wages that exceeded what was otherwise available to workers in those communities, which caused some community conflict. For example, citizens who would otherwise generate income through child daycare made much more money cleaning oil off the rocks, which led to very limited child daycare services for the community.

Cohen said that one way to mitigate adverse effects is through local control—not only with respect to compensating local residents but also with respect to including residents in clean-up activities without over-whelming community resources and the physical and mental capabilities of the residents. Redlener reflected further, but from a different perspective, on the need for an immediate sense of control. He replied that it is essential that residents immediately know who is in control and where they can access information on a daily basis to help them make decisions (e.g., about whether it is safe to let their children play outside). Many of the most affected families were medically under-served and disadvantaged before the oil disaster, and their access to the usual forms of health care information is extremely limited. Affected families need to be provided a sense of structure and cohesion, as well-trusted messengers, to help them get through what is a very stressful time. The failure to provide these services will exacerbate problems that already exist.

Other panelists identified the need to develop effective communication strategies for vulnerable populations. Specifically, Eskenazi emphasized the importance of focusing on pregnant women. Some studies have shown that some of the mental health consequences are greater in women than in men, and pregnant women are particularly vulnerable because they are not just protecting themselves but also their developing fetuses. She asked how pregnant women can obtain accurate information from a trusted source about the risks (e.g., of eating seafood)? Spencer agreed with Eskenazi and remarked that chemical exposure during development can potentially cause permanent changes to the brain and other parts of the body. He emphasized the importance of considering the other end of the aging spectrum as well. Older adults are uniquely vulnerable to chemical exposure because of weight loss, loss of liver metabolism and renal excretion functions, etc.

Spencer also discussed variation in susceptibility to the adverse effects of exposure. Specifically, he reminded the workshop that the federal threshold levels that have been established to protect health are based on “protection of the majority but not the totality of the population.” Scientists are increasingly recognizing that there are individual genetic susceptibilities to certain exposures, one example being heat



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