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Korfmacher KS, Brody JG. Moving Forward with Reporting Back Individual Environmental Health Research Results. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:125002. [PMID: 38095662 PMCID: PMC10720702 DOI: 10.1289/ehp12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND The practice of reporting back individual results to participants in environmental health research has evolved significantly over the past 20 years. Research findings support the potential of report-back to enhance the ethics, quality, and impact of environmental health research. Nonetheless, implementation of environmental health report-back practices is not yet routine. OBJECTIVES We propose a framework for institutionalizing appropriate report-back to participants of their individual results across the environmental health research enterprise. We provide a brief overview of the rationales for report-back, social science research on report-back experiences over the past two decades, and recent efforts to synthesize guidance in this field. We also describe barriers to be addressed in moving toward widespread implementation of report-back. DISCUSSION Report-back of individual results is increasingly recognized as an ethical responsibility and essential component of impactful environmental health research. Experience shows that when personal results are returned with appropriate contextual information, report-back can increase environmental health literacy, promote individual actions, and enhance engagement in policy change. Therefore, report-back can promote environmental justice and reduce disparities in access to science. Despite this evidence base, report-back is not widely implemented. We recommend the collaborative development of guidelines, training, and resources to build capacity for appropriate report-back to study participants across the environmental health research enterprise, and we identify research priorities to advance the field. Development of tools and shared infrastructure for report-back holds promise for reducing barriers while ensuring high-quality personalized reports. Disseminating successful case studies could also advance excellence. We recommend including diverse scientific disciplines, community partners, representatives of study populations, clinicians, institutional review boards (IRBs), legal experts, public health professionals, and government officials in further developing this critical aspect of environmental health research. https://doi.org/10.1289/EHP12463.
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Safarlou CW, Jongsma KR, Vermeulen R, Bredenoord AL. The ethical aspects of exposome research: a systematic review. EXPOSOME 2023; 3:osad004. [PMID: 37745046 PMCID: PMC7615114 DOI: 10.1093/exposome/osad004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
In recent years, exposome research has been put forward as the next frontier for the study of human health and disease. Exposome research entails the analysis of the totality of environmental exposures and their corresponding biological responses within the human body. Increasingly, this is operationalized by big-data approaches to map the effects of internal as well as external exposures using smart sensors and multiomics technologies. However, the ethical implications of exposome research are still only rarely discussed in the literature. Therefore, we conducted a systematic review of the academic literature regarding both the exposome and underlying research fields and approaches, to map the ethical aspects that are relevant to exposome research. We identify five ethical themes that are prominent in ethics discussions: the goals of exposome research, its standards, its tools, how it relates to study participants, and the consequences of its products. Furthermore, we provide a number of general principles for how future ethics research can best make use of our comprehensive overview of the ethical aspects of exposome research. Lastly, we highlight three aspects of exposome research that are most in need of ethical reflection: the actionability of its findings, the epidemiological or clinical norms applicable to exposome research, and the meaning and action-implications of bias.
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Affiliation(s)
- Caspar W. Safarlou
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
| | - Karin R. Jongsma
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
| | - Roel Vermeulen
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
- Department of Population Health Sciences, Utrecht University,
Utrecht, The Netherlands
| | - Annelien L. Bredenoord
- Department of Global Public Health and Bioethics, Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The
Netherlands
- Erasmus School of Philosophy, Erasmus University Rotterdam,
Rotterdam, The Netherlands
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Robinson JA, Novak R, Kanduč T, Maggos T, Pardali D, Stamatelopoulou A, Saraga D, Vienneau D, Flückiger B, Mikeš O, Degrendele C, Sáňka O, García Dos Santos-Alves S, Visave J, Gotti A, Persico MG, Chapizanis D, Petridis I, Karakitsios S, Sarigiannis DA, Kocman D. User-Centred Design of a Final Results Report for Participants in Multi-Sensor Personal Air Pollution Exposure Monitoring Campaigns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12544. [PMID: 34886269 PMCID: PMC8656880 DOI: 10.3390/ijerph182312544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/16/2023]
Abstract
Using low-cost portable air quality (AQ) monitoring devices is a growing trend in personal exposure studies, enabling a higher spatio-temporal resolution and identifying acute exposure to high concentrations. Comprehension of the results by participants is not guaranteed in exposure studies. However, information on personal exposure is multiplex, which calls for participant involvement in information design to maximise communication output and comprehension. This study describes and proposes a model of a user-centred design (UCD) approach for preparing a final report for participants involved in a multi-sensor personal exposure monitoring study performed in seven cities within the EU Horizon 2020 ICARUS project. Using a combination of human-centred design (HCD), human-information interaction (HII) and design thinking approaches, we iteratively included participants in the framing and design of the final report. User needs were mapped using a survey (n = 82), and feedback on the draft report was obtained from a focus group (n = 5). User requirements were assessed and validated using a post-campaign survey (n = 31). The UCD research was conducted amongst participants in Ljubljana, Slovenia, and the results report was distributed among the participating cities across Europe. The feedback made it clear that the final report was well-received and helped participants better understand the influence of individual behaviours on personal exposure to air pollution.
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Affiliation(s)
- Johanna Amalia Robinson
- Department of Environmental Sciences, Jožef Stefan Institute, 1000 Ljubljana, Slovenia; (R.N.); (T.K.); (D.K.)
- Jožef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia
| | - Rok Novak
- Department of Environmental Sciences, Jožef Stefan Institute, 1000 Ljubljana, Slovenia; (R.N.); (T.K.); (D.K.)
- Jožef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia
| | - Tjaša Kanduč
- Department of Environmental Sciences, Jožef Stefan Institute, 1000 Ljubljana, Slovenia; (R.N.); (T.K.); (D.K.)
| | - Thomas Maggos
- Atmospheric Chemistry and Innovative Technologies Laboratory, NCSR Demokritos, 15310 Athens, Greece; (T.M.); (D.P.); (A.S.); (D.S.)
| | - Demetra Pardali
- Atmospheric Chemistry and Innovative Technologies Laboratory, NCSR Demokritos, 15310 Athens, Greece; (T.M.); (D.P.); (A.S.); (D.S.)
| | - Asimina Stamatelopoulou
- Atmospheric Chemistry and Innovative Technologies Laboratory, NCSR Demokritos, 15310 Athens, Greece; (T.M.); (D.P.); (A.S.); (D.S.)
| | - Dikaia Saraga
- Atmospheric Chemistry and Innovative Technologies Laboratory, NCSR Demokritos, 15310 Athens, Greece; (T.M.); (D.P.); (A.S.); (D.S.)
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute (Swiss TPH), CH-4051 Basel, Switzerland; (D.V.); (B.F.)
- University of Basel, CH-4001 Basel, Switzerland
| | - Benjamin Flückiger
- Swiss Tropical and Public Health Institute (Swiss TPH), CH-4051 Basel, Switzerland; (D.V.); (B.F.)
- University of Basel, CH-4001 Basel, Switzerland
| | - Ondřej Mikeš
- RECETOX, Faculty of Science, Masaryk University, 62500 Brno, Czech Republic; (O.M.); (C.D.); (O.S.)
| | - Céline Degrendele
- RECETOX, Faculty of Science, Masaryk University, 62500 Brno, Czech Republic; (O.M.); (C.D.); (O.S.)
- Laboratory of Chemistry and Environment, Aix Marseille University, 13003 Marseille, France
| | - Ondřej Sáňka
- RECETOX, Faculty of Science, Masaryk University, 62500 Brno, Czech Republic; (O.M.); (C.D.); (O.S.)
| | - Saul García Dos Santos-Alves
- Institute of Health Carlos III (ISCIII), National Environmental Health Centre, Department of Atmospheric Pollution, 28220 Madrid, Spain;
| | - Jaideep Visave
- Department of Science, Technology and Society, University School for Advanced Study IUSS, 27100 Pavia, Italy; (J.V.); (M.G.P.); (D.A.S.)
| | - Alberto Gotti
- EUCENTRE, European Centre for Training and Research in Earthquake Engineering, 27100 Pavia, Italy;
| | - Marco Giovanni Persico
- Department of Science, Technology and Society, University School for Advanced Study IUSS, 27100 Pavia, Italy; (J.V.); (M.G.P.); (D.A.S.)
- EUCENTRE, European Centre for Training and Research in Earthquake Engineering, 27100 Pavia, Italy;
| | - Dimitris Chapizanis
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (I.P.); (S.K.)
| | - Ioannis Petridis
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (I.P.); (S.K.)
| | - Spyros Karakitsios
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (I.P.); (S.K.)
- HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, 57001 Thessaloniki, Greece
| | - Dimosthenis A. Sarigiannis
- Department of Science, Technology and Society, University School for Advanced Study IUSS, 27100 Pavia, Italy; (J.V.); (M.G.P.); (D.A.S.)
- Environmental Engineering Laboratory, Department of Chemical Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (I.P.); (S.K.)
- HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, 57001 Thessaloniki, Greece
| | - David Kocman
- Department of Environmental Sciences, Jožef Stefan Institute, 1000 Ljubljana, Slovenia; (R.N.); (T.K.); (D.K.)
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Brody JG, Cirillo PM, Boronow KE, Havas L, Plumb M, Susmann HP, Gajos KZ, Cohn BA. Outcomes from Returning Individual versus Only Study-Wide Biomonitoring Results in an Environmental Exposure Study Using the Digital Exposure Report-Back Interface (DERBI). ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:117005. [PMID: 34766835 PMCID: PMC8589017 DOI: 10.1289/ehp9072] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Study participants want to receive their biomonitoring results for environmental chemicals, and ethics guidelines encourage reporting back. However, few studies have quantitively assessed participants' responses to individual exposure reports, and digital methods have not been evaluated. OBJECTIVES We isolated effects of receiving personal results vs. only study-wide findings and investigated whether effects differed for Black participants. METHODS We randomly assigned a subset of 295 women from the Child Health and Development Studies, half of whom were Black, to receive a report with personal environmental chemical results or only study-wide (aggregate) findings. Reports included results for 42 chemicals and lipids and were prepared using the Digital Exposure Report-Back Interface (DERBI). Women were interviewed before and after viewing their report. We analyzed differences in website activity, emotional responses, and intentions to participate in future research by report type and race using Wilcoxon rank sum tests, Wilcoxon-Pratt signed ranks tests, and multiple regression. RESULTS The personal report group spent approximately twice as much time on their reports as the aggregate group before the post-report-back interview. Among personal-report participants (n=93), 84% (78) viewed chemical group information for at least one personal result highlighted on their home page; among aggregate-report participants (n=94), 66% (62) viewed any chemical group page. Both groups reported strong positive feelings (curious, informed, interested, respected) about receiving results before and after report-back and mild negative feelings (helpless, scared, worried). Although most participants remained unworried after report-back, worry increased by a small amount in both groups. Among Black participants, higher post report-back worry was associated with having high levels of chemicals. CONCLUSIONS Participants were motivated by their personal results to access online information about chemical sources and potential health effects. Report-back was associated with a small increase in worry, which could motivate appropriate action. Personal report-back increased engagement with exposure reports among Black participants. https://doi.org/10.1289/EHP9072.
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Affiliation(s)
| | | | | | - Laurie Havas
- Participant Advisory Council, Child Health and Development Studies, Public Health Institute, Oakland, California, USA
| | - Marj Plumb
- Plumbline Coaching and Consulting, Omaha, Nebraska, USA
| | - Herbert P. Susmann
- Department of Biostatistics, School of Public Health and Health Science, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Krzysztof Z. Gajos
- Computer Science, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts, USA
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Polka E, Childs E, Friedman A, Tomsho KS, Claus Henn B, Scammell MK, Milando CW. MCR: Open-Source Software to Automate Compilation of Health Study Report-Back. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6104. [PMID: 34198866 PMCID: PMC8201126 DOI: 10.3390/ijerph18116104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/23/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022]
Abstract
Sharing individualized results with health study participants, a practice we and others refer to as "report-back," ensures participant access to exposure and health information and may promote health equity. However, the practice of report-back and the content shared is often limited by the time-intensive process of personalizing reports. Software tools that automate creation of individualized reports have been built for specific studies, but are largely not open-source or broadly modifiable. We created an open-source and generalizable tool, called the Macro for the Compilation of Report-backs (MCR), to automate compilation of health study reports. We piloted MCR in two environmental exposure studies in Massachusetts, USA, and interviewed research team members (n = 7) about the impact of MCR on the report-back process. Researchers using MCR created more detailed reports than during manual report-back, including more individualized numerical, text, and graphical results. Using MCR, researchers saved time producing draft and final reports. Researchers also reported feeling more creative in the design process and more confident in report-back quality control. While MCR does not expedite the entire report-back process, we hope that this open-source tool reduces the barriers to personalizing health study reports, promotes more equitable access to individualized data, and advances self-determination among participants.
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Affiliation(s)
- Erin Polka
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA; (E.P.); (A.F.); (B.C.H.); (M.K.S.)
| | - Ellen Childs
- Abt Associates, Division of Health and the Environment, 6130 Executive Blvd, Rockville, MD 20852, USA;
- Department of Health Policy and Law, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA
| | - Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA; (E.P.); (A.F.); (B.C.H.); (M.K.S.)
| | - Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA;
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA; (E.P.); (A.F.); (B.C.H.); (M.K.S.)
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA; (E.P.); (A.F.); (B.C.H.); (M.K.S.)
| | - Chad W. Milando
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, USA; (E.P.); (A.F.); (B.C.H.); (M.K.S.)
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Malone C, Çığ G, Brown P, Ducatman A. Participant Reactions to Medical Screening: A Survey of Satisfaction With the C8 (PFOA) Health Project. New Solut 2019; 29:186-204. [PMID: 31092115 DOI: 10.1177/1048291119850109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We report participant perceptions of the 2005–2006 C8 Health Project, a massive medical monitoring effort in response to perfluorooctanoic acid (C8) in West Virginia and Ohio. The C8 Health Project consisted of a health survey ( n = 69,030), blood testing for ten per- and polyfluoroalkyl substances, and 50+ laboratory tests ( n = 66,899). A randomly selected subgroup was surveyed in 2007 on (1) demographics (2) satisfaction with the project, and (3) perceptions of outcomes such as contribution to personal/family, community health, and links to health outcomes. The response rate was 573/1500 (38.2 percent). Most (92.7 percent) characterized their participation experience as “excellent” or “good,” and most (96.2 percent) considered the project very “important,” “important,” or “moderately important.” No demographic variable predicted important changes in satisfaction or perception of project importance. We conclude that responses to the survey indicate strong positive assessments of project benefits.
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Affiliation(s)
| | - Gülnaz Çığ
- 2 Istanbul University - Cerrahpasa, Turkey
| | - Phil Brown
- 1 Northeastern University, Boston, MA, USA
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