Promoting environmental justice through community-based participatory research: the role of community and partnership capacity

Community-based participatory research and policy advocacy to reduce diesel exposure in West Oakland, California

We conducted a multimethod case study analysis of a community-based participatory research partnership in West Oakland, California, and its efforts to study and address the neighborhood's disproportionate exposure to diesel air pollution. We employed 10 interviews with partners and policymakers, participant observation, and a review of documents. Results of the partnership's truck count and truck idling studies suggested substantial exposure to diesel pollution and were used by the partners and their allies to make the case for a truck route ordinance. Despite weak enforcement, the partnership's increased political visibility helped change the policy environment, with the community partner now heavily engaged in environmental decision-making on the local and regional levels. Finally, we discussed implications for research, policy, and practice.

Integration of social epidemiology and community-engaged interventions to improve health equity

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.

Working with Concepts: The Role of Community in International Collaborative Biomedical Research

The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term 'community' and its specific normative contribution. We argue that 'community' is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals' lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of 'half knowing' intrinsic to processes of developing new understandings.

Assets, challenges, and the potential of technology for nutrition education in rural communities

OBJECTIVE

To examine assets of and challenges to getting adequate nutrition and physical activity among low-income rural residents, and the potential for technology to provide health education.

METHODS

Environmental scans and community stakeholder interviews were conducted in 5 rural counties in Maryland. During environmental scans, stakeholders guided tours around each county to explore community services and resources for nutrition, physical activity and technology. In-depth interviews with stakeholders (n=58) focused on nutrition, physical activity, and technology issues.

RESULTS

Low-income residents both benefit from and face challenges in rural settings. Besides attitude and knowledge barriers, lack of affordable resources and public transportation contributed to inattention to nutrition and physical activity. Stakeholders' reactions to a proposed Internet-based intervention were mostly favorable, but questions emerged about providing computers and Internet to individual families.

CONCLUSIONS AND IMPLICATIONS

Internet-based education may be a viable option to help low-income rural residents overcome barriers to nutrition and physical activity.

Dissemination of results in community-based participatory research

CONTEXT

Community-based participatory research (CBPR) has been promoted as an approach to understanding complex health problems not amenable to research conducted solely by outside investigators. Although broad dissemination of research results is a key element of the CBPR approach, existing dissemination efforts have not been assessed.

EVIDENCE ACQUISITION

In this systematic review, researchers evaluated studies utilizing the CBPR approach to characterize dissemination of research results beyond scientific publication. Specifically, the focus was on dissemination to community participants and the general public. The literature search encompassed articles published between January 1, 2005, and December 31, 2009. Corresponding authors were also invited to complete a web-based survey. Data were collected and analyzed between July 1, 2008, and March 8, 2010.

EVIDENCE SYNTHESIS

In all, 101 articles met inclusion criteria. All articles were assessed for the quality of community involvement in research. Scores ranged from 1.4 to 3.0 (on a 3-point scale), with a mean of 2.3. The 21 articles in which an intervention was evaluated were scored for the rigor of research methods. Scores ranged from 2.0 to 2.9 (on a 3-point scale), with a mean of 2.4. Dissemination beyond scientific publication was reported in 48% of publications with varying levels of detail. However, among survey respondents, 98% reported dissemination of results to community participants and 84% reported dissemination to the general public.

CONCLUSIONS

Among research meeting strict criteria for inclusion as CBPR, dissemination beyond scientific publication is largely occurring. However, myriad challenges to timely and widespread dissemination remain, and current dissemination to community participants and the general public is variable.

Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities

There have been increasing calls for community-academic partnerships to enhance the capacity of partners to engage in policy advocacy aimed at eliminating health disparities. Community-based participatory research (CBPR) is a partnership approach that can facilitate capacity building and policy change through equitable engagement of diverse partners. Toward this end, the Detroit Community-Academic Urban Research Center, a long-standing CBPR partnership, has conducted a policy training project. We describe CBPR and its relevance to health disparities; the interface between CBPR, policy advocacy, and health disparities; the rationale for capacity building to foster policy advocacy; and the process and outcomes of our policy advocacy training. We discuss lessons learned and implications for CBPR and policy advocacy to eliminate health disparities.

Sí se puede: using participatory research to promote environmental justice in a Latino community in San Diego, California

Community-based participatory research (CBPR) increasingly is seen as a potent tool for studying and addressing urban environmental health problems by linking place-based work with efforts to help effect policy-level change. This paper explores a successful CBPR and organizing effort, the Toxic Free Neighborhoods Campaign, in Old Town National City (OTNC), CA, United States, and its contributions to both local policy outcomes and changes in the broader policy environment, laying the groundwork for a Specific Plan to address a host of interlocking community concerns. After briefly describing the broader research of which the OTNC case study was a part, we provide background on the Environmental Health Coalition (EHC) partnership and the setting in which it took place, including the problems posed for residents in this light industrial/residential neighborhood. EHC's strong in-house research, and its training and active engagement of promotoras de salud (lay health promoters) as co-researchers and policy change advocates, are described. We explore in particular the translation of research findings as part of a policy advocacy campaign, interweaving challenges faced and success factors and multi-level outcomes to which these efforts contributed. The EHC partnership's experience then is compared with that of other policy-focused CBPR efforts in urban environmental health, emphasizing common success factors and challenges faced, as these may assist other partnerships wishing to pursue CBPR in urban communities.

Community organizing network for environmental health: using a community health development approach to increase community capacity around reduction of environmental triggers

The Community Organizing Network for Environmental Health (CONEH), a project of Community Action Against Asthma, used a community health development approach to improve children's asthma-related health through increasing the community's capacity to reduce physical and social environmental triggers for asthma. Three community organizers were hired to work with community groups and residents in neighborhoods in Detroit on the priority areas of air quality, housing, and citizen involvement in the environmental project and policy decision-making. As part of the evaluation of the CONEH project, 20 one-on-one semi-structured, in-depth interviews were conducted between August and November 2005 involving steering committee members, staff members, and key community organization staff and/or community members. Using data from the evaluation of the CONEH project, this article identifies the dimensions of community capacity that were enhanced as part of a CBPR community health development approach to reducing physical and social environmental triggers associated with childhood asthma and the factors that facilitated or inhibited the enhancement of community capacity.

Perceptions of community-based participatory research in the Delta Nutrition Intervention Research Initiative: an academic perspective

Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) is an academic-community partnership between seven academic institutions and three communities in Mississippi, Arkansas, and Louisiana. A range of community-based participatory methods have been used to develop sustainable nutrition intervention strategies. Focus groups were conducted with 22 faculty and staff members from the academic partners on the project to document their perceptions of community-based participatory processes in a federally funded, multi-academic-community partnership spanning a decade. Focus groups were conducted to glean insights or lessons from the experiences of academic personnel. Focus groups were transcribed and analyzed using the constant comparative method. Two researchers analyzed each transcript independently and reached consensus on the consistent themes. Participants candidly shared their experiences of working with community members to devise research plans, implement programs, and evaluate outcomes. The majority of faculty and staff members were attracted to this project by an excitement for conducting a more egalitarian and potentially more successful type of research. Yet each academic partner voiced that there was an underlying disconnect between community practices and research procedures during the project. Additional barriers to collaboration and action, located in communities and academic institutions, were described. Academic partners stressed the importance of open and ongoing communication, collective decision-making strategies, and techniques that support power sharing between all parties involved in the project. Findings from this research can inform academic-community partnerships and hopefully improve the community-based participatory research process implemented by academic institutions and communities.

Tools available to communities for conducting cumulative exposure and risk assessments

This paper summarizes and assesses over 70 tools that could aid with gathering information and taking action on environmental issues related to community-based cumulative risk assessments (CBCRA). Information on tool use, development and research needs, was gathered from websites, documents, and CBCRA program participants and researchers, including 25 project officers who work directly with community groups. The tools were assessed on the basis of information provided by project officers, community members, CBCRA researchers, and by case study applications. Tables summarize key environmental issues and tool features: (1) a listing of CBCRA-related environmental issues of concern to communities; (2) web-based tools that map environmental information; (3) step-by-step guidance documents; (4) databases of environmental information; and (5) computer models that simulate human exposure to chemical stressors. All tools described here are publicly available, with the focus being on tools developed by the US Environmental Protection Agency. These tables provide sources of information to promote risk identification and prioritization beyond risk perception approaches, and could be used by CBCRA participants and researchers. The purpose of this overview is twofold: (1) To present a comprehensive, though not exhaustive, summary of numerous tools that could aid with performing CBCRAs; and (2) To use this toolset as a sample of the current state of CBCRA tools to critically examine their utility and guide research for the development of new and improved tools.

Ecological information needs for environmental justice

The concept that all peoples should have their voices heard on matters that affect their well-being is at the core of environmental justice (EJ). The inability of some people of small towns, rural areas, minority, and low-income communities, to become involved in environmental decisions is sometimes due to a lack of information. We provide a template for the ecological information that is essential to examine environmental risks to EJ populations within average communities, using case studies from South Carolina (Savannah River, a DOE site with minority impacts), Washington (Hanford, a DOE site with Native American impacts), and New Jersey (nonpoint, urbanized community pollution). While the basic ecological and public health information needs for risk evaluations and assessments are well described, less attention has been focused on standardizing information about EJ communities or EJ populations within larger communities. We suggest that information needed about EJ communities and populations includes demographics, consumptive and nonconsumptive uses of their regional environment (for example, maintenance and cosmetic, medicinal/religious/cultural uses), eco-dependency webs, and eco-cultural attributes. A purely demographics approach might not even identify EJ populations or neighborhoods, much less their spatial relation to the impact source or to each other. Using information from three case studies, we illustrate that some information is readily available (e.g., consumption rates for standard items such as fish), but there is less information about medicinal, cultural, religious, eco-cultural dependency webs, and eco-cultural attributes, all of which depend in some way on intact, functioning, and healthy ecosystems.

Using network analysis to assess the evolution of organizational collaboration in response to a major environmental health threat

Effective inter-organizational collaboration is essential to a community's ability to leverage social and material resources for community problem solving, particularly in the face of complex public health problems. This study used network analysis to document the evolution of collaboration among 21 organizations in the Tar Creek Superfund site in northeastern Oklahoma from 1997 to 2005. The Tar Creek Superfund site was part of a major lead and zinc mining operation and suffers from widespread heavy metal contamination. An organizational network of 21 organizations and a subset of eight tribes were assessed through interviews at three points in time for density and centrality. In addition to collaboration on any topic, we examined information exchange and joint planning related to lead. Density scores were consistently higher in 2005 than in 1997 for both the full and tribal networks. Centralization indices for information exchange showed a marked reduction in the hierarchical structure of information exchange over time. Of particular note is that tribal linkages with local, state and federal agencies increased over time, as did inter-tribal linkages to address the lead issue.

Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity

Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.

Linking science and policy through community-based participatory research to study and address health disparities

With its commitment to balancing research and action, community-based participatory research (CBPR) is well suited to efforts at the intersections of science, practice, and policy to eliminate health disparities. Drawing on a larger study, we use 2 case studies to highlight the role of CBPR in helping achieve policy changes promoting, respectively, access to healthy foods (Bayview, San Francisco, CA) and higher air quality standards (Harlem, New York, NY). We then present facilitating factors and challenges faced across all 10 case studies from the larger study. Although we underscore the importance of analyzing contribution rather than claiming attribution in policy-focused work, CBPR's attention to both the distributive and the procedural justice necessary for eliminating health disparities may make it a particularly relevant approach in such work.

Unintended benefits: leadership skills and behavioral change among Guatemalan fieldworkers employed in a longitudinal household air pollution study

The RESPIRE and CRECER studies measured the effects of reduced household air pollution (HAP) from wood-fired cookstoves on respiratory health in rural highland Guatemala. This article examines behavior change and leadership skill development in local community members who were hired as fieldworkers to assist with research. Fieldworkers administered household questionnaires, shared functions similar to community health workers, and bridged health resources to communities. A mixed-methods design for data collection (in-depth interviews, focus groups, impact drawings, knowledge questionnaire, and retrospective pre-test) was used. Purposive sampling included 10 fieldworkers and 13 local service providers. Fieldworkers showed an increase in knowledge, positive attitudes, and practices around HAP. They developed new technical, interpersonal, and leadership skills. Fieldworkers played a crucial role in building confianza (trust) with the community, bridging resources, and improving outside researchers' relationships with locals. Recommendations for future researchers include inclusion of additional training courses and adoption of community participatory approaches.

Primary prevention of lead poisoning in rural Native American children: behavioral outcomes from a community-based intervention in a former mining region

The current study examined the effectiveness of a community-based lay health advisor intervention, combined with youth engagement, in improving lead poisoning prevention behaviors and associated beliefs in a rural Native American population located in and near a Superfund site containing mining waste. Three sequential (1997, 2000, and 2004) cross-sectional assessments involving in-person interviews with Native American and White caregivers of young children were conducted. Results showed significant improvements over time for Native American, but not for White, for children washing their hands before meals and snacks, and for annual blood lead testing of both Native American and White children. Findings lend support to the value of community-based education for primary prevention of lead poisoning in Native American and rural communities.

Partnerships for environmental and occupational justice: contributions to research, capacity and public health

In 1994, the National Institute of Environmental Health Sciences (NIEHS) initiated a program to address communication gaps between community residents, researchers and health care providers in the context of disproportionate environmental exposures. Over 13 years, together with the Environmental Protection Agency and National Institute for Occupational Health and Safety, NIEHS funded 54 environmental justice projects. Here we examine the methods used and outcomes produced based on data gathered from summaries submitted for annual grantees' meetings. Data highlight how projects fulfilled program objectives of improving community awareness and capacity and the positive public health and public policy outcomes achieved. Our findings underscore the importance of community participation in developing effective, culturally sensitive interventions and emphasize the importance of systematic program planning and evaluation.

Occupational health, mercury exposure, and environmental justice: learning from experiences in Tanzania

Mercury is a potent neurotoxin that is used by poverty-driven miners to extract gold in more than 50 countries. This article examines efforts of the United Nations to address occupational health and environmental justice amid these challenges, focusing on a 3-year campaign in one of the fastest-growing mining communities in Tanzania. By providing an integrative analysis of environmental health risks, labor practices, public health policies, and drivers of social inequity and marginalization, this study highlights the need for interdisciplinary public health approaches that support community development by strengthening local capacities. It illustrates why, to ensure that the needs of vulnerable populations are met, environmental justice and public health paradigms have to expand beyond the conventionally narrow attention paid to toxic exposure and emissions issues.

Improving disaster mental health care in schools: a community-partnered approach

BACKGROUND

Although schools are often the first institutions to provide recovery efforts for children post-disaster, few studies have involved the school community in research to improve the delivery of these mental health services on campuses. This community-partnered study explores post-disaster counseling services 10 months following Hurricane Katrina.

METHODS

In July 2006, nine focus groups, consisting of 39 school-based mental health counselors and six program administrators (10 men, 35 women), were conducted following a 2-day clinical training regarding a youth trauma intervention following Hurricane Katrina. Participants discussed the types of services they had been providing prior to the training and potential barriers to delivering services.

RESULTS

Participants identified high mental health needs of students and described populations that did not seem to be adequately supported by current funding sources, including those with pre-existing traumatic experiences and mental health issues, indirect psychological and social consequences of the storms, and those students relocated to communities that were not as affected. Participants also described the need for a centralized information system.

CONCLUSIONS

Participants described the need for greater organizational structure that supports school counselors and provides system-level support for services. Implications for next steps of this community-partnered approach are described.

The role for community-based participatory research in formulating policy initiatives: promoting safety and health for in-home care workers and their consumers

Although community-based participatory research (CBPR) can be effective in influencing policy, the process of formulating policy initiatives through CBPR is understudied. We describe a case study to illustrate how alliances among various community partners could be united to formulate policy directions. In collaboration with partners, the National Institute for Occupational Safety and Health initiated a project aimed at improving health and safety for low-income elderly and disabled persons and their in-home care workers. Community partners and stakeholders participated in focus groups, stakeholder interviews, and meetings; they played multiple roles including identifying organizational policy changes the partners could initiate immediately, as well as broader public policy goals. Results indicated that a strong community partnership, participation, and shared values contributed to successful formulation of policy initiatives.

Health and healthcare perspectives of African American residents of an unincorporated community: a qualitative assessment

Residential perspectives about health in unincorporated communities are virtually unexplored. In this study, we conducted focus groups to assess individual and community health status, environmental health mediators, and systematic barriers to healthcare among African American residents of the unincorporated town, Fresno, Texas. Residents described their individual health status as excellent, but depicted the community's health status as fair. Unaffordable healthcare, limited access to healthcare, and environmental mediators were perceived to impact the Fresno community's health status. Our findings suggest a need to begin to examine health outcomes for minority residents in other unincorporated communities.

The TERRA framework: conceptualizing rural environmental health inequities through an environmental justice lens

The deleterious consequences of environmentally associated diseases are expressed differentially by income, race, and geography. Scientists are just beginning to understand the consequences of environmental exposures under conditions of poverty, marginalization, and geographic isolation. In this context, we developed the TERRA (translational environmental research in rural areas) framework to explicate environmental health risks experienced by the rural poor. Central to the TERRA framework is the premise that risks exist within physical-spatial, economic-resources, and cultural-ideologic contexts. In the face of scientific and political uncertainty, a precautionary risk reduction approach has the greatest potential to protect health. Conceptual and technical advances will both be needed to achieve environmental justice.

It will take persistence: the dynamics of a university-community partnership to sustain the New England worker health and safety movement

The New England Consortium (TNEC) is a university-community partnership that since 1987 has delivered health and safety training for hazardous waste operations and emergency response (HAZWOPER) workers. Through two decades of the relative loss of power by the labor and environmental movements and subsequent reductions in state support for worker health and safety, this selective history of TNEC demonstrates its ability to sustain a worker health and safety movement in New England. The evolution of TNEC's partnership process and the principles and policies by which it operates have helped to resolve several critical conflicts and strengthen its working relationships. Partnership dynamics are explored within their political and economic contexts and the need of member organizations to balance fiscal solvency with political objectives.

Justiça Ambiental: uma abordagem ecossocial em saúde

Discute-se a questão do risco das tecnologias contemporâneas em face do atual paradigma tecnológico, a sua percepção e tolerabilidade, assim como sua distribuição desigual na sociedade. A hipótese fundamental que enfatiza a Justiça Ambiental refere-se aos perigos desproporcionalmente ou injustamente distribuídos entre grupos social e economicamente mais vulneráveis, geralmente pobres e minorias, acarretados pelos riscos ambientais relativos à vida moderna. Assim, vulnerabilidade e os diversos níveis de privação agem como propulsores dos níveis diferenciais em saúde entre os grupos populacionais. Embora Justiça Ambiental tenha sido observada inicialmente como movimento popular nos Estados Unidos, seus princípios indicaram compatibilidade em escalas geográficas global e local. Desta forma, o objetivo do estudo foi compreender como os riscos da tecnologia contemporânea afetam desigualmente a população à luz da Justiça Ambiental.

Community-Based Participatory Research in Disability and Long-Term Care Policy

From 1997 to 2003, Illinois was spending approximately 80% of its long-term care budget on nursing homes and institutional care and was facing significant challenges to its long-term care delivery and the need to rebalance toward community-based supports for people with disabilities. A case-based program evaluation was done to analyze Moving Out of the Nursing Home to the Community, a community-based participatory research (CBPR) project. The Chicago-based project documented the experiences and concerns of 200 disabled people attempting to transition out of nursing homes to least restrictive community living, actively involving participants in an empowerment and systems and policy change program. The authors describe the partnership between the University of Illinois at Chicago and two centers for independent living; the project's research, policy-related goals, and activities; and the outcomes realized. Barriers and facilitating factors to long-term care systems change are described, as are implications for other CBPR partnerships focused on disability public policy.

Integrating epidemiology, education, and organizing for environmental justice: community health effects of industrial hog operations

The environmental justice movement has stimulated community-driven research about the living and working conditions of people of color and low-income communities. We describe an epidemiological study designed to link research with community education and organizing for social justice. In eastern North Carolina, high-density industrial swine production occurs in communities of low-income people and people of color. We investigated relationships between the resulting pollution and the health and quality of life of the hog operations' neighbors. A repeat-measures longitudinal design, community involvement in data collection, and integration of qualitative and quantitative research methods helped promote data quality while providing opportunities for community education and organizing. Research could affect policy through its findings and its mobilization of communities.