MV2007L8-0031
Giant Mine Remediation Project Team
Outline of scope for assessment of indirect stress effects of potential arsenic exposure
Ketan Shankardass, MHSc, PhD
July 7, 2015
Beyond the requirement of a human health risk assessment to be completed, Appendix F of
Measure #10 from the “Report of Environmental Assessment and Reasons for Decision, Giant
Mine Remediation Project” (Mackenzie Valley Review Board, June 2013) specifies that there must
be evaluation of “the indirect effects of potential exposures to arsenic on wellness, including stress
effects.”
This document shares a working outline for the scope of work. It draws mainly from my
own framework of environmental determinants of stress and disease (Shankardass, 2012) and
preliminary considerations based some review of the extant literature and facts on the ground. The
approach to measurement is also guided by concerns outlined for assessment of direct effects on
human health in Measure #10. Future revisions will incorporate the input of the Giant Mine
Working Group, Dr. Sue Moodie and the Independent Peer Review Panel. Future revisions are
also contingent on a pending contract between myself and the Government of Canada. In that
sense, this document is meant to focus and facilitate the on-going discussion that will inform the
scope of work.
This outline includes: (1) a conceptual framework for understanding how arsenic exposure
(as reflected in the built, natural and social environment) can increase harmful manifestations of
chronic stress; (2) a literature review of historical and baseline information related to indirect
effects of environmental determinants of stress in Yellowknife; and (3) an approach to for the
design, measurement and analysis of data to complete the evaluation.
Conceptual Framework: Environmental determinants of arsenic exposure and place-based stress
Stress has been conceptualized and empirically studied in unique ways by psychologists,
sociologists, psychoneuroimmunologists and others since Hans Selye first described the ‘General
Adapatation Syndrome’ in 1936 (Selye, 1936).
I have argued that a unified approach is required in order to more fully understand how
social inequalities in health are generated and maintained (in addition to other individual and
structural determinants of health) (Shankardass 2012; Shankardass and Dunn 2012). The ‘stress
process’ described by Leonard Pearlin and colleagues (Pearlin et al 1981) offers a way to integrate
diverse knowledge about stress. In brief, it describes how sources of stress (‘stressors’) can be
translated into broad manifestations on human health depending on a series of mediating factors
(Table 1).
1 Giant Mine Remediation Project Team
Outline of scope for assessment of indirect stress effects of potential arsenic exposure
Ketan Shankardass, MHSc, PhD
July 7, 2015
Table 1.
Sources
Potential stressors,
Stress process e.g., meaningful life
stage
events and daily
strains
Mediators
‐
‐
‐
Perception of stressors
Assessment of resources
for coping
Genetic features
Manifestations
Emotional,
behavioural and
physiological
dysfunction
I have recently described the stress process in terms of an individual construct embedded
in the environment (Figure 1; Shankardass 2012). This approach highlights the deterministic role
of both stressors and resources contained in the built, natural and social environment as individual
perceive and coping with stress over time. Importantly, environmental factors are potentially static
or dynamic (and sometime both where there is some aspect of permanence), and can have a
variable effect on the same individual over time.
Figure 1.
NB. Solid arrows indicate the pathways that relate environmental determinants of stress to chronic
diseases via primarily physiologic changes in response to stress hormone dysregulation (1) and in
relation to healthy and unhealthy habits related to coping (2); pathways of endogeneity (e); and
pathways of confounding (c); while dashed arrows that cross solid arrows indicate effect
modification.
The notion that individual’s construct a ‘sense of place’ (Jorgensen and Stedman, 2001) is
important for understanding how exposure to hazards of the environment (including arsenic
trioxide) affect our experience of stress and the manifestation of chronic disease, in particular.
Such hazards can interrupt one’s sense of place through cognitive, affective and conative pathways
2 Giant Mine Remediation Project Team
Outline of scope for assessment of indirect stress effects of potential arsenic exposure
Ketan Shankardass, MHSc, PhD
July 7, 2015
because of ‘place identity’, ‘place attachment’ and ‘place dependence’. Place identity refers to
beliefs about the relationship between self and place (i.e., to what extent does one internalize their
places as a part of their identity?); place attachment refers to feelings about the place (e.g., how are
we positive and negative about our places); and place dependence refers to the behavioral
exclusivity of places in relation to alternatives (i.e., to what extent do we rely on these places?
would we be just as supported and happy in other places?).
The devastating impact of the arsenic hazard in Yellowknife is that “contamination
is … invisible… sort of like a ghost… it’s in places that are supposed to be safe. It’s
like the monster under your med. And that’s the really devastating impact of
things like this is you start to be afraid to live in the place that you are.”
-
Dr. Erin Freeland Ballantyne in Shadow of A Giant (Johnson and Ferguson 2015)
A place-based approach is also enriched by acknowledging the bi-directional relationship
between individual and the places that they spend time in living, working and doing other things
(so-called ‘third places’). So, arsenic trioxide could be more or less relevant, threatening, culturally
damaging, for different individuals. Likewise, specific environmental resources offered to help
ameliorate indirect effect on stress may be more or less relevant, appealing, culturally appropriate
(or otherwise meaningful), or practically accessible for individuals.
Individuals may also be more or less prone to utilize resources in their neighbourhoods according
to how they perceive their surroundings over time. Folkman et al (1986) describe stress as
individuals “in a dynamic mutually reciprocal, bidirectional relationship” with their context, while
Luginaah et al (2002) described how residents living in the shadow of industrial hazards engage in
“cognitive reappraisal” of places over time.
Literature review: historical and baseline information
An initial (read: very brief) review of scholarly and grey literature found some impacts on stress for
families of workers involved in the 1992 strike in the Journal of the Canadian Medical Association
(Williams, 1992), as well as anecdotal evidence about relevant stressors in the interactive
documentary, ‘Shadow of a Giant’ (Johnson and Ferguson, 2015).
A more systematic review will be completed in preparing the scope of work. This includes
reviewing a paper by Paci and Villebrun (2005) in Pimatisiwin on community health impacts of
mining for the Dene nation. I have also been in contact with the Dechinta Centre for Research and
Learning, and anticipate contacting other relevant experts and organizations to find more literature.
Beyond looking strictly for historical and baseline data about stress effects of arsenic exposure in
Yellowknife, this search could be expanded to include stress impacts of arsenic and other
environmental toxins on communities (indigenous/non-indigenous) elsewhere.
Approach
3 Giant Mine Remediation Project Team
Outline of scope for assessment of indirect stress effects of potential arsenic exposure
Ketan Shankardass, MHSc, PhD
July 7, 2015
Design
Given the role of very personal psychological processes of perception and coping that mediate the
impact of arsenic trioxide and related stressors on human health, a community survey would allow
for diverse perspectives to emerge on this complicated hazard. This could comprise of a (repeated)
cross-sectional survey completed by a representative sample of the population, including closed
and open ended questions that assess the level and distribution of chronic emotional and
psychological stress and coping related to arsenic trioxide exposure at the Giant Mine. Additional
measures could assess other mental and physical health sequelae and social impacts. To facilitate a
life-course perspective on stress effects, sampling should include participants from distinct age
groups of interest: pre-born (i.e., expecting mothers, toddler, child, teen and adult. Sampling
should also be representative of gender, socio-economic dimensions and indigeneity.
Assessment of emotional and perceived psychological stress
Current emotional and (chronic) perceived psychological stress can be assessed in the community
survey using two short validated tools. The single-item Distress Thermometer (DT) measures state
distress. The DT a simple Likert scale shaped like a vertical thermometer that asks the subject to
select a number corresponding to their level of distress (Zwahlen, Hagenbuch, Carley, Recklitis &
Buchi, 2008; NCCN, 2013). Perceived psychological stress can be measured using the 4-item
Perceived Stress Scale (Cohen et al., 1983), which is an overall measure of perceived distress, as
well as global distress (Cohen, Kamarck & Mermelstein, 1983).
There are several plausible moderators of the relationship between the above-described
stress measures. Thus, additional data should be collected to help explore the role of psychological
traits, including trait anxiety and trait pessimism. A place-based approach suggests a need to stratify
assessment by age, gender, socio-economic dimensions, indigeneity (for example) to explore
whether the experience of emotional stress leads to more chronic types of (psychological) stress
and certain coping outcomes.
Assessment of specific sources of perceived stress
In order to identify the ways that arsenic trioxide at the Giant Mine affects the community
(including the role of related factors), participants could be asked to rate the salience of potential
stressors (e.g., using a three- or five-point Likert rating from Not stressful at all through Very
stressful). Participants should also be able to suggest and rate stressors not included in the survey.
If a repeated cross-sectional approach is adopted to the survey, then the list of potential surveys
could be informed by the findings of prior surveys. A proposed grid for evaluating the relevance of
possible stressors historically/over time is included Table 2. A process should be identified for
developing a more comprehensive list of possible stressors.
4 Giant Mine Remediation Project Team
Outline of scope for assessment of indirect stress effects of potential arsenic exposure
Ketan Shankardass, MHSc, PhD
July 7, 2015
Table 2.
Time period
Possible stressors relevant to arsenic
trioxide at Giant Mine
While the mine
was in operation
Since the mine
closed but not
currently
Currently
Food contamination (ingestion)
Air contamination (ihalation)
Water contamination (ingestion)
Contamination of the general
environment (absorption)
Food insecurity due to disruptive
impacts on hunting/fishing/foraging
Personal or family history of
employment at mine
Current personal or family
employment in mine site remediation
Impacts of mine closure on
employment
In addition to the survey, a process of ‘concept mapping’ could be utilized to further
investigate the specific sources of stress being experienced across the community. Concept
mapping is a computer-assisted, graphical and quantitative approach where groups of participants
create, organize and represent knowledge of a subject in response to a main idea or concept (see
Burke et al 2006 for an example). In this case, participants could use the list of all salient stressors
(including those suggested by participants) as a starting point with the goal to represent how these
stressors are inter-related and why they affect them. Concept mapping is broadly similar to the use
of focus groups but reflects a more participatory and usually more structured and systematic
approach. While concept mapping is more intensive for participants and in terms of time and
money, it can also facilitate more useful and actionable interpretation of survey findings.
A more geospatial approach could also be useful for identifying specific places for
intervention. For example, some process of community mapping could be used to identify and
validate the effect of specific locations.
Assessment of coping behaviours and related resources, and other manifestations on human health
For stressors identified as currently important, participants could be asked to describe the type
(indicative of healthier and less healthy habits) and effectiveness of their coping behaviours.
Assessment of presence and accessibility of appropriate and adequate resources for coping with
stress related to arsenic trioxide at Giant Mine could be evaluated, including using community
mapping approaches.
5 Giant Mine Remediation Project Team
Outline of scope for assessment of indirect stress effects of potential arsenic exposure
Ketan Shankardass, MHSc, PhD
July 7, 2015
Mental and physical health problems could also be assessed to examine the potential for
other impacts on human health. For example, anxiety disorders could be assessed using the 20item State-Trait Anxiety Inventory (Spielberger, 1968, 1977) and chronic disease outcomes could
be self-reported.
Assessment of resources
Analysis
To be completed
‐ Quantitative: Stratified descriptive and correlation analysis, as well as multiple regression
models to examine whether certain types of stress are associated with other manifestations
on human health.
‐ Qualitative: Concept mapping and geo-spatial mapping
Reporting
In line with Meausure #10 of the Report (Mackenzie Valley Review Board, June 2013), reporting
ought to addressing the following:
‐ “Provide a plain language explanation of the results in terms that are understandable to the
general public, and communicate this to potentially affected communities in a culturally
appropriate manner;
‐ Provide interpretation of results and related guidance; and
‐ Based on the results of this human health risk assessment, and on the results of the health
effects monitoring program (described in Measure 9 above), the Developer will, if
necessary in response to this information, identify, design and implement appropriate
design improvements and identify appropriate management responses to avoid or reduce
the severity of any predicted unacceptable health risks.
All of the above, “may also require engagement and involvement of agencies those who
specifically deal with psychological, medical, and clinical and societal manifestation of stress
related issues in the area of study.” (Personal communication, A. Mohapatra)
Literature Cited
List to be compiled
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