gests the following order of observations:

~32-


Table 6-1

Inventory of Resources for Health Services

(community)

Name, Population, Distance, and Accessibility of Communities Where Health Sez vices Are Available

Community (Name)

Population

1970

1975

Distance
(miles)

Driving Time (minutes)

Minimum

Maximum

-113-



BUREAU OF BUSINESS AND ECONOMIC RESEARCH

School of Business Administration
University of Montana

Missoula, Montana 59801
Telephone: 406/243-0211

Dr. Maxine C. Johnson, Director
COOPERATIVE EXTENSION SERVICE
Montana State University
Bozeman, Montana 59715
Telephone: 406/994-0211
SOURCES OF DEMOGRAPHIC INFORMATION
Department of Community Affairs
Capitol Station
Helena, Montana 59601
Telephone: 406/449-2896

C.R. Draper, Administrator
Research and Information Systems Division

(MONTANA CONT'D)

-134-


5. CURRENT STATUS OF HEALTH (HEALTH INDEX SURVEY)

Few communities will need to do a complete health survey.

You may, however, wish to conduct a community needs survey or de-
termine how aware the residents are of the health services avail-
able to them. In some communities, it may be desirable to find
out where people go for health services and what type of health
delivery systems they prefer. Where specific problems exist, such
as disease outbreak or deficiencies in public health services,

you may want to determine the extent of the problem and what is
being done about it.

The survey forms and procedures outlined in this section were
designed to be used selectively. You can choose those portions
that are applicable to your purpose. You should discuss your needs
with the health planners and decide what procedures would be best
for your use.

The procedures outlined were devised for the particular pur-
pose of evaluating health effects associated with energy develop-
ments, although they are applicable to general appraisal of health
status. The survey was designed to secure the folletring type of
information:

Need and adequacy of health and sanitation services in
the community.

Environmental conditions that affect health.

Extent of protection against diseases preventable by
immunizations.

Current and previous experience with diseases and injury.

Sources of health services.

~56-


evaluated. If, however, the only services available are at a
greater distance, their location should be listed, Sources of high-
ly specialized and seldom used services should not be listed if they
are at distances that require more than 90 minutes average driv-
ing time,

Resources for health services available in the community being
evaluated and those available in the communities listed in Table
6-1 should be summarized in Tables 6-2 through 6-6. Data for the
community being evaluated should be entered in the first colum,
Data for the remaining communities should then be provided in the

following columns in order of increasing driving time,

Arrangement of Forms

The form for recording the number of and location of person-
nel is shown in Table 6-2. Provision is made for identifying the
possible sources of health services for residents of the community,
indicating the accessibility in terms of average driving time, and
tabulating the number of the health service providers according to
their profession. The specialization of physicians should be de-
termined when more than five are located in a community. The form
shown in Table 6-3 should be used for this purpose.

Similar form should be used for summarizing information con-
cerning facilities where health services are provided. The form
illustrated in Table 6-4 should be used to indicate the number of.
facilities, by type, in the community being evaluated, and also
the communities listed in Table 6-1. The form illustrated in Table

6-5 should be used to provide detailed information concerning capa-

-110-


SOURCES OF RECENT MEDICAL CARE

Has (NAME) been to either a physician or a dentist in the past 12 months?

VISIT TO PHYSICIAN

VISIT TO DENTIST

How Many Times

Date of Latest

Reason for Latest
(Code)

Where
(Code)

How Many Times

Date of Latest

Reason for Latest
(Code)

Where
(Code'

~The,


Table 3-5

Current and Projected Trend in Sewage Flows
1950-1981

(Community)

Year* Population Ayerage Number of Gallons ( x 1,000) /Day

1950

1960

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

*Years for which the population is estimated, indicate with an asterisk.

-26-



member number 4 was reported to have had poliomyelitis and family
member number 5 was reported to have had encevhalitis. An

entry of '"'5" should be made in the appropriate column for each mem-
ber. Notations in the code should indicate: 4 - poliomyelitis,

5 - encephalitis. Information about "measles" should distinguish
"measles" from "rubella" by entering an "M" or "R" in the "measles"
column, The condition should be indicated by entering the appro-
priate number from the codes in the proper columns. The respon-
dent should next be shown the list of chronic conditions, Each
should be named individually, and inquiry made of experience of
each household member. The code should be used to indicate condi-
tions experienced by the various family members and the year of
onset recorded in the appropriate columns.

Page 8. Illness in the Past Two Weeks or Injury in the Past

Year. This information is useful in determining the current con-
ditions of health in the family and how medical services are ob-~
tained when needed.

The respondent should be asked what illnesses have been exper-
ienced by the individual family members within the past two weeks.
Each member should be mentioned by name. For example, ask, "Has

(name) been ill during the last two weeks or injured
during the last year?" If the answer is "yes" the respondent then
should be asked what the illness was and the information recorded
in the "Illness Name" column or the "Injury Name" column. The
respondent then should be asked whether or not a physician was
consulted, if so, the physician's name should be asked, Inquiry

also should be made about hospitalization, as indicated on Page 8,

-92-


Table 1-1

General Information Concerning Energy Development

Name or other designation of the development:

Type of energy:

Principal developer (responsible firm):

Address:

Person or office designated by developer to provide information concerning health

effects: Name

Address

Location of Development
Location of principal site(s) of operations with relation to proximity of highways,
established communities, landmarks, and other features as needed for precise

identification:

Topographic maps of area:

Name Number

wore

Area of Operations

Latitude Longitude . Size of area square miles,

or acres. Boundaries of area: Indicated on accompanying map ’
————___

or described _



ANSWER CODES FOR USE ON PAGE 10

Type of Facility

()
(2)
(3)
(4)
(5)
(6)
(7)
(8)

Local Hospital

V.A. Hospital

Convalescent Hospital

Nursing Home

State Tuberculosis Sanatorium
State Hospital

Institution tor Exceptional Children
Other health related facility

Outcome

(1) Recovered
(2) Improved

(3) No change
(4) Worsened

-75-


ANSWER CODES FOR USE ON PAGE 13

(A) Ethnic Group

(B) Type of Dwelling Unit

(C) Apparent Condition of Dwellin

Unit
Q) Caucasian (1) Separate house (5) Mobile home
(2) Spanish-American (2) Duplex (6) Trailer (1) New (occupied less than
(3) Black (3) Single cottage apartment (7) Motor home 1 year)
(4) Indian or garage apartment (8) Tent (2) Good condition
(5) Oriental (4) Apartment in multiple (9) Other: (3) Needs minor repairs
(6) Other: unit structure (paint, clean-up, etc.)
(4) Needs extensive repairs
(xeroofing, broken brick
work, broken windows,
holes in walis)
(D) Type of Heating in Home (E) Type of Cooling in Home (F) Sewage Facilities (G) Water Facilities

(1) Central, warm air (1) Part of central heating system (1) City sewer
(2) Steam or Hot Water (2) Separate central air conditioning (2) Septic tank
(3) Built-in electric (ceiling wall (3) Portable room air conditioning (3) Cess pool
or baseboard) (4) Other: (4) Privy
(4) Floor or wall pipeless furnace (5) None (5) Unknown
(5) Fireplace, stove, or portable
room heater
(6) Other:
(7) None

ie?)
(2)
(3)
(4)
(5)

Municipal (City)
Private water com{
Private source
Dug well

Cistern

(H) Solid Waste Disposal

(1) Education of Household Head

(1) Municipal collection (1) Postgraduate Work
(2) Contract with private company (2) College Graduate
(3) Resident transport to disposal site (3) College 1-3 Years

Where: (4) High School Graduate
(4) Disposal on premises: (5) 10-11 Years

Burn Bury Other (6) 7-9 Years
(5) Other: (7) 0-6 Years

(8) Unknown

-81-


Part 4. Information relating to current environmental conditions
that may be employed to ascertain land use by type and
‘geographic location; type, conditon, and location of hous~
ing and other structures; adequacy of residential water
supplies, sewage disposal, and solid waste storage; and
premises sanitation.

. Part 5. Information concerning the current status of health with
respect to protection against diseases preventable by
immunization, occurrence of acute and chronic conditions,
sources of health services, and impression of residents
with regard to current health problems and adequacy of
health services.

Part 6. Information concerning the adequacy of resources to pro-
vide health services. This includes determining the a-
vailability and accessibility of both personnel and fa-
cilities to meet the health needs of the community in
timely and practical ways.

You may also want to review the section on Applications of Infor-
mation at the same time to get a general idea as to how the data
and information you collect will be used.

After you have an indication of the parts that are helpful,
you will want to review the detailed outlines in the next section.
Keep in mind that the procedures discussed should be adapted to your

needs. Use only the material that is required and change it to

serve your purpose.

Where to Get Help

The state and regional planning offices probably were involved
in organizing the Community Impact Committee. If the State Health
Planning and Development Agency and the Health Systems Agency for
your area have not yet participated, you may wish to get in touch
with these offices to find out what information and assistance is
available if needed. In some instances, special programs have been

developed for impacted communities. The Appendix is a list of pos-

-3-


6. RESOURCES FOR HEALTH SERVICES (INVENTORY OF PERSONNEL AND FACIL-
ITIES)

This section describes procedures for preparing a community
inventory of personnel and facilities available to provide various
types of health services. Such information is necessary to deter-
mine the adequacy of existing resources to meet the needs for health
services defined by the procedures outlined in this manual and to
assist in planning for additional resources where necessary. Tables
6-1 through 6-6 illustrate the forms recommended for summarizing
essential data.

Before undertaking collection of these data you should dis-
cuss your needs with the Health Systems Agency for your area (see
Appendix). Some of the data you need may be readily available and

the Health Systems Agency can assist you with the inventory.

Conducting the Inventory

The first step in developing the inventory of resources for
health services is to determine where health services are avail-
able for residents of the community. The location of sources of
health services, other than those in the community being evaluated,
should be listed on the form shown in Table 6-1 together with the
information concerning population, distance, and accessibility.

All communities where health services are available within an aver-
age driving time of 20 minutes should be listed first. Other com-
munities where health services are secured by a majority of resi-
dents in the community being evaluated should then be listed in
order of increasing driving time. These communities will generally

be within 90 minutes average driving time of the community being

-109-


COPIES OF CARDS TO BE HANDED TO RESPONDENTS

Hazards (indicate at Home, School, or Work)

(1) Not exposed to unusual hazards

(2) Operates dangerous equipment at:(Home) (School) (Work)

Indoor Environment (indicate at Home, School, Work)

(3) Building at (Home) (School) ( Work)

is not safe because (Specify)

(4) Other hazards at (Home) (School) (Work)

are

-79-

qd)
(2)

(3)

(4)

(5)

(6)

(7)

(8)

No adverse conditions
Objectionable noise at (Home) (School) (Work)

Poor lighting at (Home) (School) ( Work)

Object: onable odors at (Home) (School) ( Work)

Objectionable dust at (Home) (School) (Work)

Eye irritation experienced at( Home) (School) (Work)

Difficult breathing experienced at(H) (S) (W)

Other objectionable conditions at (H) (S) (W)



Table 5-3

Health Index Survey

(Community)

Proportion of Persons Under 5 Years of Age Immunized

Percent Immunized
Number of

Sector Persons Polio Diphtheria Pertussis Tetanus Mumps Measles Rubella

-105-



Source of Immunization - The place where immunization was
received should be recorded by entering the appropriate
number from the code.

T.B. Skin Test - Information concerning skin test for tu-
Berculosis, and chest x-ray in the next column, is needed
to determine the extent to which the population has been
exposed to tuberculosis. This information should be ob-
tained for each member of the family. Results of skin test
should be recorded as "pos" or "neg", "+" or "-" should
not be used. If any family members are receiving medica-
tion because of a positive skin test, "M' also should be
entered under "results." Source of the test should be
indicated by entering the appropriate number from the code.

Chest X-Ray - A chest x-ray usually is made if the skin
test is positive, and also may be made for other reasons.
For example, many hospitals routinely make a chest x-ray
on admission. Information for each family member that
had a chest x-ray should be recorded using the code to
indicate the place where x-ray was made.

Physical Examination - This information is needed to de-
termine the proportion of the population that had a recent
physical examination. Data should be recorded for each
family member using the code to indicate where the exa-
mination was made.

Page 6. Frequent or Recurrent Problems or Handicaps. The in-

formation supplied on Page 6 indicates the experience of the family
with respect to frequent or recurrent illnesses and handicaps.
These data are helpful in determining what problems developed or
occurred in the current place of residence and the experience of
the family in other localities.

The respondent should be shown the list of frequent or recur-
ring illnesses and asked about the family's experience with then.
Each disease or condition should be mentioned individually. (This
information indicates other health conditions of the family and the
frequency of occurrence. The year of onset indicates whether or not

the condition developed recently or is long-standing.) The code

-90-


growing communities, the health index survey may be confined to
the recently developed portion of the community if absolutely ne-
cessary. This is, however, a poor alternative as the entire com-
munity is involved and only the extent of impact varies among
different sections. Generally, the sample should be as large as
circumstances permit -- preferably the entire community if 200 or

fewer families are involved.

Arrangement of the Interview Form

The forms used for the Health Index Survey are illustrated in
Figures 5-1, which consists of Pages 1 through 16. The series of
form shown on Pages 1 through 14 is arranged for use on a clip-
board to facilitate handling of the forms during the interview.

Page 1 of Figure 5-1 provides for recording data that iden-
tifies the community, neighborhood, household, and inter-
viewer. The data and time the survey was conducted, or
attempted, and other data also are recorded on Page l.

Page 2 was designed to obtain impressions about the needs
for health services in the community and the respondent's
evaluation of the adequacy of existing efforts.

. Page 3 is arranged to determine the extent to which se-
lected health and welfare services available in the com-
munity are used by the household members and which pre-
sently unavailable services would be used if they were
accessible.

. Page 4 concerns the impressions about environmental con-
ditions and community services that affect health.

. Page 5 provides for information on the protection that
the family members have against diseases that are pre-
ventable by immunization, the tests they have had for cer-
tain diseases, and physical examinations they have had.

. Pages 6, 7, and 8 concern the family's experience with
illness and injury.

. Pages 9 and 10 concern the sources of regular medical care

-58-


Figure 4-1

Environmental Surve’

Community

Block No.

Inspector

Date

Sector

BLOCK SUMMARY

ataeuon

poarseg
‘Sasywald IV ~dafao 78K) yON
TROL,
sonnyjed ary ody,
ast 230,
ii 87809
*e8ta ‘enop g|
won g Boning
BaKT aBoTPU 08301 °
291 3
ae oy 2 asi]
wary 30 gz. 3149 2 pauruooun
307 UREA A] orstaxo73 2
won
Tmiojess99%1 es a0 soureveg
= ig = RBoq Aro19 187: 8Suf)
$8) copmapsor SE
5 = SE} mopoA9
3 amina Bs ondos soupemep
$ orang 3 5 Aam2uspes
o ‘Suyping i = arty,
2 221330 Z| Suypuns peatesqo
‘BRUENIO 20N Suen 20N
12204;
Axsnpuy seed Tn
oyuesig WL
Axsnpuy ooo gq sang
oo ees
ssoursng z rau
oquediQ, sunt 30 e
ssouisng suoy 830] i sore,
yoord-2s013
Tmo sSupprinpno
arepr orig
ada arvoipuy Pavey Aqsa
-20120 Ten
PUPAL TPM .
asnoy, pomsonne
aul WTA
3 apne OAL
3
HA yoroy [S ¢ 8] powprdenc 8 -zan9
s[° Zz ae g
g = Ss Sf expecoy & Aydung
a 2 5 Say 8] reerormy
es vedo ry
[,aouepisoy {> a 3 satiate 2 wana
sewn [Z 2 8 _
Be Tee tay TOM
Dauapisey a E v
aymod, © Tom
Se AON wodo
aySuts

-54-


-9T-

Trends in Population, Births, Deaths, Infant Deaths, Fetal Deaths, and Maternal Deaths

Table 2-2

1960-1975

(County, State)

Year

Estimated
Population
July 1

Births

Deaths

Infant Deaths

Fetal Deaths

Maternal Deaths

Number | Rate!

Number Rate!

Number Rate?

Number

Rate”

Number | Rate?

1960

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

lper 1,000 estimated midyear population
2Per 1,000 live births
3Per 10,000 live births



Table 4-1

Codes for Land Use and Environmental Conditions

LAND USE
Residential

Units attached to integral foundations:

R-1 Single residence

R-2 Double residence (Duplex)

R-3 Multiple residence (Apartment building)
M Motel

H Hotel

Residential units not permanently affixed to integral foundations:

MH = Mobile home
HT House trailer

Non-Residential

BO _ Business producing any type of organic refuse

BN _ Business not producing any type of organic refuse
to Industry producing any type of organic waste

IN Industry not producing any type of organic waste
OB Office building

PU Public utility

I Institution
R Recreational area
Vv Vacant lot or area

ON Other - indicate‘type

MULTIPLE USE (combination of residential and non-residential use)

Condition of Structure

NW New
GR Good repair
MR Needs minor repairs
ER Needs extensive repairs
DL _Dilapidated

-V Vacant
Solid Waste Storage
Ss Satisfactory container
U Unsatisfactory container
L Unconfined litter
B . Burning
OT Other - indicate type
NO Not observed - unable to determine

Sewage Disposal

ZQBR”

Privy

Frost-proof toilet

Indoor plumbing

Other - indicate type

Not observed ~ unable to determine

Water Source

Ww
WP
cw

Open well
Well with pump
Municipal supply

OW Other - indicate type

~45-

Condition of Premises

WK
DO
Lj
oG
RH
sw
sT
Dc
cH
HR
co
PI
GA
AP
fele)

Well kept

Dilapidated outbuildings

Large items of junk

Overgrown weeds

Rodent harborage

Standing water

Septic tank overflow

Dogs or cats - indicate number observed
Chickens or other domestic fowl
Horses

Cows

Pigs

Goats

Air pollution sources

Other - indicate other objectionable
conditions

NO not observed - unable to determine


OB

Vv

ON

Office buildings. Indicate if specific purpose is obvious, such as:
bank, court house, county office, city hall, etc.

Public utilities. Area used by government or other organization for
public services. Examples: power distribution sub-stations, air
monitoring stations, refuse disposal sites, health department. Where
practical, the specific use should be indicated on the form.

Institution, Indicate type such as school, church, college, hospital.

Recreational area. Any area designed for decorative or recreational
purposes, Indicate type of use when apparent; for example, park,
playground, golf course.

Vacant lot or area. If agricultural or pasture use, indicate by V-A.

Other non-residential use. Indicate type.

Multiple Use - indicates structures used for both residential and business purposes
by combinations uf symbols for residences and businesses. For example,
a combination single-family residence and grocery store would be indicated
R-1 - BO; a combination single-family residence and beauty shop would be
indicated R-1 - BN.

Condition of Structure

NW

GR

MR

ER

DL

New structure - obviously recently built or recently placed on location.
Good repair - no apparent sign of neglect or deterioration.

Needs minor repairs ~ no structural defects or hazards observed but
some work needs to be done to prevent deterioration. For example,
peeling paint, torn screens, broken window, etc.

Needs extensive repairs - value of basic structure justifies cost of
major repairs. For example, roof needs replacing and entire struc-

ture needs painting.

Dilapidated - value of basic structure does not warrant cost of exten-
sive repairs.

Add to above symbols when structure is vacant.

-~49-


HABITS AND BEHAVIOR THAT AFFECT HEALTH

DIET: The statement on this card can be used to describe
a person's eating habits. Which of these
apply to (NAME)? (Code as many as apply.)

SMOKING:

This card describes various smoking
habits. Which of these apply
to (NAME)? (Code as many as apply.)

1[213)41516 7 1J2 [3] +15
| 1
seein ene nns|
|
4
|

-78-


STATE DEPARTMENT OF HEALTH

Wyoming ‘Division of Health and Medical Services
Hathaway Building, Fourth Floor
Cheyenne, Wyoming’ 92002

Lawrence J. Cohen, M.D.
Administrator
Telephone: 307/777-7121

H.S. Parish, M.D., M.P.H.

Assistant State Administrator for Division
of Health and Medical Services

Telephone: 307/777-7513

Robert L. Coffman, Director
Food and General Sanitation Division
Telephone: 307/777-7358

Jo Ann Amen, Deputy State Registrar
Vital Records Services

Division of Health and Medical Services
Department of Health and Social Services
Cheyenne, Wyoming 82002

Telephone: 307/777-7591

STATE PLANNING AND RESOURCES AGENCIES

Department of Economic Planning and Development
Barrett Building, Third Floor

Cheyenne, Wyoming, #2002

Telephone: © 307/777-7284

Sherman Karcher, Director

Department of Environmental Quality
Water Quality Division

Hathaway Building

Cheyenne, Wyoming 82002
Telephone: | 307/777-7781

William L. Garland, Administrator
Wyoming Conmunity Development Authority
139 West Second
Gasper, wyoming | $2602
Telephone: 307/265-0603

CITY-COUNTY PLANNING AGENCIES

Lincoln-Uinta Association of Governments
Post Office Box 389

Kemmerer, Wyoming 83101

Telephone: © 307/877-3707

Richard Jentzsch, Executive Director

Cheyenne-Laramie County Regional Planning Office
Post Office Box 3232

Cheyenne, Wyoming 82001

Telephone: 307/635-0186

Peter L. Innis, Director of Planning

Rawlins-Carbon County Regional Planning Office
Box 953

Rawlins, Wyoming 92

Telephone: 307/424- 3013

Herb Hogue, Director of Planning

Casper-Natrona County Planning Office
Incermountain Buildin,

Casper, wyoming | 8360

Telephone 1235-6503

Charles L. "Chuck" Davis, City-County Planner

Sweetwater County Planning and Zoning Commission
Post Office Box 791

Green River, Wyoming 82935

Telephone: 307/275-2611, Extension 270

Dennis Watt, Planning Director

WYOMING

-140-

Regional Planning Office

Box 228
Basin, Wyoming 82410
Telephone: 307/568-2566

Newell Sorensen, Director of Planning

Laramie-Albany County Regional Planning Office
Albany County Courthouse

Room 402

Laramie, Wyoming 82070

Telephone: 307/742-3166

Nakul "Nick" Verma, City-County Planning
Director

Converse Area Planning Office
Post Office Box 1303

Douglas, Wyoming 82633
Telephone: 307/358-4066

Al Straessle, City-County Planner

Department of Planning and Development
City of Gillerce-Campbell County

Post Office Box 540

Gillette, Wyoming 82716

Joe Racine, Director

Rock Springs Planning Office
Rock Springs, Wyoming 82901
Telephone: 307/362-6892

Platte County Joint Planning Office
Post Office Box 718

Wheatland, Wyoming 82201
Telephone: 307/322-9128

David Sneesby, Planning Director

Sheridan Area Planning Agency
Post Office Box 652

Sheridan, Wyoming 82801
Telephone: | 307/672-3426

Les Jayne, Planning Director

Fremont Association of Governments
191 South Fourth

Lander, Wyoming 82520

Telephone: 307/332-9208

Tom Curren, Executive Director

Northeast Wycming Three County Joint Powers Board
Post Office Box 743

Newcastle, Wyoming 82701

Telephone: 307/746-2433

Abbie Birmingham, Director

Fremont County

County Courthouse
Lander, Wyoming 82520
Telephone: 307/332-5371

Ron Martin, Planning Director
INDUSTRIAL ORGANIZATIONS

Missouri Basin Power Project
Post Office Box 518
Wheatland, Wyoming 82201
Telephone: 307/322-9121

Tim Rafferty, Impact Coordinator
Southwest Wyoming Industrial Association
638 Elias
Rock Springs, Wyoming 82901
Telephone: 307/382-4190

Kim Briggs, Executive Director


MONTANA

STATE DEPARTMENT OF HEALTH

State Department of Health and Environmental Sciences
Cogswell Building
Helena, Montana 59601

Archur C. Knight, M.D., Director
Telephone: 406/449-2544

Martin D. Skinner, M.D., Chief
Preventive Health Services Bureau
Telephone: 406/449-2645

Harry F. Hull, M.D.
Epidemic Intelligence Service (EIS) Officer
Telephone: 406/449-2645

Vernon E. Sloulin, Chief
Food and Consumer Safety Bureau
Telephone: 406/449-2408

John C. Wilson, Chief
Records and Statistics Bureau
Telephone: 406/449-2614
(Health Information)

Benjamin F. Wake, Administrator
Environmental Sciences Division
Telephone: 406/449-3454

DEPARTMENT OF COMMUNITY AFFAIRS

Capitol Station
Helena, Montana 59601
Telephone: 406/449-3757

Harold A. Fryslie, Director

C.R. Draper, Administrator
Research and Information Systems Division

Harold M. Price, Administrator
Planning Division

Barbara Garrett, Administrative Officer
Coal Board

Department of Natural Resources and Conservation
37 South Ewing

Natural Resources Building

Helena, Montana 59601

Telephone: 406/449-3780

John Orth, Director

Robert Anderson, Administrator
Energy Planning’ Division

DISTRICT PLANNING COUNCILS

District 1 Daniels, Phillips, Roosevelt, Sheridan, and
and Valley Counties

High Plains Provisional Council for District One
Post Office Box 834

Scobey, Montana 59203

Telephone: 406/487-5026

V.C, Tousley, Administrator
District 4 Blaine, Hill, and Liberty Counties
Bear Paw Development Corporation of Northern Montana
Post Office Box 1549
Hill County Courthouse
Havre, Montana 59501
Tony Preite, Executive Director

District 6 Fergus, Golden Valley, Judith Basin, Musselshell.
Petroleum, and Wheatland Counties

Central Montana District Six Council

Post Office Box 302
Roundup, Montana 59072

-133-

Telephone: 406/323-2547
Ralph Gildroy, Director

District 11 Mineral, Missoula, and Ravalli
Counties

District Eleven Council of Governments
c/o Board of County Commissioners
Missoula County Courthouse

Missoula, Montana 59801

Gladys Elison, Director
PLANNING DIRECTORS

Barbara Keneedy
Miles City

City-County Planning Board

Powder River County Planning Board
9 South 6th, #301

Miles City, Montana 59301
Telephone: 406/232-6339

Douglas C. Dean
Richland County Planning Board
Post Office Box 1011

Sidney, Montana 5972
Telephone: 406/482-4340

Eldon Rice
Rosebud County Planning Board
Route 2

Forsyth, Montana 59237
Telephone: 406/356-7551

Albion M. Hettich (Bud)
Tri-County Planning Board
Box 199

Circle, Montana 59215
Telephone: 406/485-2622

Jim Ashbury
Dawson City-County Planning Board
City Hall

Glendive, Montana 59930
Telephone: 406/365-5029

Tom Eggensperger
Fallon County Planning Board
County Courthouse

Baker, Montana 59313
Telephone: 406/778-3603

HEALTH PLANNING AND DEVELOPMENT AGENCY

State Health Planning and Resource Development
Bureau

836 Front Street

Helena, Montana

Telephone: 406/449-3121

Wallace King, Chief
HEALTH SYSTEMS AGENCY

Montana Health Systems Agency

324 Fuller Avenue

Helena, Montana $9601

Telephone: 406/443-5965

Ralph Gildroy, Executive Director

STATE ENERGY OFFICE

Energy Research and Conservation Office

State Capitol

Helena, Montana 59601

Telephone: 406/449-3940

Bill Christiansen, Staff Coordinator


2. PHYSICAL AND DEMOGRAPHIC PROFILE OF THE COMMUNITY
You will have frequent need for general information about

It is well to assemble the material outlined in
Much

your community.

this part and have it available for reference when required.
of this information will be needed when making some of the evalua-
tions outlined later.

The process of developing the proposed profile helps you gather
pertinent references and informs the task force about the community
and its residents. No particular surveys or forms are suggested.
The primary sources of material are locally available records and
publications and information obtained directly from local persons.
An appropriate length under each of the suggested headings in the
following outline would be about one or two double-spaced typewrit-
ten pages. You may wish to develop more information about some
aspects of your community, or omit altogether some items in the
outline.

The population data for Table 2-1 usually can be obtained
from the sources of demographic data listed in the Appendix,
However, you may wish to examine such population estimates in light
of what you know about employment projections for the industries
that affect your community. It is desirable to discuss the basis
for the population estimates with the persons who prepared them
and with the health and regional planners. Extrapolations from the
decennial census are of little value to impacted communities.

Local employment projections must be considered. Be sure to get
the best possible information because much of your planning will

be based on the estimated number of people that will be in the

ell-


NORTH DAKOTA

STATE DEPARTMENT OF HEALTH

North Dakota Department of Health
State Capitol
Bismarck, North Dakota 58505

Jonathan B. Weisbuch, M.D.
State Health Officer
Telephone: 701/224-2372

Willis H. Van Heuvelen, Chief
Environmental Health and Engineering
Telephone: 701/224-2371

Kenneth Mosser, Director
Communicable Disease Control
Telephone: 701/224-2376

Kenneth W. Tardif, Director
Environmental Senitation and Food Protection
Telephone: 701/224-2360

STATE PLANNING AND RESOURCE AGENCIES

State Planning Division
State Capitol, Fourth Floor
Bismarck, North Dakota 58505
Telephone: 701/224-2818

Austin Engle, Director
Bonnie Austin Banks, Associate Planner

State Board for Vocational Education
State Office Building

900 East Boulevard

Bismarck, North Dakota 58505
Telephone: 701/224-3187

Coal impact Information Project
Cooperative Extension Service
North Dakota State University
Fargo, North Dakota 58102
Telephone: 701/237-7392 or 7393

Regional Environmental Assessment Program (REAP)
316 North Fifth Street, Room 521

Bismarck, North Dakota 58505

Telephone: 701/224-3700

Dr. A. William Johnson, Director

Regional Environmental Impact Statement Office
1200 Missouri Avenue, Room 105
Bismarck, North Dakota 58501

Rebecca Lee
Community Affaris Specialist

REGIONAL PLANNING ORGANIZATIONS

Region I Divide McKenzie, and Williams Counties
Williston Basin RC & D

Law Enforcement Center

512 Fourth Avenue East

Williston, North Dakota $8801

Telephone: 701/572-8191

Ron Kiedrowski, Executive Director

Region II Bottineau, Burke, McHenry, Mountrail, Pierce,
Renville, and Ward Counties

Souris Basin Planning Council
Minot State College

Dakota Hall, Room 118

Minot, North Dakota 58701
Telephone: 701/839-6641

Mark Hinthorne, Executive Director

Region III Benson, Cavalier, Eddy, Ramsey, Rolette, and

Towner Counties

-135-

North Central Planning Council
Post Office Box 651

Devils Lake, North Dakota 58301
Telephone: 701/662-8131

Region IV Grand Forks, Nelson, Pembina, and
Walsh Counties

Red River RC & D

Post Office Box 633

Grafton, North Dakota 58237

Telephone: 701/352-3550

Julius Wangler, Executive Director

Region V ~- Cass, Ranson, Richland, Sergent, Steel:
and Traill Counties

Lake Agagsiz Regional Council
319 1/2 North Fifth Street
Post Office Box 428

Fargo, North Dakota 58102

Ervin Rustad, Executive Director
Region VI Barnes, Dickey, Foster, Griggs,
LaMoure, Logan, McIntosh, Stutsman, an
Wells Counties

South Central Dakota Regional Council
701 Third Avenue, SE
Post Office Box 903
Jamestown, North Dakota
Telephone: 701/252-8060

Larry Heisner, Executive Director

58401

Region VII Burleigh, Emmons, Grant, Kidder,
McLean, Mercer, Morton, Oliver, Sherid

and Sioux Counties

Lewis and Clark 1805 RCD
801 Boundary Road
Mandan, North Dakota
Telephone: 701/663-6587

John O'Leary, Project Director
Region VIII Adams, Billings, Bowman, Dunn,

Golden Valley, Hettinger, Slope,
and Stark Counties

Roosevelt-Custer Regional Council
19 West First Street

Dickinson, North Dakota 58601
Telephone: 701/227-0647

Marcoe Drem, Project Coordinator
HEALTH PLANNING AND DEVELOPMENT AGENCY

State Department of Health
Capitol Building
Bismarck, North Dakota 58505
Telephone: 701/224-2894

Edward L. Sypnieski, Director and SHPDA
Coordinator

Division of Health Facilities
Missouri Office Building
1200 Missouri Avenue
Bismarck, North Dakota 58505
Telephone: 701/224-2352

Joe Pratschner, Director
Division of Health Statistics
Capitol Building

Bismarck, North Dakota 58505
Telephone: 701/224-2360

Rick Blari, Director


of

Page

Table 4-5

Community

Inspector

Summary
Environmental Survey

State

Sector,

Water Supply, Sewage Disposal, Solid Waste Storage

Number of Premises

Solid Waste

Storage

Sak
= 22N10

Suraing

XOTT
peuruooun,

Tourewop
Axoyovystyesuy

TouTeUOD
Azojovjsnies

Sewage

Disposal

pearesqo
JON

adky,
- 1810

Butquntd
xOopuy

PTIOL
joord-3so01,J

Aatig

Water
Sources

peatesqg
ON

adh,
- 190)

Aqddng
Tedrorunyy

duing
THEM TPM

TIeM
uado

Block
Number

-53-


3

TABLE OF CONTENTS

PREFACE .

HOW TO USE THESE PROCEDURES .

METHODS
1.

APPLICAT

APPENDIX.

AND PROCEDURES.

GENERAL INFORMATION CONCERNING ENERGY
DEVELOPMENTS . sone :

. PHYSICAL AND DEMOGRAPHIC PROFILE OF THE

COMMUNITY .

. COMMUNITY ENVIRONMENTAL SERVICE .
. CURRENT ENVIRONMENTAL CONDITIONS

(ENVIRONMENTAL SURVEY) .

. CURRENT STATUS OF HEALTH

(HEALTH INDEX SURVEY)

. RESOURCES FOR HEALTH SERVICES

(INVENTORY OF PERSONNEL AND FACILITIES)
IONS OF INFORMATION .

11
18

29

56

99
109
117


PREVIOUS DISEASES AND CHRONIC CONDITIONS

What chronic or acute disesase has (NAME) had? In what year was the onset of that disease?

Year of Year of Year of Year of Year of Year of
Code Onset Code Onset Code Onset Code Onset Code Onset Code Onset

=m.



Table 3-4

Municipal Facilities for Sewage and Waste Water Treatment

(Community)
Identification Type Daily flows (gal. x 1,000/day) Means of effluent disposal
(Name or Location) Current average Capacity

All Facilities:

Current average daily flow:

Capacity:

~25-



Does (NAME) have any frequent or recurring health problems or handicaps?

FREQUENT OR RECURRENT PROBLEMS AND HANDICAPS

FREQUENT OR RECURRENT PROBLEMS HANDICAPS
{_Number of Episodes} Year of Number 9: j Year of Year of
Code | Day |Week | Year Onset | Code | Day 1 Week Year { Onset. Code Onset

Year of
nset Code

a

(perc accor emeresrap OT

+

—{

Page 6



RESPONDENT'S GENERAL IMPRESSIONS OF HEALTH AND SANITATION SERVICES

Health Services

A. Some health services that are available in one town may not B. Are you satisfied with the variety of health services
be available in another town, have you or anyone in your provided in this community at the present time or do
household ever needed a health service that was not available you feel additional services are needed?
in this community? 1_Yes (If yes) What type of service was needed? 1 Satisfied now

2_No 2 Need additional services (Ask C)

C. What do you consider to be the most urgent needs for additiona! health services in this community?

a. b.
Cc. d.

Sanitation Services

What do you think could be done to make the
entire community a more healthy and attractive
lace to live?

Who, if anyone, is doing
anything about the communi-
ty needs at the present time?

Do you think they are doing
enough, or could additional
work be done?(CIRCLE NO.)

What else should be done, who should

do it?

1, Doing enough now

a. 2. Could do more

1. Doing enough now
ib. 2, Could do more

T. Doing enough now
c. 2. Could do more

T. Doing enough now
a 2. Could do more

What do you think could be done to make your
own neighborhood a more healthy and attractive
lace to live?

Who, ifanyone, is doing any-
thing about your neighborhood
needs at the present time?

Do you think they are doing
enough, or could additional
work be done?(CIRGLE NO.)

What else should be done, who should

do it?

1. Doing enough now
2, Could do more

1. Doing enough now

b. 2. Could do more

T. Doing enough now
c. 2. Could do more

1. Doing enough now
d. 2, Could do more

Page 2

-61-



3. COMMUNITY ENVIRONMENTAL SERVICES

This section outlines procedures for evaluating the major en-
vironmental services available in your community. For our purpose,
“community environmental services" include water supplies, sewage
disposal, and solid waste disposal. The best sources of information
are the local offices responsible for these facilities. In areas
where state agencies have responsibility for planning facilities and
developing standards for communities, these offices should be able
to give you information to supplement that available in your commu-
nity. State and sub-area planning offices also are involved in
projection of needs for environmental services. You may also want
to ask these offices for information (see Appendix). Some state
offices publish annual summaries of data that may be used to com-
plete this section.

No forms or survey instruments are suggested for securing
the information outlined in this section. All of the data needed
probably can be obtained from published sources, public records,
or public officials. Tables similiar to those on the following
pages may be used for abstracting data. Sources of information
should be noted on the tables and a complete citation should be
given of references.

These tables may not be necessary if there is only one source
for a service. In these instances, information may be given in the
narrative. Maps of water distribution and sewage collecting sys-

tems are desirable to supplement the tables.

-18-


this purpose. The overall dimension should not exceed 3 by 4 feet.
The scale should enable depiction of blocks at a size of 1/2 to
3/4 inch for the shortest dimension. In some communities, a map
for the entire area prepared at a small scale may be necessary for
orientation. Maps of the sectors that comprise the area then can
be prepared on a larger scale for plotting information. The se~-
lection of scales should be governed to a large extent by the avail.
ability of maps of community environmental services and other maps
of the community. Information also should be sought from the state
and local health planning agencies concerning formats and symbols
for depicting environmental conditions relating to health and san-
itation. The list of selected references following this section
also may be helpful for this purpose.

A convenient procedure is to use a basic map on which is in-
dicated the outline of blocks, names of streets, and prominent
areas or landmarks. The maps may be reproduced in sufficient quan-
tity for plotting each group of conditions, such as condition of
housing, land use, and sanitiation services, on separate maps.

An alternative is to overlay the basic map with clear acetate
sheets on which the various conditions are plotted. The latter
has the advantage of enabling visual presentation of combinations
of conditions by superimposing the sheets depicting the various
conditions.

The mechanical processes of preparing a basic map, plotting
data, and choices of symbols and colors are largely the preference
of the preparer. It is advisable, however, to also review these

matters with the local health planning agencies to determine if

+35-


Figure 4-2

Environmental Surve’

M Smith

Date 8/18/76 inspector C:

Coalville

Community

Block No. /7_

Sector. A

BLOCK SUMMARY

4S 4S7T
~ Xx ~ wt
£ y ie
Fo®Q sn
ST ¥oasty z0°8 = MN
x 9) G
x
TSaeke “|
3 3
al, &
GIT + wear 2
Yom @SlSk al 228 aqev? of8 y
5 a ¥ x we Wa
x ® z, A
RN ~~
Epgessy | gg 38
a 33
ss
2
~7 y
<| Sr agussk
45 459M L/
)
Hf Vi

arqeuon

paarsqo
soeywarg ITV = 22fa0 221119, ON
mot,
sao4n0y
oon uopnfod apy oy
~ -
sidney ano
amon} g
Troy, g Som |
adh 92> 1DUT 69830}¢ °
=59n0 §
H
poay 40 ~| 12 azar]
307 110A eusyoro. z pourruosuy
way
Teuonea199y eg Che) saurewoy
3 fy + siog | —~ Azoxomsresun 2
2 wopmansuy ra
og Sa 2A
2+ Guna a rn sore +
3 anand 3¢ Aoansnes
= Z a0
3 ag Burrus | peasasao}
‘pyuczQ 30N, aory
Aasnpvr aBezouze |
DyueszO. EDO ody,
Ansnpg q + 301ng
spam | om
SpIO ION noses g ~
ssoujsng waortzaAQ z Buyrunys Ry
FOOpLT
‘Dpu320 sunt jo X &
cong sna ie
mo | rey jooxd-25035
BAAL o7eOI UT day] Ss
230100 worl Sg
soreaL | Tem, "
poaszeqo
20N
wrt)
3 ek,
8 ¢ 8] pewordeaa z -aan9
3 EE 3
¢ 3 gf sreoul |g Aidens
i aa] oie ont an
Sq [Espa 3
SS] [ESL som} oy} [F dung
Eel ae Ses id
~~] FZ meeo| Se
TRA} =
x) won] OY ado,

-55-.


Table 3-1

Community Water Supplies

(Community )

Identification Ownership Source Storage Treatment Number
(Name or Location) Type Capacity Type Capacity Type Capacity of
(gal.* /day) (gal.*) (gal.* /day) Users
All Supplies:
Source Storage Treatment
Zapacities

Number of Users

‘Gallons X 1,000

-21-



TECHNICAL REPORT DATA
(Please read Instructions on the reverse before completing)

iy, REPORT No. z (3. RECIPIENT'S ACCESSION NO,
EPA-908/4-77-012
ja. TITLE AND SUBTITLE 5. REPORT DATE

November ]9
PROCEDURES FOR EVALUATING HEALTH IMPACTS RESULTING a

6. PERFORMING ORGANIZATION CODE

FROM DEVELOPMENT OF ENERGY RESOURCES

7, AUTHOR(S) JB. PERFORMING ORGANIZATION REPORT NO.

9. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT NO.

Copley International Corporation

11, CONTRACT/GRANT NO.

7817 Herschel Avenue

La Jolla, California 92037 68-01-1949

12, SPONSORING AGENCY NAME AND ADORESS . 13, TYPE OF REPORT AND PERIOD COVERED
Environmental Protection Agency, Region VIII Final
Office of Energy Activities 14, SPONSORING AGENCY CODE

1860 Lincoln Street
Denver, Colorado 80295

15. SUPPLEMENTARY NOTES
In addition to this manual, a document entitled "Suggestions for Commmities Impacted
by Energy Developments" and a 20 minute slide presentation were prepared.

‘16. ABSTRACT

This manual is a compilation of formats, protocols, and procedures that may be used by
communities and state agencies to evaluate health impacts resulting from the develop-
ment of energy resources. The manual also considers ways of using these evaluativiis
to develop plans for coping with health impacts. It is an outgrowth of a study of
health problems experienced by impacted commmnities in Colorado, Montana, North Dakota,
South Dakota, Utah and Wyoming. Many communities, especially small ones, found that
such problems required actions by both elected officials and the general public that
were new to the commmity. This manual was developed to relate what some commmities
have experienced and to suggest ways that a community may assemble information and
organize to avoid or overcome undesirable health impacts from rapid growth.

17. KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS lb. IDENTIFIERS/OPEN ENDED TERMS |c. COSATI Field/Group
Energy Development Environmental Survey;
Physical § Demographic Profile Health Index Survey;
Community Environmental Service Inventory of Health
Current Environmental Conditions Personal and Services.

Current Status of Health
Resources for Health Services

18. DISTRIBUTION STATEMENT. TRGSITERS TMTM Revord SNOOP PAGES
DISTRIBUTION UNLIMITED

20. SECURITY CLASS (This page) 22. PRICE

EPA Form 2220-1 (Rev. 4-77) | PREVIOUS EDITION IS O@SOLETE



and the answer recorded. After inquiring about the items on each
list, the respondent should be given the opportunity to identify
and comment about any other conditions or services. (After com-
pleting Page 4, the interviewer should tell the respondent that

the interviewer will need to ask questions concerning individual
members of the household. The interviewer should turn to Page 13
and ask the respondent to give the names of each member of house-
hold. Names of only those persons regarded as members of the "fa-
mily" should be recorded, Names of either relatives or non-relatives,
that are so regarded, should be listed but renters or boarders
should not be. The family name, address, and phone number should
first be obtained and recorded. The names, age, sex, and relation-
ship of the individual household members then should be obtained
and recorded. The first listed should be the head of the house-
hold, then the spouse, the children in order of age -- the oldest
first, then relatives or other members. The remaining information
on Page 13 should not be obtained until Page 12 is completed.)

Page 5. Immunizations, Tests, Physical Examinations. Know-

ledge of the number of persons protected against diseases prevent-
able by immunization is useful for two primary purposes; (1) it
provides an indication of the extent to which the entire population
is protected against certain diseases, and (2) it is an indication
of the availability and efficiency of health services in the com-
munity.

Except for the column for recording "TD or T" and "other", in-
formation should be obtained only for children under ten years of

age. Usually the most reliable information on immunization is ob-

-88-


ditions, Other circumstances may require detailed illustration
by type and specific location. If distinction of types is not
indicated, any means of identifying the blocks involved is appro-
priate. For example, a red overlay may be used or a color or sym-
bol code can be devised.

Where identification of the type of condition is desirable,
each type should be assigned a specific indicator or symbol.
These may be used singly or in combinations, Symbols have the ad-
vantage that location can be approximated by appropriate place-
ment of the symbol. In some instances, it is desirable to develop
a map illustrating a single condition or specific combination of
conditions, for example, the location of lots overgrown with weeds
or the location of lots with large animals. The data consolidated
in Table 4-5 are sufficiently detailed for this,

Use of Illustrations

The maps prepared as outlined above have obvious application
of making a forceful display of sanitary conditions of the environ-
ment. When presented in combination with the illustration prepared
from the data related to health conditions (Part 3) a convinc-
ing picture of the interrelation of health and environmental fac-
tors is developed. The maps also are operational tools that enable
determination of the relative magnitude of problems and assignment
of priorities for remedial programs. Together with other informa-
tion, the maps provide indications of the types of corrective and
preventive measures. For example, desirable locations of health
services and advantageous extensions of community environmental

services can be determined from them. The maps also aid in eval-

~42-


DEATHS OF MEMBERS OF IMMEDIATE FAMILY (INCLUDING STILLBIRTHS)

Relation to Head Place of Place of Residence
Date of Death Age at Death of Household Death State County Cause of Death
Page 14

-83-



Figure 5-1
HEALTH INDEX SURVEY

Investigations of Health Effects Associated with Energy Development

Record of Call Attempts

Date Tire Comments

AM
Ll. PM

AM
2. PM

AM
3. PM

AM
4. PM.

Record of Interview

Time Date Completed Comments

Non-Interview Keason

Vacant __4_ Other (SPECIFY)

2 Not at home

3 Refused

Page |

~60-

Identification No.

Interviewer.

Community

Sample Number
Neighborhood

Household

Office Use
Only


15

THE MENTAL HEALTH QUESTIONNAIRE

You have given us a good deal of important general health information which the
Health Department will find very helpful in their work of protecting the community's
health. In addition, health is often related to how people live and the kind of problems
they face. In order to know whether services should be provided to help out with these
problems, and if so where, and how much, and what kinds of service, we must first
have some information about the problems. Please answer the following questions,
and feel free to ask the interviewer about any you don't understand.

Please do not sign this paper unless you wantto. Place the paper in the pro-
vided envelope, seal the envelope and put it in the mail. Nobody
will know what answers you gave to these questions because this
paper is not identified in any way.

Check the line that you think best answers the question .

Don't
Yes No Know
Has anyone in the household retired in the past two years,

or will they in the next year?
How many?

Are there any serious problems with raising the children?
How many "problem children"?

Have any of the children dropped out of school in the past
two years?

How many children dropped out?

Have any of the children been in trouble with the law
(juvenile court) ?

How many have been?

Has anyone else in the household been in trouble with the
law (convicted) in the past two years?

How many?

Do any members of the household drink excessively?
How many do?

Has there been a divorce in the past two years?
Has there been one or more separations of the parents?

Do they ever threaten or discuss divorce or separation?

-84-


-61T-

HOSPITAL CONTROL CODES

Government, nonfederal

12 - State

13 - County

14 - City

15 - City-county

16 - Hospital district or authority

Nongovernment not-for-profit
21 - Church operated
23 - Other

Investor -owned (for profit)
31 - Individual

32 - Partnership

33 - Corporation

Government, Federal

41 - Air Force
42 - Army
43 - Navy

44 - Public Health Service other than 47
45 - Veterans Administration

46 - Wederal other than 41-45, 47-48

47 - Public Health Service Indian Service
48 - Department of Justice

Osteopathic

61 - Church operated

63 - Other not-for-profit
64 - Other

71 - Individual for-profit
72 - Partnership for-profit
73 - Corporation for-profit


OCCURRENCE OF DISEASE

The health index survey, as well as data from state and local
reports and other sources, will reveal and to some extent quantify
the. occurrence of clinical illness. Comparison of the incidence of
specific diseases, or health indicators, in various sectors of the
community will enable you to define specific geopgraphic location
where occurrence is excessive, that is, above average or expected
rates for the community or area. Similar comparisons among commu-
nities or comparisons with county, state, or regional rates will
indicate the relative severity of diseases or other problems in the
various communities. The areas where specific disease problems are
identified should then be evaluated to define the associated envi-
ronmental, behavioral, or other factors. For most of the diseases
considered in this evaluation, the etiology and epidemiology are
well known, The majority of analyses involve quantitation, defini-
tion, and description of local circumstances and conditions rather
than exploratory research.

For example, if an excessive rate of acute respiratory infec-
tions reported as common colds was detected in an area, environ-
ment data would be examined to ascertain if poor housing, inade-
quate heating, ambient toxins, or other factors were positively
correlated with the reports of clinical illness, Such a correla-
tion leads, of course, to definition of possible remedial measures
that may involve physical alternation of dwelling units.

Another example illustrates the indication for a different type
of remedial effort, Consider, for instance, the detecticn of a

high incidence or excessive recent occurrence of measles or other

-122-


4. CURRENT ENVIRONMENTAL CONDITIONS (ENVIRONMENTAL SURVEY)

You may find that not enough information is available for your
task force to determine the extent of unsatisfactory environmental
conditions, This situation is most likely to develop when rapid
population growth has already commenced. A block-by-block survey
is a relatively quick and inexpensive way to accumulate data that
will be useful for a variety of planning activities. The procedures
outlined below will enable you to gather information concerning the
following factors:

Location and extent of various types of land use

Types and condition of dwelling unit

Source of domestic water

Methods and adequacy of sewage disposal

Methods and adequacy of storage and disposal of solid wastes

Location of breeding places and harborage of vectors and
reservoirs of disease-producing agents

Location of dilapidated structures

Location of objectionable environmental conditions

Maps
Your first need for this activity is an accurate map of the

community. Sources of maps are the local government offices, such
as the mayor's and tax assessor's or the offices providing envi-
ronmental services. Maps of water and sewer systems may be suit-
able for use in the environmental survey. Other possiblities are
the area planning offices and health planning agencies. The state
highway office will be able to offer suggestions and may be able

to provide aerial photographs at a scale suitable for use in the

-29-


METHODS AND PROCEDURES

1. GENERAL INFORMATION CONCERNING ENERGY DEVELOPMENTS

Table 1-1 outlines the information needed concerning each energy
development. It is necessary to obtain this general yiew of each
operation in order to identify all of the communities that may be
affected by each industrial operation and to determine the number of

different developments that may impact your community.
The projected employment estimates and information concerning

duration of the activity will aid you in making population estimates
These data also will be useful later on when you consider whether
arrangements should be made for temporary or permanent residents.
They also provide a guide in preparing schedules for planning and
for implementing programs.

Much of this material outlined in Table 1-1 already is avail-
able from published or other readily accessible sources. The state
planning office or state energy office (see Appendix) probably
will be able to provide a great deal of this information that was
collected in preparing Environmental Impact Statements. Be sure
to take advantage of available material.

After getting together as much information as you can, you
then probably will want to get in touch with representatives of the
industry and obtain the information that was not available from

other sources. It is also a good idea to check the accuracy of

-5-


SOUTH DAKOTA

STATE DEPARTMENT OF HEALTH

South Dakota State Department of Health
State Office Building #2

Pierre, South Dakota

57501

Edward DeAntoni, Ph.D., Secretary of Health

Telephone:

James

605/224-3361

D. Corning, Director

Communicable Disease Control and Laboratory Services

Telephone:

605/224-3143

Howard Hutchings, Chief
Section of Environmental Sanitation

+ Telephone:

605/224-3141

William Johnson
Office of Public Health Statistics
Joe Fosse Office Building

Pierre, South Dakota
Telephone:

$7501
605/224-3355

(Health Information)

Sherman Folland, Ph.D., Health Economist
Health Manpower and Linkage Project

STATE PLANNING AND RESOURCES AGENCIES

State Planning Bureau
State Capitol Building

Pierre, South Dakota

Telephone

57501
605/224-3661

Dan Bucks, Commissioner

Department

of Environmental Protection

State Cffice Building

Pierre, South Dakota

Telephone:

57501
605/224-3351

Dr. Allyn 0. Leckner, Secretary

PLANNING AND DEVELOPMENT DISTRICTS

District I

Brookings, Clark, Codington, Devel, Grant,
Hamlin, Kingsbury, Lake, Miner, and Moody Counties

Planning and Development District I
401 Ist Avenue, Northeast

Watertown,
Telephone:

South Dakota
605/886-7224

57201

Lowell D. Richards, Director

District IT

Clay, Lincoln, McCook, Minnehaha, Turner,
and Union Counties

Planning and Development District II
(South Eastern Council of Governments)
208 East 13th

Sioux Falls, South Dakota 97102

Telephone

605/336-1297

William BR. Choate, Director

District III

Aurora, Bon Homme, Brule, Charles Mix, Davison,
Douglas, Gregory, Hanson, Hutchinson, Jerauld,
Sanborn, and Yankton Counties

Planning and Development District 111
Yankton County Courthouse
Post Office Box 687

Yankton, South Dakota

Telephone:

57078
605/665-4403

Herman Tushaus, Director

District IV

Beadle, Brown, Day, Edmunds, Faulk, Hand,
Marshall, McPherson, Spink, and Roberts Counties

Planning and Development District IV
310 S. Lincoln

Aberdeen, Souch Dakota

Telphone

Larry

57401
605/229-4740

Rehfeld, Director

137-

= Armstrong, Buffalo, Campbell, Carson
Districe V Dewey, lasken , Hughes, Hyde, Jones,
Lyman, Mellette, Perkins, Pocter, St.
ley, Sully, Todd, Tripp, Walworth,
and Ziebach Counties

Flanning and Development District V
365 1/2 S. Pierre Street

Post Office Box 640

Pierre, South Dakota 57501
Telephone: 605/224-1623

Dennis W. Potter, Director

Bennett, Butte, Custer, Fall River,
Harding, Jackson, Lawrence, Meade,
Pennington, Shannon, Washabaugh, an
Washington Counties

District VI

Sixth District Council of Local Governments
306 East Saint Joe

Post Office Box 1586
Rapid City, South Dakota
Telephone: 605/342-8241

57791

Larry Finnerty, Director
HEALTH PLANNING AND DEVELOPMENT AGENCY

Edward DeAntoni, Ph.D.
Secretary of Health
Department of Health

State Office Building #2
Pierre, South Dakota 57501
Telephone: 605/224-3361

Donald G. Kurvink, Director
Office of State Health Planning and Development

Telephone: 605/224-3693
HEALTH SYSTEMS AGENCY

South Dakota Health Systems Agency, Inc.
216 East Clark Street

Vermillion, South Dakota 57069
Telephone: 605/624-4446

Donald Brekke, Executive Director
STATE ENERGY OFFICE

Office of Energy Policy
State Capitol Building
Pierre, South Dakota 75701
Telephone: 605/224-3603

James Van Loan, Director
John Culbertson, Deputy Director

BUSINESS KESEARCH BUREAU

School of Business
University of South Dakota
Vermillion, South Dakota 57069
COOPERATIVE EXTENSION SERVICE

South Dakota State University
Brookings, South Dakota 57006

SOURCE OF DEMOGRAPHIC INFORMATION

Rural Sociology Department
Agricultural Eyperiment Station
South, Dakota State University
Brookings, Souch Dakota 57006

William Bergen
University of South Dakota

Vermillion, South Dakota 57069


nomic area.
Condition of housing, by sector or neighborhood.

Environmental deficiencies, by type, by sector or neigh-
borhood, by type of dwelling.

Source of water for domestic use, by type, by sector or
neighborhood, by type of dwelling.

Method of sewage disposal, by type, by sector or neigh-
borhood, by type of dwelling.

Land drainage,

Environmental deficiencies, by sector or neighborhood, by
type of dwelling.

REFERENCES

Public Health Service. Community block survey and socioeconomic
stratification. National Communicable Disease Center.
Atlanta, Georgia.

Institute of Rural Environmental Health, Colorado State University.
Environmental Sutdy for Health Planning. Montezuma County,
Colorado, 1972. Fort Collins, Colorado.

Wyoming Department of Health and Social Services. Community Health
Analysis for Sheridan, Wyoming, March 1970. Office of Compre-~
hensive Health Planning.

Public Health Service. Community Disease Control Demonstrations.
National Communicable Disease Center. Atlanta, Georgia.

Public Health Service. Community Disease and Immunization Survey.
National Communicable Disease Center. Atlante. Georgia.

~44-


sible source of information and assistance. Some of these agencies
can assist in evaluating the usefulness of the various procedures

for your purpose.

e4n


If the proportion of business and non-business is about the same,
or if either use is as much as 25 percent of the total, the data
on the survey form for the block in question usually will indicate
the segments of the block where a specific use clearly is dominat.
The appropriate color or shading pattern then can be applied to
that segment. Use of more than one indicator for a block is help~
ful to illustrate areas where transition in types of land use oc-
curs.

Type of Housing. Data concerning type of housing also is
available from Table 4-3. Such information is especially useful
for a community where rapid growth has occurred or is in progress.
In such instances, temporary or mobile housing may be concentrated
or interspersed with more permanent types of dwellings. It is im-
portant to relate these areas to availability of community envi-
ronmental services (Part 3). If temporary or mobile housing
is present adjacent to or in established communities where streets
have not been constructed and, consequently, individual blocks are
not delineated, the approximate boundaries of such areas should
be delineated on the display maps. If the area is generally homo-
genous with respect to type and condition of housing, environmen-
tal services, and environmental conditions, the entire area may
be mapped as would be an individual block.

A suitable color code should be selected for the type of hous-
ing to be illustrated on the map. Seldom, if ever, will it be
necessary to depict all of the types of housing indicated on
Table 4-3. The important distinctions to make are between the per-

manent type dwelling and the temporary or mobile types that fre-

-38-


Table 6-5

Inventory of Resources for Health Services

(Community)

Number, Types, Capacity, and Occupancy of Accessible Hospitals

Classification Inpatient Days
Code! (Code)
“ 9 ‘ 4 2 3
3 4 2 g|
2/3 2o18 |deal 2
Facilities e115 |e 13 28] 2 |8 g ) 2 | 2
Community Name of Hospital (Code) So [a iale alo [8a 8) als

-118-



) J \ 4 1
tuble!s- 3 ( {

Trends in Numbers and Rates of Deaths Per 100,000 Population by Principal Causes, by Place of Residence Page -17-
1960-1979
(County, State)
Cause* of Death :

Diseases of Influenza |Bronchitis, Certain |All Accidents

the Heart Cerebro- and mphysema,} Causes of [Except Motor Motor

(390-398; Malignant | vascular Arterio- | Penumonia and Mortality in} Vehicle Vehicle

402; 404 Neoplasms | Diseases sclerosis | (470-474; Asthma Early Infancy (E800-E807;| Accidents All
410-429) (140-209) | (430-438) ( 440) 480-486) (490-493) |(760-769.2; | E825-E949) (E810-E823)| Causes
7694-772;
774-778) ;

Year| No. |Rate | No. | Rate | No. | Rate | No. |Rate | No. | Rate | No.| Rate} No.j|Rate| No.| Rate] No.| Rate| No. | Rate
1960
1970
1971
1972
1973
1974
1975
1976
1977
1978

{ae72 \ \



community.

In developing accounts of health conditions in the community,
you probably will want to get some assistance from the health plan-
ners. Information is desirable concerning the previous health pic-
ture, the current situation, and what may happen as a result of
energy developments. Obtaining the data indicated in Tables 2-2
and 2-3 is a convenient place to start. Sources of health infor-
mation are listed in the Appendix. You problably can get informa-
tion for your county but it is unlikely that data will be available
for specific communities. County rates can be compared with state
and national rates to give you some idea of relative severity of
health problems in your area.

Insofar as possible sources of information, including personal
communications, should be indicated by citation in the text and the

title and other information should be listed under References.

w12n°


HOW TO USE THESE PROCEDURES

What_to Use

Use only the procedures in this Manual that are needed for your
purpose. This compilation addresses most of the health-related is-
sues that a community may encounter. There would seldom, if ever,
be a need to carryout all of the procedures or complete all of the
tables. Use this material selectively. Be sure that you know the
application of information before going to the trouble and expense
of collecting it. Also, determine what other assessments are being
made in your community and coordinate your efforts. Try to develop
data and survey instruments that will serve as many purposes as pos-

sible without becoming too cumbersome and difficult to manage.

How to Use the Procedures

These procedures are designed for use as part of the overall
community effort to deal with impacts. You probably will find that
some of the procedures would be useful in work that already is under
way. If you are just beginning to plan your work, you will want to

read Handling Health Impacts -- Suggestions for Communities Impacted

by Energy Developments! and Action Handbook for Small Communites

1 .

: Copley gnternational Corporation, 1977. Handling Health Im-
pacts -- Suggestions for Communities Impacted by Energy Developments
Prepared for the Office of Energy Activities, U.S. Environmental
Protection Agency. Denver, Colorado. (Contract 68-01-1949.)

-1-


FEDERAL, REGIONAL, AND MULTISTATE AGENCIES

FEDERAL

U.S. Environmental Protection Agency Region VITI
Office of Energy Activities

1860 Lincoln Street

Denver, Colorado 80203

Telephone: 303/837-3691

N.L. Hammer

U.S. Department of Health, Education, and Welfare Region VIII
Federal Office Building .

1961, Stout Street

Denver, Colorado 80202

Telephone: 303/837-4461

Hilary H. Conner, M.D
Regional Health Administrator

Dr. Gunner Sydow, Director
Division of Health Resources Development

Michael Liebman, Liaison Officer
National Center for Health Statistics

James E. Ver Duft, Chief
Health Planning Branch

Ralph C. Barnes, Director
Division of Prevention

Dean Hungerford, Director
Division of Health Service

George Rold
Office of Intergovernmental Affairs

Federal Regional Council
1961 Stout Street
Denver, Colorado 80202
Telephone: 303/837-2751

Russell W. Fitch, Representative
Federal Energy Administration

U.S. Department of Health, Education, and Welfare
Indian Health Service Area Offices

Montana and Wyoming:
2727 Central Avenue
Post Office Box 2143
Billings, Montana 59103
Teiphone: 406/585-6452

Richard J. Anderson, Assistant Area Director
Environmental Health and Engineering Programs

North Dakota and South Dakota:
Aberdeen Area,
115 - 4th Street, SE.
Aberdeen, South Dakota 57401
Telephone: 605/782-7553

Bill F, Pearson, Chief
Office of Environmental Health

Utah
Navajo Area, THS
Post Office Box G
Window Rock, Arizona 86515
Telephone: 602/871-5851

Donald G. Myer, Assistant Area Director
Enviormental Health and Engineering Programs

Colorado:
Federal Building and U.S. Courthouse
500 Gold Avenue, S.W
Albuquerque, New Mexico 87101
Telephone: | 505/474-2155

Perry C. Brackett, Chief
Office of Environmental Health

130-

U.S. Department of the Interior

Oil Shale Environmental Advisory Panel
Room 690, Building 67

Denver Federal Center

Denver, Colorado 80225

Henry 0. Ash
Executive Director

REGIONAL COMMISSIONS

Old West Regional Commission
Room 306~A

Fratt Building

Billings, Montana 59102
Telephone: 406/245-6711

Montana
Nebraska

North Dakota
South Dakota

Beth Givens
Information Specialist

Four Corners Regional Commission

3535 East 30th Street Arizona
Suite 238 Colorado
Farmington, New Mexico 87401 New Mexico
Utah

Telephone: 505/327-9626

Carl A. Larson

Executive Director

MULTI-STATE OFFICES

Fort Union Regional Task Forces Montana

State Capitol
Bismarck, North Dakota 58505
Telephone: 701/224-2916

North Dakota
South Dakota
Wyoming

Sheila Miedema
Project Coordinator

PACT Health Planning Center
90 Madison Street

Suite 604

Denver, Colerado 80206
Telephone: 303/320-0917

H. Sterling Drumwright
Associate Director for Consultation


Table 5-6

Health Index Survey

( Community)

Occurrence of Problems Related to Mental Health

Percent of Households Where Problem Was Reported

Number Any
of Problem Legal Emotionel | Financial | Unem- Stressful
Sector Households Children | Difficulties] Alcohol Drugs _| Difficulties | Difficulties] ployment | Situation

-108



ANSWER CODES FOR USE ON PAGE 6

Frequent or Recurrent Problems

()
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
q7)

Upper Respiratory Infection
Pneumonia

Cough

Sore Throat

Asthma or Allergy
Diarrhea

Stomach Ulcers
Headaches

Eye Irritation

Ear Infections

Fever Blisters

Skin Rash

Painful or Swollen Joints
Kidney/Bladder Infections
Dental Conditions

Nervous or Emotional Problems
Other Health Problems (not defined)

-67-

Handicaps

()
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)

Birth Deformities
Cerebral Palsy
Hearing Trouble
Missing fingers /arm
Missing toes/leg
Paralysis

Permanent Stiffness
Seeing Prsblems
Speech Trouble


Table 3-2

Current Trends in Use of Domestic Water
1950-1978

(Community)

Number of Users and Average Daily Use (gal. x 1, 000)

Year

Residences

Businesses

Industries A

Number Amount Used

Number Amount Used

Number

Amount Used «

1950

1960

1970

1971

1972

1973

1974

1975

1976

1977

1978

-22-


HEALTH PLANNING AND DEVELOPMENT AGENCY

Lawrence Cohen, M.D., Director
Department of Health and Medical Services
Hathaway Building, Fourth Floor

Cheyenne, Wyoming 92002

Telephone: © 307/777-7121

Lawrence Bertilson, Director
Comprehensive Health Planning
Hathaway Building, Fourth Floor
Cheyenne, Wyoming 82002
Telephone: 307/777-7121

HEALTH SYSTEMS AGENCY

Wyoming Healh Systems Agency
Post Office Box 106

Cheyenne, Wyoming 82001
Telephone: 307/634-2726

Richard M. Neibaur, Executive Director
STATE ENERGY OFFICE

Department of Economic Planning and Development
Barrett Building, Third Floor

Cheyenne, Wyoming 82002

Telephone: 307/777-7284

John Niland, Executive Director
John. Goodier, Chief of Mineral Division

SOURCE OF DEMOGRAPHIC INFORMATION

Economic Research Unit
State Planning Coordinator's Office
24th and Capitol Avenue
Cheyenne, Wyoming 82002
Telephone: 307/777-7504

Division of Business and Economic Research
University of Wyoming

Post Office Box 3295

Laramie, Wyoming 82071

Telephone: 307/766-5141

Dr. Mike Joehnk, Director
WYOMING HUMAN SERVICES PROJECT

University of Wyoming

Merica Hall 207

Laramie, Wyoming 82071

Telephone: 307/766-6318
Dr. Keith A. Miller, Project Director

Gillette Human Services Project

202 Warren Ave.

Post Office Box 1104

Gillette, Wyoming 82716

Telephone: © 307/682-4219

JoAnn Shurigar-Wzorek
Community Coordinator

Platte County Human Services Project
962 Gilchrist Ave.

Wheatland, Wyoming 82201
Telephone: 307/322-4480

Sharron Kelsey, Field Director

(WYOMING CONT'D)

-141-

HEALTH PLANNING RESOURCE CENTER

Institute for Policy Research
Post Office Box 3925
University of Wyoming
Laramie, WY 820

Telephone: 307/766-5141

Dr. George Piccagli, Director
COOPERATIVE EXTENSION SERVICE

College of Agriculture
Post Office Box 3354
University of Wyoming
Laramie, Wyoming 82071
Telephone: 307/766-3253

Josephine B. Rund, State Extension Leader
Home Econonomics


Table 1-1
(cont'd)

Activation and Duration

Actual or anticipated date development or construction was begun or will begin:

Actual or anticipated duration of development or construction phase:

years months

Anticipated duration of operation: Indefinite Number of years

Not known.

Employment

Actual or anticipated number of employees by years from initiation of activities:

Construction Phase

Year of activity 1 2 3 4 5 6 7

Date Fn ee Ce

INo. of employees

Operating Phase

Year of Activity 1 2 3 4 5 6 7

19 19 19 19 19 19 {19

ate = — — = —_

19

Ino . of employees



HEALTH PLANNING AND DEVELOPMENT AGENCY

Department of Social Services
150 West North Temple

Room 310

Salt Lake City, Utah 84103
Telephone: 801/533-5331

Anthony W. Mitchell
Director

State Health Planning and Development Agency

Office of Planning and Research
150 West North Temple

Room 333

Salt Lake City, Utah 84103

Stewart C. Smith
Assistant Director

HEALTH SYSTEMS AGENCY

Utah Health Systems Agency
19 West South Temple

th Floor

Salt Lake City, Utah 84102
Telephone: 801/571-3476

Paul Bomboulian
Director

STATE ENERGY OFFICE

Department of Natural Resources
State of Utah

State Capital Building

Room 438

Salt Lake City, Utah 84114

Clifford R. Coilins
State Energy Coordinator

SOURCE OF DEMOGRAPHIC INFORMATION

Office of State Planning Coordinator
State Capitol Building

Room 118

Salt Lake City, Utah 84114
Telephone: 801/533-5245

James Edwin Kee
State Planning Coordinator

COOPERATIVE EXTENSION SERVICE

Utah State University
Logan, Utah 84322
Telephone: 801/752-0961

William F. Farneworth
Staff Development Leader

INSTITUTE OF GOVERNMENT SERVICE

Brigham Young University
Provo, Utah 4602
Telephone: 801/374-1211

Dr. Doyle W. Buckwalter
Associate Director

BUREAU OF COMMUNITY DEVELOPMENT

University of Utah

1141 Annex Building

Salt Lake City, Utah 84112
Telephone: 801/581-6491

Dr. Richard P. Lindsay
Director

HEALTH SERVICES ORGANIZATIONS

Health System Research Institute
715 East 3900 South

Suite 205

Salt Lake City, Utah 4107
Telephone: 801/261-1000

George F. Fowell, Jr.

(UTAH CONT'D)

-139-

ity of Utah Medical Center
Deparenent of Family and Comunity Medicine
50 North Medical Drive
Salt Lake City, Ucah 94132
Telephone: Bi /581-5094

Dr. Richard F.H. Kirk
Division of Family Practice

Utah Valley Hospital
1034 North Fifth West
Provo, Utah 8460:
Telephone: 801/373-7850

Mark J. Howard
Director of Rural Health


Table 3-6

Municipal Facilities for Solid Waste Disposal

(Community)

Identification
(Name or Location)

Ownership

Type

Daily Use (tons x 1, 000/di

Current

Capacitl

All Facilities:

Current average daily use:

Capacity

-27-



Page 13. Family and Environmental Information. Page 13 per-

tains to condition of the residence where the family lives and to
general information about the family. (Information concerning the
household roster was provided following description of Page 4.)
Since planning for health and environmental services requires data
on the number of people that will use them, it is necessary to
determine how many people are currently living in the community and
how long they plan to remain. Answers to the questions about occu-
pation place of employment are helpful in this connection when the
respondent is not certain about the future plans for the family.

Information concerning type and condition of the dwelling unit
is needed to anticipate the futre requirements for housing and
the necessity of repair and replacement. Data pertaining to source
of domestic water, sewage disposal, and solid waste storage are
necessary to project needs for community environmental surveys.

The interviewers should, in their own words, explain to the
respondent why the information requested by the questions on Page
13 is important for evaluating the health and sanitary conditions
of the community.

In completing Page 13 information should first be obtained
concerning length of residence and anticipated length of stay in
the community. The type of dwelling unit and the ethnic group
usually can be determined by observation. Inquiry should be made
to determine the number of rooms in the dwelling and the number of
rooms used only as bedrooms.

The remaining information should be obtained by direct ques-

tions to the respondent. The appropriate number from the codes

-96-


STATE DEPARTMENT OF SOCIAL SERVICES

Ucah State Division of Health
150 West North Temple

Room 474

Salt Lake City, Utah 84103

Lyman J. Olsen, M.D., M.P.H.
Director of Health
Telephone: 801/533-6111

Taira Fukushima, M.D., M.P.H,
Deputy Director of Health
Room 460

Telephone: 801/533-6191

E. Arnold Isaacson, 4.D., M.P.H.

Deputy Director of Health for Community
Health Services

Room 440

Telephone: 801/533-6129

Alan G. Barbour, M.D., (EIS) Officer
Epidemic Intelligence Service

Room 426

Telephone: 801/533-6163

Mervin R. Reid, Director
Bureau of Sanitation
Environmental Health Services
Room 430

Telephone: 801/533-6163

Lynn M, ‘Thatcher

Deputy Director of Kealth for
Environmental Health Services

Room 430

Telephone: 801/533-6121

Howard M. Hurst, Director
Bureau of Environmental Health
Room 430

Telephone: 801/533-6121

John Breckert, Director
Bureau of Statistical Services
Room 158

Telephone: 801/533-6186

STATE PLANNING AGENCIES

Office of State Planning Coordinator
State Capitol Building

Room 118

Salt Lake City, Utah 84114
Telephone: 801/533-5356

James Edwin Kee
State Planning Coordinator

Department of Community Affairs
State Capitol Building

Salt Lake City, Utah 84114
Telephone: 801/533-5236

Beth S, Jarman
Executive Director

Division of Energy Conservation and Development

455 East 4th South

Suite 300

Salt Lake City, Utah 84111
Telephone: 533-6491

Rhead Searle, Executive Secretary

Energy Conservation and Development Council

-138-

MULTI-COUNTY ASSOCIATIONS OF GOVERNMENTS

Bear River--Box Elder, Cache, and Rich Counties

Bear River Association of Governments
160 North Main Street

Room 203

Cache County Hall of Justice

Logan, Utah 84321

Telephone: 752-7721

Bruce King
Executive Director

Wasatch Front -- Davis, Morgan, Salt Lake, Tooele,
and Weber Counties

Wasatch Front Regional Council
424 West Center Street
Bountiful, Utah 84010
Telephone: 801/292-4469

Will Jeffries
Executive Director

Mountainland -- Summit, Utah, and Wasatch Counties

Mountainland Association of Governments
160 East Center Street

Provo, Utah 84601

Telephone: 801/377-2262

Homer Chandler
Executive Director

Six County -- Juab, Millard, Piute, Sanpete,
Sevier, and Wayne Counties

Six County Commissioners Organization
Post Office Box 191

Richfield, Utah 84701

Telephone: 801/896-4676

Five County -- Beaver, Garfield. Iron, Kane, and
Washington Counties

Five County Association of Governments
Post Office Box 0

St. George, Utah 84770

Telephone: 801/673-3548

Rhead Bowman
Executive Director

Unitah Basin -- Daggett, Duchesne, and Unitah
Counties

Unitah Basin Association of Governments
Post Office Box 1449

Roosevelt, Ucah 84066

Telephone: 801/722-4518

Clint Harrison
Executive Director

Energy Planning Council
Unitah County Building
Room 303

Vernal, Utah 84078
Telephone: 801/789-2300

Chuck Henderson
Director

Southeastern -- Carbon, Emery. Grand, and San Juan

Counties

Southeastern Association of Governments
Post Office Drawer A-1

Price, Utah 84501

Telephone: 801/637-1396

William K. Dinebare
Executive Director


tained from the mother. The interviewer should ask if she has
records on immunization of the children and if she would get the
data from them. If records are not available, the respondent should
be asked to try to recall the year of each immunization for each
child. Information in each column should be asked for specifically.

Polio vaccine - Only the date of the most recent immuni-
nation should be recorded. Children usually receive oral
polio vaccine. Immunization records may indicate "OTPV"
(oral trivalent polio vaccine). If the type of vaccine is
not recalled, the respondent should be asked if drops were
placed in the child's mouth or on a sugar cube which was
given to the child. If the answer is affirmative, the im-
munization should be recorded under "Oral." If the type
cannot be determined, "?" should be recorded under "Oral."

DPT - (diptheria, pertussis, tetanus) Often identified as
“baby shots."" Only the year of the most recent immuniza-
tion should be recorded.

TD or T - (tetanus-diptheria or tetanus) "TD" may be writ-
ten also as "DT." Tetanus-diptheria usually is given to
persons over five years of age. Tetanus may be given
following an injury in which the skin is broken. Year of
administration for both adults and children should be re-
corded.

Mumps, Measles, and Rubella - Vaccines for mumps, measles,
and rubella may be given singly or in combination. Appro-
priate number from code should be used to identify single
immuniation for mumps, measles, and rubella or for combi-
nations of immunization. Measles is also called hard
measles, 10-day measles, red measles, and rubeola. Rubel-
la is also called German measles and 3-day measles. If
"measles shots" are reported for a child, but the respon-
dent doesn't know whether or not other immunizations were
given in combination, this should be recorded as '"(1)
measles single."

Qther - This column may be omitted except for special pur-
poses, for example, a local epidemic for which immuniza-
tion is available. However, the information should be
recorded if the respondent volunteers it. There are only
two principal "other" kinds: yellow fever and cholera.
Persons who have traveled abroad may have received one or
both. Smallpox should not be recorded since this immuni-
zation is no longer required or recommended in the United
tates.

-89-


Table 1-1
(cont'd)

Communities

New communities planned for construction: No Yes

Name Location

Established communities within 50 miles of the site of development:

Name _ Distance Direction Access highway
(miles) or road (Number)

Available Reports and Other Information

Sources of information prepared by the developer or others relating to the effects of
the development on health and sanitation:

1. Environmental Impact Statement (available) ; Yes No

Title Date Source



members that affect health. All of these questions are concerned
with prevention of adverse health conditions. This information
is requested near the end of the interview since by the time this
point is reached, good rapport should be established between the
respondent and the interviewer.
Some of the questions pertain primarily to adults and others
to children. The interviewer should mention the appropriate family
members by name in each group as the card is displayed pertaining
to each set of questions.
Diet - Pertains generally to all members, but specific
Inquiries should be made concerning children, especially
consumption of candy and soft drinks.
Smoking - Concerns teenage and adults.

Hazards - Applies to everyone. Specific inquiries should
Be made about schools and places of work.

Indoor Environment - Also applies to everyone. Specific
inquiries shouid be made about schools and places of work,

Conditions should be indicated in the proper columns by selecting
appropriate numbers from each of the corresponding codes.

Space is provided on Page 11 and Page 12 for entering data
in the columns. Note that some items in the codes or Page 11 and
Page 12 have blank spaces. Appropriate data are to be recorded
in the columns on the forms. If, on Page 11, an item in the code
without a blank space is applicable, make a check mark in the col-
umn with the corresponding number. If an item with a blank space
is applicable, enter the appropriate information in the column
corresponding with that number. On completing the forms on Page
12, circle H, S, or W as appropriate and write the information for

the blanks in the corresponding columns.

-95-


each interview on the same horizontal line on each of the analysis
forms. The corresponding line on each of the analysis forms is
identified with the same identification number. Entries of data
on the analysis form is made by a single vertical mark in the ap-
propriate column. Data from the entire set of forms a household
interview should be recorded before work is commenced on another
set of forms. When data from all interviews in a block are com-
pleted, the number of marks in each column is totaled and entered.
Information concerning each block is extended on a summary sheet
for the neighborhood or sector depending on how the means of ag-

gregation was planned,

Extracting Data from Survey Forms

The survey forms were designed to secure data in detail for
individual factors, such as diseases and conditions, rather than
for groups of factors. In the initial extraction of data from the
survey forms, however, related factors often should be grouped.
This is determined by the relative frequency with which specific
diseases occur and the problems and needs of the community. Before
designing the layout for data to be transcribed, the completed
survey forms should be reviewed to determine the specific items of

data and the extent of detail to be extracted,

Tabular Compilations

\
Developing information from the data recorded on the survey

forms requires, first, preparation of a series of tables summariz-

ing the data and, second, analyses and interpretations of the data,

-100-


Table 6-4

Inventory of Resources for Health Services

(community)

Number of Types of Facilities Available for Health Services

2 3

4

5

Name of Community

‘Average Driving
Time (minutes)

Type of Facility

Number

Hospital Number

No, of Beds

Infirmary

iagnostic and
Treatment Center

Outpatient Survival Facility

Outpatient Medical Facility

First Aid Station

Number,

Nursing Home Fo eho

Physician's Office

Dentist's Office

Nurse Practitioner's Office

Physician's Assistant's Office

Health Department

School Health Office

Drug Store

Other (specify)

-116-



AWARENESS AND USE OF COMMUNITY HEALTH SERVICES

(Interviewer: Before the interview, check which services are actually available in the community.)

A. Which of the following health services do you know are available in this community? (READ ENTIRE LIST)

B. Which of the following health services in this community have ever been used by members of your family or other
residents in your home? (READ AVAILABLE LIST)

C. Which of the following health services would your family or other residents in your home use now if they were
available? (READ UNAVAILABLE LIST)

Dont No Don't
Available Type of Health Service Yes_| No | Know Yes _| (Code) | Know

Yes

(Code)

Don't
Know

Immunization clinic

Prenatal clinic

Well-child clinic

Nutrition counseling service

Family planning service

Tuberculosis clinic

Venereal disease clinic

Mental health center

Cancer detection clinic

Program for physically handicapped

Alcoholics anonymous (or similar program)

Drug abuse

School lunch program

Programs for the elderly

Welfare services



ANSWER CODES FOR USE ON PAGE 7

Previous Diseases Chronic Conditions
(1) Mumps (6) Chronic cough (26) Kidney Stones
(2) Measles (7) Chest pain (27) Prostate Trouble
(3) Rubella (8) Shortness of breath
(4) Whooping Cough (9) Emphysema (28) Hemorrhoids (Piles)
(5) Other (10) Asthma (29) Varicose Veins
(11) Bronchitis
(12) Tuberculosis (30) Thyroid Trouble

(31) Diabetes
(13) Sinus Trouble

(14) Allergy (any) (32) Arthritis/Rheumatism
(15) Skin Trouble (33) Back Trouble

(16) Anemia (34) Convulsions (Epilepsy)
(17) High Blood Pressure (35) Nervous Conditions
(18) Stroke

(19) Hardening of the arteries (36) Hernia

(20) Heart Trouble (37) Tumor or Cancer

(21) Rheumatic Fever

(38) Other
(22) Stomach Trouble
(23) Stomach Ulcer

(24) Gallbladder/Liver Trouble
(25) Hepatitis (Jaundice)

-69-


ments. '

. Interpretative narrative based on Data in Table 2-1, Table 2-2,
Table 2-3, and other available related information.

Health
. General description of health conditions in the community.

. Apparent variations, if any, in health conditions among
various population groups or in various geographic locations.

. Known or apparent influences of climate and topography on
health.

. Recognized or suspected relation of occupations to health.
General trends in morbidity and mortality.

. Identified or suspected causes of changes in rates of di-
sease and death.

. Problems that have developed as a result of energy develop-
ment, what measures were taken to cope with them, and how
effective the measures were.

. Anticipated changes in health conditions as a result of
energy development.

Interpretative narrative based on Table 2-2 and Table 2-3
and other related available data.

References

. Sources of information. (Notations in text to reports,
literature, and personal communications,)

~14-


should be entered in the corresponding spaces.

Page 14, Deaths of Immediate Family Members (Including Still-

births). Information concerning causes of death is useful in char-
acterizing significant health problems of the population.

The information requested for Page 14 is not related to the
household roster. Names should not be entered on Page 14, only
the information indicated in the column headings.

The immediate family includes the spouses, their children
(natural or adopted), and any other relatives who lived in the same
dwelling with the current family members,

If a stillbirth is reported "S" should be entered in the "Age
of Death" column. If the cause of stillbirth is reported, the
information should be indicated in “Cause of Death" column. For
example, “cord around neck," "mother had rubella," or "mother had
diabetes." If the cause is not known, "UNK" should be recorded.

If the age at death was less than one year, age should be in-
dicated in months in the "Age at Death" column. For example, "5

months."

Mental Health Information

The Mental Health Questionnaire (Figure 5-1, Pages 15 and 16)
is designed to obtain information concerning stressful situations
that may affect the health and social well-being of the family.
The questions are very personal and many people are reluctant to
discuss them with anyone. Answers to them are necessary, however,
to plan the types of health and social services that will meet

the needs of citizens in the community.

-97-


~

Suggested Outline for Evaluating Community Environmental Services

Water Supplies and Distribution Systems

Provide interpretative narrative of data in Table 3-1,
Table 3-2, and Table 3-3.

Describe current sources of domestic water used in the com-
mutnity, present and projected rates of consumption, and
adequacy of supplies.

Seasonal variations in use (summer vs winter).

Indicate quality of domestic water as determined by appli-
cable state or local standards or the 1962 U.S. Public
Health Service drinking water standards for domestic water
supplies. Evaluation of quality should include total dis-
solved solids, fluorides, hardness, and coliform concen-
trations.

Describe additional sources of domestic water, if required.

Description of water distribution systems including:

- number of residences to which services are provided

- number of residences to which the distribution systems
are not accessible

- number of residences that have access to the distri-
bution system but are not served by it

- number of vacant building lots to which distribution
systems are accessible

- hydrostatic pressure

- type of pipe network

- fire protection including hydrant locations, main
size, number of personnel, number of vehicles, and com-
munity classification by national underwriters or other
rating group.

Sources of water for residences not served by distribution
systems,

Current and anticipated water supply problems such as
excess fluorides, or mineral content, limited storage ca-
pacity, excessive hydraulic gradient in supply system,
zones of inadequate pressure and supply.

-19-


Solid Waste Storage

Ss Satisfactory containers ~ covered metal or plastic cans, covered
storage bins, or other arrangements that prevent access by flies
and rodents.

U ‘Unsatisfactory containers - uncovered containers such as oil drums
or boxes that enable access of flies and rodents.

L___Unconfined litter - refuse and trash discarded without apparent at-
tempt to confine.

B Burning - evidence of trash disposal by burning in an incinerator,
improvised metal container, or on the ground.

OT Other type of storage - indicate type.

NO Not observed - unable to determine method of refuse storage, if any.

Sewage Disposal
P Privy.
FP = Frost-proof toilet.
ID Indoor plumbing ~ this cannot be determined conclusively without
questions or inspection, but the presence of vent pipe and evidence
of municipal water supply are indicative.

OS Other - specify type.

NN_ Not observed - unable to determine,

Conditions of Premises
WK Well-kept. Appearance of yard or lot indicates regular maintenance,

DO _ Dilapidated outbuildings - sheds, barns, chicken coop, or other struc-
tures that are deteriorating.

LJ = Large items of junk - abandoned vehicles or other machines, refrig-

erators or other appliances, or other articles for which a truck would
be needed to transport. Indicate type if identifiable.

~48-


and record the information in the "Hospitalized" column. The res-
pondent also should be asked where the injury occurred and the code
should be used to indicate the place in the "Accident Place" colum.
Any additional pertinent information volunteered by the in-
formant should be noted at the bottom of Page 8 or on the facing

code sheet,

Information is sought only for the two previous weeks since
experience has shown that minor illnesses that occurred before this
time frequently are forgotten, If the informants tell you about
an earlier illness or injury, make a note of this at the bottom
of the page or on facing page but do not specifically ask about
earlier illnesses or injuries.

Page 9. Sources of Regular Medical Care, The information on

Page 9 is needed to determine the frequency with which medical and
dental services are sought, for what reasons, and where these ser-
vices are obtained. This information then is used to indicate what
additional provisions should be made for these services and where
they should be located.

To obtain the information for the "Frequency" columns, the res-
pondent should be asked how many times within the last year each
family member visited a physician or dentist, Each family member
should be mentioned by name. The number reported should be recorded
in the "How Many Times" colum,

The respondent should then be asked the date of the most re-
cent visit of each family member and the date reported should be
recorded in the "Date of Latest" column. A list should not be

displayed, just the reason should be recorded as reported.

-93-


Field Observation
Each block in the area to be evaluated is inspected from an

automobile driven at slow speed. The inspector records his obser-

vations and indicates to the driver the appropriate rate of travel
and when stops are necessary. The survey should begin at the north-
west corner of each block, proceed eastward, and then continue by
making right turns to keep the area being surveyed to the inspector's
right. Only general features, such as the type of land use and
other easily observable aspects, are recorded during the drive
around the block. If there is an alley, observation of other
conditions then are made by driving through the alley. When ade-
quate observations cannot be made from the automobile, the inspec-
tor should walk to secure a better view. Unless special arrange-
ments have been made, the inspector ordinarily will not enter pri-
vate property.

In rapidly expanding communities, mobile and temporary housing,
as well as other types, may develop in areas where streets and
blocks have not been defined. In these cases, the inspector should
indicate the location of the area as accurately as possible on the
community map and identify it with an appropriate notation so that
the relevant Environmental Survey Form can be related to the area.
(A recommended Environmental Survey Form and tables for compiling
data are provided at the end of this section (see Figure 4-1 and
Tables 4-1 through 4-8.) Such areas are evaluated and data trans-
ferred to the data consolidation forms, described below, as are
the data for defined blocks. The block outline on the Environmen-

tal Survey Form will have to be modified or a separate sketch pre-

-31-


STATE DEPARTMENT OF HEALTH

Colorado Department of Health
4210 East lith Avenue
Colorado 80220

+ 303/388-6111

Anthony Robbins, M.D., M.P.H.
Executive Director
Extension 315

Thomas M. Vernon, M.D., Chief
Epidemiology Section
Extension 252

Robert E. Fontaine, M.D.
Epidemic Intelligence Service (EIS) Officer
Extension 252

Orlen J. Wiemann, Chief
Milk, Food, and Drug Section
Consumer Protection
Extension 252

Donald J. Davids, Chief
Records and Statistical Section
Extension 237

(Health Information)

Frank Rozich, Director

Water Quality Control and’ Public Health
Engineering

Extension 325

STATE PLANNING AGENCY

Division of Planning
Department of Local Affairs
1313 Sherman Street, Room 520
Denver, Colorado 80203
Telephone: 303/839-2351

Philip H. Schmuck
Planning Director

REGIONAL PLANNING COMMISSIONS
Region 1

Sedgwick, Phillips, Yuma, Logan, Washington
and Morgan Counties

Northeastern Colorado Countil of Governments
Post Office Box 1782

Sterling, Colorado 80751

Telephone: 303/522-0040

John Harrington, Executive Director

Region 2. Larimer and Weld Counties
Larimer-Weld Regional Council of Governments
201 East Fourth Street, Room 201

Loveland, Colorado 80537
Telephone: 303/667-3288

Ronald Thompson, Director

Region 3
Douglas, Clear Creek, and Gilpin Counties

Denver Regional Council of Governments
1776 South Jackson Street, Suite 200
Denver, Colorado 80210

Telephone: 303/758-5166

Robert D. Farley, Executive Director
Region 4 Ei Paso, Park, and Teller Counties
Pikes Peak Area Council of Governments
27 East Vermijo Avenue
Colorado Springs, Colorado 80903
Telephone: 303/471-7080

Roland Gaw, Executive Director

Denver, Adams, Arapahoe, Boulder, Jefferson,

COLORADO

-131-

Lincoln, Elbert, Kit Carson, and Cheyenn

Region 5
Counties

East Central Council of Governments

Box 28
Stratton, Colorado 80836
Telephone: 303/348-5562

Maryjo M. Downey, Director

Region 6 - Crowley, Kiowa, Otero, Bent, Prowers, an
Baca Counties

Lower Arkanasas Valley Council of Governments
Bent County Courthouse

Las Animas, Colorado 81054

Telephone: ’ 303/456-0692

James N. Miles, Executive Director

Region 7a - Pueblo County and City of Pueblo

Pueblo Area Council of Governments
One City Hall Place

Pueblo, Colorado 81003

Telephone: 303/545-0562

Region 7b Huerfana and Las Animas Counties
Huerfano-Las Animas Area Council of Governments
Room 100 County Court House

Trinidad, Colorado 81082

Telephone: 303/846-4478

Fred E. Weisbrod, Executive Director

Region 8 Sauache, Mineral, Rio Grande, Alamosa,
Conejos, and Costilla Counties

San Luis Valley Council of Governments

Adams State College, Box 26

Alamosa, Colorado 81101

Telephone: 303/589-7925

Rondall Phillips, Director

Region 9 Dolores, Montezuma, La Plata, San Juan,
and Archuleta Counties

San Juan Regional Commission

1911 North Main

Durango, Colorado 81301

Telephone: 303/259-1691

Region 10 Gunnison, Delta, Montrose, Ouray, San
Miguel, and Hindsdale Counties

District 10 Regional Planning Commission

107 S$. Cascade

Post Office Box 341

Montrose, Colorado 81401

Telephone: 303/249-9638

John J. Collier, Director

Garfield, Moffat, Mesa, and Rio Blanco
Counties

Region 11

Colorado West Area Council of Governments
1400 Access Road

Post Office Box 351

Rifle, Colorado 81650

Telephone: 303/625-1723

Steve Schmitz, Director
Region 12 Routt, Jackson, Grand, Summit, Eagle, #
Pitkin Counties

Northwest Colorado Council of Governments
Holiday Center Building

Post Office Box 739

Frisco, Colorado 80443

Telephone: 303/468-5445


-ST-

Table 2-1

Trends in Population by Age*
1950-1979

(County, State)

Number of Persons by Age Group in Years

Year**

<i

1-4 5-14 15-24 25-34 35-44

45-64

65+

All Ages

1950

1960

1970

1971

1972

1973

1974

1975

1976

1977

* Source of data;

** Years for which the population is estimated are indicated with an asterisk.



and places and reasons for health care in institutions.

Pages 11 and 12 relates to information concerning habits
and behavior that affect health of family members .

Page 13 contains provisions for listing the names and ages
of household members and recording other information about
the family and the place of residence.

Page 14 is for recording information regarding deaths of
immediate family members.

Page 15 and 16 are a separate list of questions relates
to mental health. This is left with the respondent to
complete after the interview and then mail to the inter-
viewer or the organization conducting the survey.
Pages 1, 2, 3, 4, 13, and 14 are eight and one-half by fourteen
inches and the remainder are eight and one-half by eleven inches.
Any other convenient proportionate sizes can be used provided the
names of household members listed on the roster on Page 13 is vis-

ible and properly aligned when overlain by Pages 5 through 12. The

pages of the survey forms are stapled on the right hand margin.

Suggestions for Conducting the Interview

A brief explanatory statement should be prepared for use by
interviewers in each community. This should contain an explanation
of the local sponsorship of the survey and its purpose. It should
give a brief overview of what information will be requested. The
respondents should be assured that all responses are confidential
and that individuals and premises will not be identified in reports
or otherwise. It should be emphasized that the survey is designed
to gather statistical data that will be used to improve and deve-
lop health services for the community.

Page 1. Identification Data and Schedule of Interview. The

identification data should be recorded on Page 1 of each series of

-59-


community being evaluated and will suggest approaches to meet them.
This planning should be done in collaboration with state and local

health planning agencies.

FACILITIES FOR HEALTH SERVICES

The adequacy of facilities for health services is evaluated the
same as personnel. As indicated above, characteristics of the
community -- including size of population -- determine the kinds
and quantity of services needed. This, in turn, suggests the types
and numbers of health personnel required, Knowledge of the ser-
vices to be provided and the types of providers determines the types
of facilities that are appropriate. The evaluation for a community
should be made in the following sequence: first, the services needed
should be defined; next, the type of personnel required to perform
the services should be identified; and finally, the facilities
appropriate for housing the services should be determined. The
methods for evaluating the adequacy and needs for services and
personnel were outlined in the preceding sections, The inventory
of resources for health services also provides the Jata for evalua-
ting the adequacy of facilities.

Consideration of facilities for health services should involve
the state Health Planning and Development Agency and the Health

Systems Agency.

-128-


After data are obtained from the sources indicated, rough
drafts of Tables 6-1 through 6-6 should be prepared, The appropri-
-ate professional associations and institutions should be requested
to check them for accuracy and incorporate any changes since the

source data were collected.

-112-


Table 6-2

Inventory of Resources for Health Services

(community)

Number and Types of Personnel Available for Health Services

2 3 3 4 5

Name of Community

Average Driving
Time (minutes)

Profession

M.D,

D.O,

Dentist

Nurse Practitioner

Physician's Assistant

Registered Nurse

Licensed Practical Nurse

Nurse’s Aid

Public Health Nurse

Emergency Medical Technician

Pharmacist

Optometrist

Podiatrist

Physical Therapist

Other (specify)

Other (specify)

-114-



Facing Rapid Growth.” Both are available from the Official Energy
Activities, U.S. Environmental Protection Agency, 1860 Lincoln Street,
Denver, Colorado 80203.

You probably will use these procedures in work carried out by
one or more task forces organized by your Community Impact Committee.
Organization of such a Committee is outlined in the Suggestions and
the Action Handbook. Planning offices and governmental departments
also may fitid some of the procedures useful in their activities.

After the Community Impact Committee has formed its task forces
and decided on the major areas of activity, these procedures should
be reviewed to determine which would be helpful. The procedures
outlined are grouped in six parts in the next section, Methods and
Procedures. To assist you in selecting the parts that may be useful
in your work, the following is a brief summary of the information
considered:

. Part 1. General information concerning the energy development, or
developments, that are expected to have an impact on the
community. This information will identify the type of
development and enable anticipation of the kinds, magni-
tude, and duration of impacts that may be anticipated
for the community.

. Part 2. Information to enable preparation of a physical and demo-
graphic profile of the community that will aid in defin-
ing health problems associated with geographic location
and population growth. Information will be obtained on
health problems that have occurred or are currently pre-
sent in the community, how the community coped with the
problems, and how effective were such efforts.

. Part 3. Information concerning current and anticipated needs for

community environmental services such as water supplies,
sewage disposal, and solid waste disposal.

2Briscoe, Mephis, Murray and Lamont. 1977. Action Handbook
for Small Communities Facing Rapid Growth, Prepared for the U.S.
Environmental Protection Agency. (Contract 68-01-3579.)

-2-


should be used to indicate the condition(s) identified by the res-
pondent for each family member.

The respondent should then be asked how frequently the condi-
tion occurs. This might be reported as about twice a day, three
times a week, or twice a year. The number given should be entered
in the appropriate column under "Number of Episodes," The columns
are ruled for recording two conditions for each household member,
however, space is adequate for making additional entries if neces-
sary.

The respondent should then be asked the year when the problem
started and this should be entered under "Year of Onset,"

For example, a report that a person has had a headache twice
a day for the past year should be entered on the proper line for
that family member as follows: 5 in the "(code)" column, 2 in the
"Day" column, and 1975 in the "Year of Onset" column.

Page 7. Previous Diseases and Chronic Conditions. The infor-

mation secured from answers to questions on Page 7 augments that
which is on Page 5 and aids in evaluating the levels of immuniza-
tions in the community and availability of public health services,
The respondent should be shown the list of “Previous Diseases"
and asked which household members have had any of those listed.
Each disease should be mentioned individually. Any “other" reported
should be recorded as "(5)" opposite the name of the proper person.
The "other" should be identified under (5) in the list of "Previous
Diseases" specified in the code. If "other" is reported for more
than one household member, the members‘ numbers should be noted by

the condition added under (5) in the code. For example, family

-91-


conventions specifying these steps have been adopted. This will
assure uniformity and compatibility with similar work in the area.
Generally, commercially available acetate transfers used in draft-
ing are best for symbols and color blocks. Legend symbols, such
as those used on maps and for other purposes, are available in a
variety of styles that may be used for this purpose. Colors or
shading patterns also are available in many forms. In using trans-
ferable colors or shading patterns, the worst conditions ususally
are depicted by red or a dark pattern, the best conditions by

blue or a light pattern, and intermediate conditions by intergrades
of colors or shades between these.

The following types of information should be displayed on maps.
Separate maps may be used for each factor, or related ones may be
displayed on the same maps.

Land use
Types of housing

. Water distribution system and sources of water for domes-
tic use

Sewerage collecting system and type of sewage disposal

Land drainage

Solid waste storage

Environmental deficiencies

Local conditions and needs may indicate the necessity of other

displays or suggest that some of those listed would not be useful.
Only those required for evaluating conditions of “health..and ‘san--
itation should be included. The purpose, in this context, is not
to develop an exhaustive characterization of all aspects of the

community.

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infectious disease preventable by immunization. The obvious in-
dications are a deficiency in public health programs , specifically
immunization and child health programs, or the failure of residents
to use available services. These possiblities could be easily
evaluated with data from the health index survey. Depending on
results of this evaluation, the remedial measures considered might
include the organization of immunization clinics, greater publicity
for available programs, making services more convenient, or further
inquiry to determine why services were not used.

Similar procedures would be followed in analyzing other indi-
cations of adverse health effects associated with disease occurrence
The specific problems to be explored will be evident from the re-
sults of analyses described in Part 5 of Methods and. Procedures.
Local situations, of course, determine the possibilities for devel-

oping remedial programs or measures.

HEALTH SERVICES

Data derived from evaluation of community environment services
and the environmental survey (Parts 3 and 4 in Methods and Proce-
dures) together with those from the community profile, and other
sources, will indicate the adequacy and needs for services relating
to water supplies, sewage disposal, solid waste disposal, and gen-
eral sanitation. Procedures for consolidation and analyses to
characterize the entire community and various sectors of the commu-
nity with respect to these services are included in Methods and
Procedures. The state agencies responsible for community environ-

mental services (see Appendix) should be consulted in the develop-

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The interviewer should carefully explain to the respondent the
importance of obtaining the information. The fact that no one
can identify the family that provides the data or the place where
they live should be emphasized. Neither the questionnaire nor
the envelope provided is marked in a way to enable anyone to know
the source of information,

The interviewer should request the respondent to read the form
through and ask about any questions that are not clear. An ad-
dressed, stamped envelope should be left with the respondent to

return the completed form by mail to the interviewing agency.

Filing Completed Survey Forms

A filing system should be established for the orderly accumu-
lation and storage of completed survey forms. Individual folders
should be provided for each block or neighborhood (or sector)
using the identification notations, if available, developed for the
environmental survey. The exact method of filing will depend on
the sampling units employed. As a general guideline, the system
used should permit consolidation of information as interviews are
completed in a defined geographic area, a block ox neighborhood
for example. The completed forms should be filed each day. When
the survey has been completed in an area, information should be
consolidated as described below. The sets of survey forms should

be numbered consecutively to provide control of the record,

Compilation and Analysis of Data

The forms used for the Health Index Survey were so designed

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quently occur in “boom town" situations. As indicated above,

a blue color or a light shading pattern should be used to represent
the most desirable type of housing and red or a dark shading pat-
tern for the least desirable. Intermediate types should be de-
picted by intermediate colors or shadings. When more than 75 per-
cent of housing is of one type, the entire block should be shown
as that type. Multiple types can be represented by combinations
of colors or shading patterns, as suggested for indicating types
of land use. Because dwelling units may be sparsely distributed
in some locations within communities, especially on the periphery,
a symbol code should also be used for depicting location of one

or a few units. The number of units to be indicated individually
will depend on local circumstances. Generally, fewer than five
units should be shown by a separate symbol for each unit, This
procedure is convenient when the block contains a preponderance

of one type but also has a few of another. The latter can be
shown individually by superimposing the appropriate symbol on the
background indicating the predominant type.

Condition of Housing. Data from Table 4-4 are used to illus-

trate condition of housing, Note that condition of the dwelling
unit is being illustrated without reference to type of unit,
As indicated above, in some instances, it may be convenient and
desirable to illustrate types and conditions on the same map.

As with the illustrations previously considered, the objec~
tive is to reflect predominant conditions for the block. If 75
percent or more of the dwelling units on a block are in the same

condition, and if the others are not extremely different, it gen-

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