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

California dreaming: Why environmental justice is integral to the success of climate change policy

In the realm of climate policy, issues of environmental justice (EJ) are often treated as second-order affairs compared to overarching sustainability goals. We argue that EJ is in fact critical to successfully addressing our national and global climate challenges; indeed, centering equity amplifies the voices of the diverse constituencies most impacted by climate change and that are needed to build successful coalitions that shape and advance climate change policy. We illustrate this perspective by highlighting the experience of California and the contentious processes by which EJ became integrated into the state's climate action efforts. We examine the achievements and shortcomings of California's commitment to climate justice and discuss how lessons from the Golden State are influencing the evolution of current federal climate change policy.

Development and Outcomes of Returning Polycyclic Aromatic Hydrocarbon Exposure Results in the Washington Heights, NYC Community

Report-back of research results (RBRR) is becoming standard practice for environmental health research studies. RBRR is thought to increase environmental health literacy (EHL), although standardized measurements are limited. For this study, we developed a report back document on exposure to air pollutants, Polycyclic Aromatic Hydrocarbons, during pregnancy through community engaged research and evaluated whether the report increased EHL. We used focus groups and surveys to gather feedback on the report document from an initial group of study participants (Group 1, n = 22) and then sent the revised report to a larger number of participants (Group 2, n = 168). We conducted focus groups among participants in Group 1 and discussed their suggested changes to the report and how those changes could be implemented. Participants in focus groups demonstrated multiple levels of EHL. While participant engagement critically informed report development, a survey comparing feedback from Group 1 (initial report) and Group 2 (revised report) did not show a significant difference in the ease of reading the report or knowledge gained about air pollutants. We acknowledge that our approach was limited by a lack of EHL tools that assess knowledge and behavior change, and a reliance on quantitative methodologies. Future approaches that merge qualitative and quantitative methodologies to evaluate RBRR and methodologies for assessing RBRR materials and subsequent changes in knowledge, attitudes, and behavior, may be necessary.

Shifting terrains: Understanding residential contaminants after flood disasters

Flood disasters can induce the mass transport of soils and sediments. This has the potential to distribute contaminants and present novel combinations to new locations - including residential neighborhoods. Even when soil contaminants cannot be directly attributed to the disaster, data on bacterial and heavy metal(loids) can facilitate an environmentally just recovery by enabling reconstruction decisions that fill data gaps to minimize future exposure. These data-gathering interventions may be especially useful in poor, rural, and racially diverse communities where there is a high probability of exposure to multiple hazards and a potential dependency on the financial resources of disaster aid as a means of reducing chronic exposures to other environmental pollutants. At the same time, entering these post-disasters spaces is ethically complex. To acknowledge this complexity, we pilot a framework for work that gathers social-ecological hazard information while retaining a fair-minded approach to transdisciplinary work. Assembled a transdisciplinary team to recruit participants from 90 households subjected to flooding in the southeastern US. Participating households agreed to interviews to elicit flood experience and environmental health concerns, soil sampling for fecal bacteria (E. coli) and soil sampling for selected heavy metals and metalloids (Pb, As, Cd) at their flooded residence. Soil sampling found a wide range of E. coli concentrations in soil (0.4-1115.7 CFU/ dry gram). Heavy metal(loid)s were detected at most residences (As 97.9 %; Ca 25.5 %; Pb 100 %). Individually, heavy metal(loid) concentrations did not exceed regulatory thresholds. Hazard, risk, and mitigation concerns expressed during interviews reveal that integrated human-nature concepts complicate common understandings of how hazard perceptibility (smell, sight, touch, and information) affects research-action spaces. Qualitative analysis of interviews and field notes revealed that soil-related hazards addressed by our biophysical protocols were less salient than changes with direct causal associations with flooding. We conclude by discussing the potential for the social-ecological hazard information that is fair-minded and transdisciplinary (SHIFT) framework to advance environmentally just approaches to research-action spaces after disasters.

The role of academia practice partnerships in the well-being economy: Retracing synergies between health and social sciences using bibliometric analysis

Well-being economies develop policies at the intersection of health and socio-economic inequalities. These policies are often informed by data-driven approaches, such as quality-of-life indicators. However, despite great efforts in measurement, it is known that the perspectives of underserved and unhealthy populations are not always fully captured. This raises the question to what extent well-being economy policies, informed by data alone, can adequately improve well-being for all. In this paper we investigate the potential of academia practice partnerships (AcPrac) in facilitating transfer and production of knowledge and skills between researchers and practitioners (including decision makers, governments, and communities) to create well-being policies informed by both data and people. We use bibliometric analysis to visualise the current state of knowledge on AcPrac. We find that 1) the health field has made the largest scientific contribution in this area, 2) cross-fertilization, which is at the heart of the well-being economy approach, is starting to take place between health and social sciences, and 3) concerns for equity are a shared value underlying transdisciplinary partnerships for well-being. Our findings contribute to understanding the role of AcPrac in advancing well-being economies and informing policy, but further research is needed to draw conclusions about its effectiveness.

Multi-directional communication between decision makers and environmental health researchers: a qualitative inquiry

It has been three decades since key leaders gathered to pave a path toward healthier and more just environments and recommendations were made to improve communication between scientists and community stakeholders who can influence decision making. Since that time, community engaged research has flourished while building the capacity of researchers to engage in the work of making change to those environments has lagged. The purpose of this study was the development of guidelines to inform interactions between researchers and decision makers and influencers who participate in the policy change process. This community engaged, pragmatic and iterative inquiry includes insight from a review of existing resources and key informant interviews. Resulting guidelines were piloted, and formative evaluation by community stakeholders informed and resulted in refinement to the guidelines. Strategies for communicating and disseminating scientific evidence are presented as well as tactics that sensitise researchers to the nuances of policy makers' realities so they may serve as a resource for dealing with complex information and decisions. We provide tactics and archived resources in an on-line toolkit that we have cultivated over time to foster effective communication between scientists and those who have a stake in ensuring that decisions are evidence informed.

Strategies for knowledge exchange for action to address place-based determinants of health inequalities: an umbrella review

BACKGROUND

Place-based health inequalities persist despite decades of academics and other stakeholders generating ideas and evidence on how to reduce them. This may in part reflect a failure in effective knowledge exchange (KE). We aim to understand what KE strategies are effective in supporting actions on place-based determinants and the barriers and facilitators to this KE.

METHODS

An umbrella review was undertaken to identify relevant KE strategies. Systematic reviews were identified by searching academic databases (Medline, Embase, Scopus, Web of Science) and handsearching. Synthesis involved charting and thematic analysis.

RESULTS

Fourteen systematic reviews were included comprising 105 unique, relevant studies. Four approaches to KE were identified: improving access to knowledge, collaborative approaches, participatory models and KE as part of advocacy. While barriers and facilitators were reported, KE approaches were rarely evaluated for their effectiveness.

CONCLUSIONS

Based on these four approaches, our review produced a framework, which may support planning of future KE strategies. The findings also suggest the importance of attending to political context, including the ways in which this may impede a more upstream place-based focus in favour of behavioural interventions and the extent that researchers are willing to engage with politicized agendas.

Along the energy justice continuum: An examination of energy disposal through the lens of feminist community based participatory action research

Energy justice research tends to focus on inequalities that result from energy systems, including from fossil fuel extraction to production, distribution, and consumption. However, little research has investigated local effects of the disposal of waste products from fossil fuel extraction. To better understand these impacts, we employed a case study approach with qualitative interviews of residents of Kettleman City, a rural community in California's Central Valley (USA) that hosts a hazardous waste landfill which accepts predominantly waste from fossil fuel production. Informed by a novel feminist community-based participatory action research approach (CBPAR), interview data were collected from residents in the Summer of 2019 and analyzed using deductive and inductive coding strategies. Resident interviews highlighted the disproportionate distribution of pollution and environmental degradation shouldered by the community along with their experiences of adverse health and social impacts. Our analysis revealed the importance of incorporating an intersectional perspective to frame resident experiences of energy injustice. Our research highlights the untapped potential of feminist-informed CBPAR to catalyze change and challenge the production of energy injustice from energy waste disposal.

An applied environmental justice framework for exposure science

On the 30th anniversary of the Principles of Environmental Justice established at the First National People of Color Environmental Leadership Summit in 1991 (Principles of Environmental Justice), we continue to call for these principles to be more widely adopted. We propose an environmental justice framework for exposure science to be implemented by all researchers. This framework should be the standard and not an afterthought or trend dismissed by those who believe that science should not be politicized. Most notably, this framework should be centered on the community it seeks to serve. Researchers should meet with community members and stakeholders to learn more about the community, involve them in the research process, collectively determine the environmental exposure issues of highest concern for the community, and develop sustainable interventions and implementation strategies to address them. Incorporating community "funds of knowledge" will also inform the study design by incorporating the knowledge about the issue that community members have based on their lived experiences. Institutional and funding agency funds should also be directed to supporting community needs both during the "active" research phase and at the conclusion of the research, such as mechanisms for dissemination, capacity building, and engagement with policymakers. This multidirectional framework for exposure science will increase the sustainability of the research and its impact for long-term success.

Community Perceptions of Arsenic Contaminated Drinking Water and Preferences for Risk Communication in California's San Joaquin Valley

Due to chronic exposure to elevated levels of arsenic in drinking water, thousands of Californians have increased risk for internal cancers and other adverse health effects. The mortality risk of cancer is 1 in 400 people exposed to above 10 μg/L of arsenic in their drinking water. The purpose of this community assessment was to understand the perceptions and awareness of the residents and public water representatives in rural, unincorporated farming communities of color in San Joaquin Valley, California. In our research, we asked 27 community informants about their (1) available water sources, (2) knowledge about the health impacts of arsenic, and (3) preferences for risk communication and education regarding the health impacts of arsenic-contaminated drinking water. Through our qualitative coding and analysis, we found that most community informants indicated that there was limited community awareness about the health effects of drinking water with elevated arsenic levels. Preferences for risk communication included using in-language, culturally relevant, and health literate health promotion strategies and teaching these topics through the local K-8 schools' science curriculum with a language brokerage approach to transfer student knowledge to family members. Key recommendations include implementing these communication preferences to increase community-wide knowledge about safe drinking water.

"They Kept Going for Answers": Knowledge, Capacity, and Environmental Health Literacy in Michigan's PBB Contamination

The Michigan PBB Oral History Project documented community residents' descriptions of a large-scale chemical contamination-the PBB contamination-that occurred in Michigan in 1973. These oral histories document residents' and others' experiences during and after the contamination. We conducted a grounded theory qualitative analysis of 31 oral histories to examine the experiences of community members, researchers, lawyers, and others who actively sought out and contributed essential information about the contamination and its impacts. Our findings highlight several challenges encountered in the development of this knowledge including four central themes-contested knowledge, community skills, inaction, and uncertainty. Integrating environmental health literacy, community capacity, and contested illness frameworks, we examine the contributions of community residents, scientists (from inside and outside the community), and others to the development of knowledge to inform decisions and sustain action regarding this large-scale contamination. We close with a discussion of lessons learned regarding efforts to build environmental health knowledge within uncertain and often contested contexts and for promoting environmental health and action related to large-scale chemical contaminations. Our findings suggest the importance of integrated frameworks for examining and promoting the critical role of community skills, leadership, participation, sense of community, and community power in promoting environmental health.

COVID-19 and the malaria elimination agenda in Africa: Re-shifting the focus

The global Coronavirus disease 2019 (COVID-19) pandemic has resulted in public health, political, scientific and private sector response at an unprecedented scale. However, this shift in focus has caused widespread disruption to global health services and has the potential to reverse gains made in efforts to control malaria. If health systems are not able to maintain malaria control interventions while managing the response to the COVID-19 pandemic, malaria cases will increase, thereby placing even more strain on already overtaxed systems. Using a Narrative Review Approach, this commentary explores the impact of COVID-19 on progress made with malaria control and prevention strategies in Africa; and discusses possible mitigation steps to aid community resilience building, through proactive planning and implementation of integrated, inclusive and sustainable strategies to re-shift the focus to attain the malaria elimination goals. We propose strengthening community partnerships, where academia and communities should collaborate and these knowledge-sharing strategies be implemented in order for awareness and interventions to become more networked, inclusive, resilient and effective. Communities should be viewed as 'thought partners', who challenge conventional strategies and aid in developing innovative approaches to community resilience building.

Community-engaged learning to broaden the impact of applied ecology: A case study

Ecological changes are creating disruptions that often disproportionately impact communities of color and economically disadvantaged areas. Scientists who study the consequences experienced by these communities are uniquely suited to bring the public into their work as a way of setting conditions that enable impacted residents to empower themselves to advance environmental and community change. In addition to involving community stakeholders in the process of science, community science can be used to motivate learning and increase engagement of students. Here we highlight a case study of one way a historically Black college involved local communities and students in water quality monitoring efforts to examine the role of the environment in human health. Students in an introductory-level environmental toxicology course collaborated with community members to track pollution and monitor conditions in an urban, impaired stream. Students participated in bi-monthly water quality monitoring alongside community watershed researchers and an annual day-long multisite sampling event with community residents and organizations. Through this engagement, students and community members contributed to the collection of data, learned about the significance of their results, and translated findings into strategies to advance watershed restoration, health, quality of life, and environmental justice goals.

Engaging communities in addressing air quality: a scoping review

BACKGROUND

Exposure to air pollution has a detrimental effect on health and disproportionately affects people living in socio-economically disadvantaged areas. Engaging with communities to identify concerns and solutions could support organisations responsible for air quality control, improve environmental decision-making, and widen understanding of air quality issues associated with health. This scoping review aimed to provide an overview of approaches used to engage communities in addressing air quality and identify the outcomes that have been achieved.

METHODS

Searches for studies that described community engagement in air quality activities were conducted across five databases (Academic Search Complete, CABI, GreenFILE, MEDLINE, Web of Science). Data on study characteristics, community engagement approach, and relevant outcomes were extracted. The review process was informed by a multi-stakeholder group with an interest in and experience of community engagement in air quality. Thirty-nine papers from thirty studies were included in the final synthesis.

CONCLUSION

A range of approaches have been used to engage communities in addressing air quality, most notably air quality monitoring. Positive outcomes included increased awareness, capacity building, and changes to organisational policy and practice. Longer-term projects and further exploration of the impact of community engagement on improving air quality and health are needed as reporting on these outcomes was limited.

Air pollution exposure assessment at schools and playgrounds in Williamsburg Brooklyn NYC, with a view to developing a set of policy solutions

Community science offers unique opportunities for non-professional involvement of volunteers in the scientific process, not just during the data acquisition, but also in other phases, like problem definition, quality assurance, data analysis and interpretation, and the dissemination of results. Moreover, community science can be a powerful tool for public engagement and empowerment during policy formulation. This paper aims to present a pilot study on personal exposure to fine particulate matter (PM_2.5) and raises awareness of the hazards of air pollution. As part of data acquisition conducted in 2019, high school students gathered data at their schools, schoolyards, and playgrounds using low-cost monitors AirBeam2. The data was automatically uploaded every second onto the AirCasting mobile app. Besides, a stationary network of air monitors (fixed stations) was deployed in the neighborhood to collect real-time ambient air concentrations of PM_2.5. Students involved in the project attended workshops, training sessions, and researched to better understand air pollution, as part of their science class curriculum and portfolio. This air quality monitoring was incorporated into the "Our Air/Nuestro Aire" - El Puente grassroots campaign. The main goals of this campaign included sharing the data collected with the community, engaging academic partners to develop a set of policy and urban design solutions, and to be considered into a 5-point policy platform.

Understanding the Impact of Equitable Collaborations between Science Institutions and Community-Based Organizations: Improving Science through Community-Led Research

To advance justice, equity, diversity, and inclusion in science, we must first understand and improve the dominant-culture frameworks that impede progress and, second, we must intentionally create more equitable models. The present authors call ourselves the ICBOs and Allies Workgroup (ICBOs stands for independent community-based organizations), and we represent communities historically excluded from the sciences. Together with institutional allies and advisors, we began our research because we wanted our voices to be heard, and we hoped to bring a different perspective to doing science with and not on communities. We created a community framework to guide our research and we led all aspects of our work, from creating research protocols to analyzing and interpreting the data to disseminating the results. We share our research framework, methods, and results so that science institutions can better understand how to intentionally create more equitable research partnerships with our communities.

Exposure monitoring toward environmental justice

Executive Order 14008, signed on 27 January 2021, established environmental justice (EJ) as a core priority of the Biden Administration. There is a need for state and federal regulators, as well as industry, to enhance risk assessment methods and exposure monitoring approaches to be more inclusive of EJ community involvement and more representative of EJ community exposures. Cumulative risk assessment models are critical for understanding the unique interaction between chemical exposures and nonchemical stressors that EJ communities encounter daily. Enhanced environmental monitoring with personal and portable sensors, especially when deployed using community partnerships, can capture chemical exposures with sufficient resolution to characterize exposures down to the neighborhood level. Use of internet-linked sensors will also require thoughtful advances in management of big data to inform meaningful and time-sensitive decisions. Integr Environ Assess Manag 2022;18:858-862. © 2021 SETAC.

Bringing the Community to the Uni—Critical Reflections on Youth Recreation Partnerships in Toronto

The focus of this paper is an evaluation of a recreation project partnership between a co-curricular university department and various youth community programs in downtown Toronto, Canada. The goal of the Hart House Youth Community Recreation Project (YCRP) is to build a bridge between the university and its neighboring communities through recreation, arts, and dialogue-based programming that responds to the needs and interests of community partners and their youth members. Informed by the understanding that university/community partnerships are often paradoxical, the study assessed understandings of the program from the perspectives of the stakeholders involved. To do so, semi-structured interviews were conducted with the following two groups: organizers and leaders from the youth community programs, and staff members coordinating the project from the co-curricular university department. The results indicate that meaningful opportunities can be created within such partnerships through the provision of access to unique resources and recreation spaces; inclusion of partners in planning and program delivery; and through forging meaningful relationships between university staff and the program participants. However, significant challenges to creating and sustaining such opportunities also exist, including structural and social inequities that result in participants feeling othered in program settings; the instability and “delicacy” of trust within partnerships; and funding structure and resources. The findings shed light on, and make recommendations about, the potential benefits that youth organizations might gain from participating in university-community recreation partnerships, as well as the paradoxical nature of delivering and maintaining these partnerships.

Problem Definition and Community Participation in Environmental Health Interventions: An Exploratory Study of Groundwater Arsenic Remediation

Arsenic, a known carcinogen, naturally occurs in the groundwater in large parts of West Bengal, a state in eastern India. Communities that depend on groundwater face twice the lifetime mortality risk for cancers, cardiovascular diseases, and developmental disorders. This study, focused on arsenic-affected communities in the state of West Bengal, offers an initial exploration of how local stakeholders construct groundwater arsenic as a health problem. Arsenic remediation interventions involve a host of international, regional, and local stakeholders (public health departments, government engineers, community health workers, consultants, hydrologists, etc.). How an environmental health problem is constructed has implications for who is considered responsible, what causes it, and pertinently, how/whether affected communities participate in addressing the problem. Drawing from a culture-centered approach, this fieldwork-based study offers three distinct yet related problem construction discourses, viz. social/political, technical and personal, in how the problem of arsenic is construed locally, and how such discourses are related to a particular conceptualization of community participation in environmental health.

What Is a "Racial Health Disparity"? Five Analytic Traditions

What exactly is a "racial health disparity"? This article explores five lenses that have been used to answer that question. It contends that racial health disparities have been presented-by researchers both within academia and outside of it-as problems of five varieties: biology, behavior, place, stress, and policy. It also argues that a sixth tradition exploring class-and its connection to race, racism, and health-has been underdeveloped. The author examines each of these conceptions of racial disparities in turn. Baked into each interpretive prism is a set of assumptions about the mechanisms that produce disparities-a story, in other words, about where racial health disparities come from. Discursive boundaries set the parameters for policy debate, determining what is and is not included in proposed solutions. How one sees racial health disparities, then, influences the strategies a society advocates-or ignores-for their elimination. The author ends by briefly discussing problems in the larger research ecosystem that dictate how racial health disparities are studied.

Health Equity and Actionable Disparities in Stroke: 2021 Update

There are stark inequities in stroke incidence, prevalence, acute care, rehabilitation, risk factor control, and outcomes. To address these inequities, it is critical to engage communities in identifying priorities and designing, implementing, and disseminating interventions. This issue of Stroke features health equity themed lectures delivered during the International Stroke Conference and Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving meetings in 2021 as well as articles covering issues of disparities and diversity in stroke. Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, received the 2021 William Feinberg Award Lecture for his lifetime achievements in seeking global and local solutions to cerebrovascular health inequities. The second annual Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving symposium, which took place the day before the International Stroke Conference in February 2021, focused on community-engaged research for reducing inequities in stroke. Phil Gorelick, MD was awarded the Edgar J. Kenton III Award for his lifetime achievements in using community engagement strategies to recruit and retain Black participants in observational studies and clinical trials. Walter Koroshetz, MD, Director of the National Institute of Neurological Disorders and Stroke delivered the keynote lecture on stroke inequities and Richard Benson, MD, PhD, Director of the Office of Global Health and Health Disparities at National Institute of Neurological Disorders and Stroke, gave a lecture focused on National Institute of Neurological Disorders and Stroke efforts to address inequities. Nichols et al highlighted approaches of community-based participatory research to address stroke inequities. Verma et al showcased digital health innovations to reduce inequities in stroke. Das et al showed that the proportion of underrepresented in medicine vascular neurology fellows has lowered over the past decade and authors provided a road map for enhancing the diversity in vascular neurology. Clearly, to overcome inequities, multipronged strategies are required, from broadening representation among vascular neurology faculty to partnering with communities to conduct research with meaningful impact.

Selecting Data Analytic and Modeling Methods to Support Air Pollution and Environmental Justice Investigations: A Critical Review and Guidance Framework

Given the serious adverse health effects associated with many pollutants, and the inequitable distribution of these effects between socioeconomic groups, air pollution is often a focus of environmental justice (EJ) research. However, EJ analyses that aim to illuminate whether and how air pollution hazards are inequitably distributed may present a unique set of requirements for estimating pollutant concentrations compared to other air quality applications. Here, we perform a scoping review of the range of data analytic and modeling methods applied in past studies of air pollution and environmental injustice and develop a guidance framework for selecting between them given the purpose of analysis, users, and resources available. We include proxy, monitor-based, statistical, and process-based methods. Upon critically synthesizing the literature, we identify four main dimensions to inform method selection: accuracy, interpretability, spatiotemporal features of the method, and usability of the method. We illustrate the guidance framework with case studies from the literature. Future research in this area includes an exploration of increasing data availability, advanced statistical methods, and the importance of science-based policy.

Using the Community Engagement Framework to Understand and Assess EJ-Related Research Efforts

Within an environmental justice frame, capacity-building has been an important component of efforts to address health disparities at the policy, system, and environment levels. While the literature is replete with studies that discuss the necessity of collective action as a means to generate power to overcome inequities, limited attention has been given to the structure of these efforts to build capacity and challenge environmental injustices. This study applies the community engagement continuum as a framework for understanding the scope of capacity-building strategies and the manner in which research investigators engage with their intended target community. Paired teams of independent analysts screened articles for relevance (n = 8452), identified records for content abstraction (n = 163), and characterized relevant studies (n = 58). Many articles discussed community engagement as being either collaborative or shared leadership (n = 32, 55.2%). While the most commonly used capacity-building strategies were organizing/social action (58.6%) and CBPR (50%), few studies were able to make an environmental impact (n = 23; 39.7%), and fewer had a direct legislative policy-related outcome (n = 13; 22.4%). This review identifies levels of collaborative involvement and strategic approaches used for strengthening community capacity in efforts of making transformative policy, systems, and environmental change.

Engaged communication of environmental health science: Processes and outcomes of urban academic-community partnerships

Those who bear the greatest environmental burdens often have the least access to information, and explanations for engaging communities to develop solutions are lacking. We describe, and use a case study to depict, a participatory process of urban academic and community members to co-produce educational and communication tools. Over five years, we interfaced with 763 individuals at eleven events and three times that (n=2,273) through attendees' networks at 109 small group events using snowball methods. The resulting communication tools, paired resources, and mobile dissemination were responsive to residents' circumstances and enhanced their ability to access health protecting information and resources.

Synthesising the shifting terminology of community health: A critiquing review of agent-based approaches

The field of community health promotion encompasses a wide range of approaches, including bottom-up approaches that recognise and build on the agency and strengths of communities to define and pursue their health goals. Momentum towards agent-based approaches to community health promotion has grown in recent years, and several related but distinct conceptual and methodological bodies of work have developed largely in isolation from each other. The lack of a cohesive collection of research, practice, and policy has made it difficult to learn from the innovations, best practices, and shortcomings of these approaches, which is exacerbated by the imprecise and inconsistent use of related terms. This article provides a review of three agent-based approaches to promoting community health: asset-based approaches, capacity building, and capabilities approaches, noting the theoretical origins and fundamental concepts, applications and methodologies, and limitations and critiques of each. This article discusses their commonalities and differences in terms of how they conceptualise and approach the promotion of community health, including a critical consideration of their limitations and where they may prove to be counterproductive. This article argues that agent-based approaches to community health must be met with meaningful opportunities to disengage from the structures that constrain their health.

Choosing strategies that work from the start: A mixed methods study to understand effective development of community-academic partnerships

Community-academic partnerships are believed to increase the effectiveness and feasibility of action research. While factors facilitating and hindering community-academic partnerships have been identified, their influence on the collaborative process is unknown, especially during community-academic partnership initiation and development. This explanatory sequential mixed methods study (quantitative→QUALITATIVE) evaluated perspectives of members in an autism community-academic partnership to determine frequently endorsed and influential factors facilitating and hindering the collaborative process during the community-academic partnership's development. Participants (n = 11; community stakeholders, implementation scientist, and researchers) endorsed and ranked the importance of factors present in the formation of the community-academic partnership then completed a semi-structured qualitative interview to elaborate on survey responses. Interviews were coded using a coding, comparison, and consensus method and analyzed using the Rapid Assessment Process for frequency and salience of themes across interviews. Integrating mixed methods yielded ranked factors that were perceived to facilitate and hinder the development of the community-academic partnership, and highlighted the relative influence of interpersonal factors on the facilitation of community-academic partnership processes and organizational factors on the hindrance of community-academic partnership processes during development. Some discrepancies emerged between community and academic partners. Results may assist to improve the development of community-academic partnerships, which is becoming increasingly important in healthcare services research, dissemination, and implementation.

Adopting a "Compound" Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity

BACKGROUND

In June 2020, the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop focused on integrating the science of aging and environmental health research. The concurrent COVID-19 pandemic and national attention on racism exposed shortcomings in the environmental research field's conceptualization and methodological use of race, which have subsequently hindered the ability of research to address racial health disparities. By the workshop's conclusion, the authors deduced that the utility of environmental aging biomarkers-aging biomarkers shown to be specifically influenced by environmental exposures-would be greatly diminished if these biomarkers are developed absent of considerations of broader societal factors-like structural racism-that impinge on racial health equity.

OBJECTIVES

The authors reached a post-workshop consensus recommendation: To advance racial health equity, a "compound" exposome approach should be widely adopted in environmental aging biomarker research. We present this recommendation here.

DISCUSSION

The authors believe that without explicit considerations of racial health equity, people in most need of the benefits afforded by a better understanding of the relationships between exposures and aging will be the least likely to receive them because biomarkers may not encompass cumulative impacts from their unique social and environmental stressors. Employing an exposome approach that allows for more comprehensive exposure-disease pathway characterization across broad domains, including the social exposome and neighborhood factors, is the first step. Exposome-centered study designs must then be supported with efforts aimed at increasing the recruitment and retention of racially diverse study populations and researchers and further "compounded" with strategies directed at improving the use and interpretation of race throughout the publication and dissemination process. This compound exposome approach maximizes the ability of our science to identify environmental aging biomarkers that explicate racial disparities in health and best positions the environmental research community to contribute to the elimination of racial health disparities. https://doi.org/10.1289/EHP8392.

Participatory Research for Environmental Justice: A Critical Interpretive Synthesis

BACKGROUND

Environmental health risks are disproportionately colocated with communities in poverty and communities of color. In some cases, participatory research projects have effectively addressed structural causes of health risk in environmental justice (EJ) communities. However, many such projects fail to catalyze change at a structural level.

OBJECTIVES

This review employs Critical Interpretive Synthesis (CIS) to theorize specific elements of participatory research for environmental health that effectively prompt structural change in EJ communities.

METHODS

Academic database search was used to identify peer-reviewed literature describing participatory research with EJ communities to address environmental health. Synthetic constructs were developed iteratively related to study characteristics, design elements, and outcomes; and data were extracted for included records. Statistical analyses were performed to assess correlations between study design elements and structural change outcomes. Through critical, comparative, and contextual analyses of the "structural change" case study group and "non- structural change" group, informed by relevant theoretical literature, a synthesizing argument was generated.

RESULTS

From 505 total records identified, eligibility screening produced 232 case study articles, representing 154 case studies, and 55 theoretical articles for synthesis. Twenty-six case studies resulted in a structural change outcome. The synthesizing argument states that participatory research with EJ communities may be more likely to result in structural change when a) community members hold formal leadership roles; b) project design includes decision-makers and policy goals; and c) long term partnerships are sustained through multiple funding mechanisms. The assumption of EJ community benefit through research participation is critically examined.

DISCUSSION

Recommended future directions include establishing structural change as a goal of participatory research, employing participatory assessment of community benefit, and increased hiring of faculty of color at research institutions. The power, privilege, and political influence that academic institutions are able to leverage in partnership with EJ communities may be as valuable as the research itself. https://doi.org/10.1289/EHP6274.

Bounded Justice and the Limits of Health Equity

Programs, policies, and technologies - particularly those concerned with health equity - are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil's National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity.

Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce

BACKGROUND

Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort.

CASE PRESENTATION

In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally.

CONCLUSIONS

Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.

A Scoping Review of Capacity-Building Efforts to Address Environmental Justice Concerns

Environmental justice (EJ) efforts aimed at capacity building are essential to addressing environmental health disparities; however, limited attention has been given to describing these efforts. This study reports findings from a scoping review of community-academic partnerships and community-led efforts to address environmental inequities related to air, water, and land pollution in the United States. Literature published in peer-reviewed journals from January 1986 through March 2018 were included, and community capacity theory was applied as a framework for understanding the scope of capacity-building and community change strategies to address EJ concerns. Paired teams of independent analysts conducted a search for relevant articles (n = 8452 citations identified), filtered records for content abstraction and possible inclusion (n = 163) and characterized selected studies (n = 58). Most articles implemented activities that were aligned with community capacity dimensions of citizen participation (96.4%, n = 53), community power (78%, n = 45), leadership (78%, n = 45), and networks (81%, n = 47); few articles identified a direct policy change (22%, n = 13), and many articles discussed the policy implications of findings for future work (62%, n = 36). This review synthesizes three decades of efforts to reduce environmental inequities and identifies strategic approaches used for strengthening community capacity.

Oceans and human health—navigating changes on Canada’s coasts

Ocean conditions can affect human health in a variety of ways that are often overlooked and unappreciated. Oceans adjacent to Canada are affected by many anthropogenic stressors, with implications for human health and well-being. Climate change further escalates these pressures and can expose coastal populations to unique health hazards and distressing conditions. However, current research efforts, education or training curriculums, and policies in Canada critically lack explicit consideration of these ocean–public health linkages. The objective of this paper is to present multiple disciplinary perspectives from academics and health practitioners to inform the development of future directions for research, capacity development, and policy and practice at the interface of oceans and human health in Canada. We synthesize major ocean and human health linkages in Canada, and identify climate-sensitive drivers of change, drawing attention to unique considerations in Canada. To support effective, sustained, and equitable collaborations at the nexus of oceans and human health, we recommend the need for progress in three critical areas: ( i) holistic worldviews and perspectives, ( ii) capacity development, and ( iii) structural supports. Canada can play a key role in supporting the global community in addressing the health challenges of climate and ocean changes.

Youth Engaged Participatory Air Monitoring: A 'Day in the Life' in Urban Environmental Justice Communities

Air pollution in Southern California does not impact all communities equally; communities of color are disproportionately burdened by poor air quality and more likely to live near industrial facilities and freeways. Government regulatory monitors do not have the spatial resolution to provide air quality information at the neighborhood or personal scale. We describe the A Day in the Life program, an approach to participatory air monitoring that engages youth in collecting data that they can then analyze and use to take action. Academics partnered with Los Angeles-based youth environmental justice organizations to combine personal air monitoring, participatory science, and digital storytelling to build capacity to address local air quality issues. Eighteen youth participants from four different neighborhoods wore portable personal PM2.5 (fine particles <2.5 µm in diameter) monitors for a day in each of their respective communities, documenting and mapping their exposure to PM2.5 during their daily routine. Air monitoring was coupled with photography and videos to document what they experienced over the course of their day. The PM2.5 exposure during the day for participants averaged 10.7 µg/m3, although the range stretched from <1 to 180 µg/m3. One-third of all measurements were taken <300 m from a freeway. Overall, we demonstrate a method to increase local youth-centered understanding of personal exposures, pollution sources, and vulnerability to air quality.

Guidance for Genuine Collaboration: Insights from Academic, Tribal, and Community Partner Interviews on a New Research Partnership

As community engaged research (CEnR) increases in popularity and recognition, specific guidance on partnership approaches that are more likely to lead to community benefits is needed. Here, we describe a qualitative interview study aimed at better understanding community and academic perspectives on elements of genuine collaboration within a project’s new community–academic partnership. This partnership involved a large, public, urban university, a tribal nation government program, a small, rural, community-based university, and a local high school working together to develop CEnR on air quality. Interview questions were formulated from a literature review examining the relationships between trust, cultural relevance, and community involvement in research with partnership processes, roles, and strengths. Twelve semi-structured interviews were conducted with individuals from the community–academic partnership: six University of Washington research team members and six community partners. Guidance for an authentic collaborative partnership supported by interview analyses includes incorporating elements of partnership and project sustainability from the earliest phases and throughout; promoting funding mechanism responsiveness to relationship building and community partner involvement in budget decision-making; acknowledging community strengths, knowledge, and expertise and applying them; establishing roles that reflect community partner capacity building goals; and recognizing community diversity and dynamics to promote representation.

The RxHL study: community-responsive research to explore barriers to medication adherence

This study aims to contribute to the development of community-responsive research approaches by describing the research methods used in the RxHL study and the interprofessional and community-based collaboration that produced them. The mixed-method RxHL study was developed in close consultation with staff and providers at our research site, a federally qualified health center in Springfield, MA. We utilized quantitative methods including chart review, manual pill counts and self-report surveys to assess factors associated with medication adherence in a diverse population of low-income patients with chronic disease. We triangulated these results with findings from qualitative methods that included in-depth interviews, home visits and chronic disease diaries. We used the constant comparison method and interdisciplinary, participatory team meetings to integrate quantitative and qualitative findings. A community-responsive approach facilitated the recruitment and retention of a diverse sample of patients. Self-report surveys revealed the widespread scope of barriers to care such as medication costs and transportation, and limited health literacy among diverse groups. Qualitative research methods offered a deeper understanding of the social and environmental contexts in which medication adherence takes place. Prioritizing the needs of community partners and research participants facilitates rigorous data collection in clinical settings with maximum participation from community partners.

Development and Evaluation of a Training Program for Community-Based Participatory Research in Breast Cancer

This paper describes the development and feasibility of the Community Based Research Infrastructure to Better Science (CRIBS) training. The goal of this training program was to help new or existing community-academic teams to build strong partnerships and successfully develop together fundable research projects focused on breast cancer environmental causes and disparities. A comprehensive mixed-methods participatory approach was utilized to assess the training. Twenty-two community-academic teams applied for the training program; twelve teams were enrolled. All teams completed the training and subsequently submitted research applications for funding. All components of the training received high ratings and positive qualitative comments. Self-rated competency in all of the learning domains increased during the training. Four (33%) of teams were successful in their first attempt to garner research funding, and six (50%) were eventually successful. The evaluation of CRIBS found it to have successfully achieved all four goals of the training: (1) Twelve new CBPR (community-based participatory research) teams, (2) improved knowledge about CBPR and science, (3) twelve submitted grant proposals in the first year, and (4) six (50%) successfully funded research projects.

Cooperative Extension Gets Moving, but How? Exploration of Extension Health Educators' Sources and Channels for Information-Seeking Practices

PURPOSE

The Cooperative Extension System (Extension) has implemented concerted efforts toward health promotion in communities across the nation by acting as an intermediary between communities and universities. Little is known about how these intermediaries communicate and learn about existing evidence-based programming. This study serves to explore this gap by learning about information sources and channels used within Extension.

DESIGN

Sequential explanatory mixed methods approach.

SETTING

National Cooperative Extension System.

PARTICIPANTS

Extension community-based health educators.

METHODS

A nationally distributed survey with follow-up semistructured interviews. Survey results were analyzed using a Kruskal-Wallis 1-way analysis of variance test paired with Bonferroni post hoc. Transcripts were analyzed by conventional content analysis.

RESULTS

One hundred twenty-one Extension educators from 33 states responded to the survey, and 18 of 20 invited participants completed the interviews. Educators' information seeking existed in 2 forms: (1) information sources for learning about programming and (2) channels by which this information is communicated. Extension educators reported contacting health specialists and other educators. Extension educators also reported using technological means of communication such as e-mail and Internet to reach information sources such as peers, specialists, academic journals, and so on.

CONCLUSION

Extension state specialists were preferred as primary sources for intervention information, and technology was acknowledged as an easy contact channel. This study identifies county-based health educators' information structures and justifies the need for future research on the role of specialists in communication efforts for educators.

Shifting from "Community-Placed" to "Community-Based" Research to Advance Health Equity: A Case Study of the Heatwaves, Housing, and Health: Increasing Climate Resiliency in Detroit (HHH) Partnership

Extreme summertime heat is a significant public health threat that disproportionately impacts vulnerable urban populations. Research on health impacts of climate change (including increasing intensity, duration, and frequency of hot weather) is sometimes designed and implemented without the involvement of the communities being studied, i.e., "community-placed" not "community-based." We describe how the Heatwaves, Housing, and Health: Increasing Climate Resiliency in Detroit (HHH) partnership engaged relevant communities by integrating a community-based participatory research (CBPR) approach into an existing, academic-designed research project through a steering committee of community and academic partners. Using a case study approach, we analyze program documentation, partnership evaluation questionnaires, and HHH steering committee meeting notes. We describe the CBPR process by which we successfully collected research data in Detroit during summer 2016, engaged in collaborative analysis of data, and shared results with Detroit residents. Evaluations of the partnership over 2 years show community involvement in research; enhanced capacities; success in securing new grant funding; and ways that CBPR strengthened the validity, relevance, and translation of research. Engaging communities as equal partners using CBPR, even after a study is underway, can strengthen research to understand and address the impacts of extreme heat on health and equity in urban communities.

The SMART Framework: Integration of Citizen Science, Community-Based Participatory Research, and Systems Science for Population Health Science in the Digital Age

Citizen science enables citizens to actively contribute to all aspects of the research process, from conceptualization and data collection, to knowledge translation and evaluation. Citizen science is gradually emerging as a pertinent approach in population health research. Given that citizen science has intrinsic links with community-based research, where participatory action drives the research agenda, these two approaches could be integrated to address complex population health issues. Community-based participatory research has a strong record of application across multiple disciplines and sectors to address health inequities. Citizen science can use the structure of community-based participatory research to take local approaches of problem solving to a global scale, because citizen science emerged through individual environmental activism that is not limited by geography. This synergy has significant implications for population health research if combined with systems science, which can offer theoretical and methodological strength to citizen science and community-based participatory research. Systems science applies a holistic perspective to understand the complex mechanisms underlying causal relationships within and between systems, as it goes beyond linear relationships by utilizing big data–driven advanced computational models. However, to truly integrate citizen science, community-based participatory research, and systems science, it is time to realize the power of ubiquitous digital tools, such as smartphones, for connecting us all and providing big data. Smartphones have the potential to not only create equity by providing a voice to disenfranchised citizens but smartphone-based apps also have the reach and power to source big data to inform policies. An imminent challenge in legitimizing citizen science is minimizing bias, which can be achieved by standardizing methods and enhancing data quality—a rigorous process that requires researchers to collaborate with citizen scientists utilizing the principles of community-based participatory research action. This study advances SMART, an evidence-based framework that integrates citizen science, community-based participatory research, and systems science through ubiquitous tools by addressing core challenges such as citizen engagement, data management, and internet inequity to legitimize this integration.

Integrating multiple community perspectives in intervention development

We offer a framework and exemplify how to integrate multiple community perspectives in research to develop breast cancer screening interventions among Latinas non-adherent to national guidelines. We leverage members of an academic institution's community consultative service [community engagement advisory board (CEAB) members]; study team members [community health workers (CHWs)] and study-eligible individuals (non-adherent Latinas). First, we asked what was needed from CEAB members (N=17), CHWs (N=14) and non-adherent Latinas (N=20) in one-time semi-structured group consultations and focus groups. Second, we drafted materials. Third, we conducted group consultations and focus groups with a new set of CEAB members (N=13), CHWs (N=17) and non-adherent Latinas (N=16) to reflect on our initial analysis and draft materials. Fourth, we finalized interventions. Certain recommendations were shared across stakeholders and simple to integrate (e.g. costs → access to free services). Some recommendations varied, but complementary integration was possible (e.g. location versus recruitment → multiple recruitment in multiple community areas). Others were distinct across stakeholders and resulted in strategies to recognize participants' agency and inform their choices about breast cancer screening (e.g. differences in preferred information about screening → personalized information and evidence about all screening options).

From Crowdsourcing to Extreme Citizen Science: Participatory Research for Environmental Health

Environmental health issues are becoming more challenging, and addressing them requires new approaches to research design and decision-making processes. Participatory research approaches, in which researchers and communities are involved in all aspects of a research study, can improve study outcomes and foster greater data accessibility and utility as well as increase public transparency. Here we review varied concepts of participatory research, describe how it complements and overlaps with community engagement and environmental justice, examine its intersection with emerging environmental sensor technologies, and discuss the strengths and limitations of participatory research. Although participatory research includes methodological challenges, such as biases in data collection and data quality, it has been found to increase the relevance of research questions, result in better knowledge production, and impact health policies. Improved research partnerships among government agencies, academia, and communities can increase scientific rigor, build community capacity, and produce sustainable outcomes.

Development of the Intercultural Diabetes Online Community Research Council: Codesign and Social Media Processes

BACKGROUND

This case study describes the formation of the Intercultural Diabetes Online Community Research council (iDOCr) and community advisory board (CAB) to engage the diabetes community and researchers in the codesign of community-based participatory research (CBPR) to examine online peer support in type 2 diabetes (T2D).

METHOD

Social media engagement was the foundation for CBPR knowledge generation. During the project, the iDOCr council and CAB (n = 27) met quarterly via video conferencing and three times in person during national diabetes meetings. Data from four Twitter chats were used to explore the usefulness and utility of Twitter data to learn about concerns and priorities of the diabetes online community (DOC) and supported the evolution of iDOCr, the development of a research question and the design of a CBPR study.

RESULTS

The iDOCr project (1) created a diverse CAB; (2) raised awareness of iDOCr and online peer support, which resulted in support and trust from key opinion leaders within the DOC to enable future partnerships for research and funding; (3) engaged with English- and Spanish-speaking DOC users through social media; and (4) designed a CBPR study supported by Twitter chat data analyses.

CONCLUSIONS

Integrating the voice of people with diabetes (PWD) and the DOC in designing CBPR, through use of a CAB, ensures the most important and relevant research questions are asked. Additional research focused on online peer support may increase health care provider confidence in referring PWD to this low-cost and relatively accessible resource with the potential power to advance health.

Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation

BACKGROUND

To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community.

METHODS

A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months).

RESULTS

Bright Bodies rated highest on program characteristics and adoptability (p's < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program-iChoose-had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = - 0.047; t = - 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents.

CONCLUSION

The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.

Lessons Learned From Food & Fitness About Building Successful Partnerships: Focus, Capacity, and Sustainability

Approaches undertaken by the Food & Fitness (F&F) community partnerships demonstrate that engaging community residents in the process of creating systems change strengthens the ability of neighborhoods, organizations, and institutions to foster and sustain those changes over time. The F&F partnerships were established to increase access to locally grown food and safe places for physical activity for children and families in communities with inequities across the United States. A critical focus of this initiative has been to use community-determined approaches to create changes in policies, infrastructures, and systems that will lead not only to change but also to sustainable change that positively influences health equity. During the 9 years of the initiative, lessons were learned about the fundamental elements that built the foundation for success across all partnership work. Data were extracted from the systems and policy change tracking forms related to efforts for all F&F sites over the entire implementation period (2009-2016). Documentation related to both the process and outcomes of the efforts were qualitatively analyzed to determine factors related to success. The following factors have emerged from our analyses and uncover a deeper understanding of what actions and factors were critical for the work: focus of the work over time, capacity built in the partnerships, and sustainability of the work and outcomes.

From awareness to action: Sudbury, mining and occupational disease in a time of change

BACKGROUND:

Miners work in highly hazardous environments, but surprisingly, there are more fatalities from occupational diseases, including cancers, than from fatalities from injuries. Over the last few decades, the mining environment has become safer with fewer injuries and less exposure to the toxins that lead to occupational disease. There have been improvements in working conditions, and a reduction in the number of workers exposed, together with an overall improvement in the health of miners.

OBJECTIVES:

This study attempted to gain a deeper understanding of the impetus for change to reduce occupational exposures or toxins at the industry level. It focuses on one mining community in Sudbury, Ontario, with a high cancer rate, and its reduction in occupational exposures. It explored the level of awareness of occupational exposures from the perspective of industry and worker representatives in some of the deepest mines in the world. Although awareness may be necessary, it is often not a sufficient impetus for change, and it is this gap between awareness and change that this study explored. It examined the awareness of occupational disease as an impetus to reducing toxic exposures in the mining sector, and explores other forces of change at the industrial and global levels that have led to an impact on occupational exposures in mining.

METHODS:

From 2014 and 2016, 60 interviews were conducted with individuals who were part of, or witness to the changes in mining in Sudbury. From these, 12 labour and 10 industry interviews and four focus groups were chosen for further analysis to gain a deeper understanding of industry and labour’s views on the changes in mining and the impact on miners’ health from occupational exposures. The results from this subsection of the data is the focus for this paper.

RESULTS:

The themes that emerged told a story about Sudbury. There is awareness of occupational exposures, but this awareness is dwarfed in comparison to the attention that is given to the tragic fatal injuries from injuries and accidents. The mines are now owned by foreign multinationals with a change from an engaged, albeit paternalistic sense of responsibility for the health of the miners, to a less responsive or sympathetic workplace culture. Modernization has led to the elimination, substitution, or reduction of some of the worst toxins, and hence present-day miners are less exposed to hazards that lead to occupational disease than they were in the past. However, modernization and the drop in the price of nickel has also led to a precipitous reduction in the number of unionized miners, a decline in union power, a decline in the monitoring of present-day exposures, and an increase in non-unionized contract workers. The impact has been that miners have lost their solidarity and power to investigate, monitor or object to present-day exposures.

CONCLUSIONS:

Although an increase in the awareness of occupational hazards has made a contribution to the reduction in occupational exposures, the improvement in health of miners may be considered more as a “collateral benefit” of the changes in the mining sector. Multiple forces at the industrial and global level have differentially led to an improvement in the working and living environment. However, with the loss of union power, the miners have lost their major advocate for miner health.

Pathways to Program Success: A Qualitative Comparative Analysis (QCA) of Communities Putting Prevention to Work Case Study Programs

OBJECTIVE

To examine the elements of capacity, a measure of organizational resources supporting program implementation that result in successful completion of public health program objectives in a public health initiative serving 50 communities.

DESIGN

We used crisp set Qualitative Comparative Analysis (QCA) to analyze case study and quantitative data collected during the evaluation of the Communities Putting Prevention to Work (CPPW) program.

SETTING

CPPW awardee program staff and partners implemented evidence-based public health improvements in counties, cities, and organizations (eg, worksites, schools).

PARTICIPANTS

Data came from case studies of 22 CPPW awardee programs that implemented evidence-based, community- and organizational-level public health improvements.

INTERVENTION

Program staff implemented a range of evidence-based public health improvements related to tobacco control and obesity prevention.

MAIN OUTCOME MEASURE

The outcome measure was completion of approximately 60% of work plan objectives.

RESULTS

Analysis of the capacity conditions revealed 2 combinations for completing most work plan objectives: (1) having experience implementing public health improvements in combination with having a history of collaboration with partners; and (2) not having experience implementing public health improvements in combination with having leadership support.

CONCLUSION

Awardees have varying levels of capacity. The combinations identified in this analysis provide important insights into how awardees with different combinations of elements of capacity achieved most of their work plan objectives. Even when awardees lack some elements of capacity, they can build it through strategies such as hiring staff and engaging new partners with expertise. In some instances, lacking 1 or more elements of capacity did not prevent an awardee from successfully completing objectives. These findings can help funders and practitioners recognize and assemble different aspects of capacity to achieve more successful programs; awardees can draw on extant organizational strengths to compensate when other aspects of capacity are absent.

Development, implementation, and evaluation of a Community Engagement Advisory Board: Strategies for maximizing success

Introduction

The purpose of this paper is to describe the formation, operation, and evaluation of a Community Engagement Advisory Board (CEAB) that serves as a resource of the University of Illinois at Chicago’s (UIC) Center for Clinical and Translational Sciences (CCTS).

Methods

Current CEAB roles and functions, operating procedures for research consultations and program evaluation strategies were described. Investigators receiving a consultation from 2009 to 2017 (n=91, response rate 78%) were surveyed via an online survey immediately after the consultation and at 12-month follow-up.

Results

Overall, CEAB members were viewed as having sufficient information (92%) and expertise (79%) to provide consultation. Satisfaction levels with the specific consultation received and the overall consultation service were high. The majority of investigators indicated that they would come back to the CEAB for a future consultation, if needed, and would recommend a consultation to others (93% and 96%, respectively). At 12-months, 87% of respondents indicated they had implemented at least some of the recommendations received and 93% said that the consultation influenced their subsequent research.

Conclusions

Data from recent annual evaluations highlight the benefits of CEAB for consulting investigators. Our model can be used to inform the development of future CEAB boards.

Active involved community partnerships: co-creating implementation infrastructure for getting to and sustaining social impact

Active involved community partnerships (AICPs) are essential to co-create implementation infrastructure and translate evidence into real-world practice. Across varied forms, AICPs cultivate community and tribal members as agents of change, blending research and organizational knowledge with relationships, context, culture, and local wisdom. Unlike selective engagement, AICPs enable active involvement of partners in the ongoing process of implementation and sustainability. This includes defining the problem, developing solutions, detecting practice changes, aligning organizational supports, and nurturing shared responsibility, accountability, and ownership for implementation. This paper builds on previously established active implementation and scaling functions by outlining key AICP functions to close the research-practice gap. Part of a federal initiative, California Partners for Permanency (CAPP) integrated AICP functions for implementation and system change to reduce disproportionality and disparities in long-term foster care. This paper outlines their experience defining and embedding five AICP functions: (1) relationship-building; (2) addressing system barriers; (3) establishing culturally relevant supports and services; (4) meaningful involvement in implementation; and (5) ongoing communication and feedback for continuous improvement. Planning for social impact requires the integration of AICP with other active implementation and scaling functions. Through concrete examples, authors bring multilevel AICP roles to life and discuss implications for implementation research and practice.

Community-based participatory research for the study of air pollution: a review of motivations, approaches, and outcomes

Neighborhood level air pollution represents a long-standing issue for many communities that, until recently, has been difficult to address due to the cost of equipment and lack of related expertise. Changes in available technology and subsequent increases in community-based participatory research (CBPR) have drastically improved the ability to address this issue. However, much still needs to be learned as these types of studies are expected to increase in the future. To assist, we review the literature in an effort to improve understanding of the motivations, approaches, and outcomes of air monitoring studies that incorporate CBPR and citizen science (CS) principles. We found that the primary motivations for conducting community-based air monitoring were concerns for air pollution health risks, residing near potential pollution sources, urban sprawl, living in "unmonitored" areas, and a general quest for improved air quality knowledge. Studies were mainly conducted using community led partnerships. Fixed site monitoring was primarily used, while mobile, personal, school-based, and occupational sampling approaches were less frequent. Low-cost sensors can enable thorough neighborhood level characterization; however, keeping the community involved at every step, understanding the limitations and benefits of this type of monitoring, recognizing potential areas of debate, and addressing study challenges are vital for achieving harmony between expected and observed study outcomes. Future directions include assessing currently unregulated pollutants, establishing long-term neighborhood monitoring sites, performing saturation studies, evaluating interventions, and creating CS databases.