The Truth, the Whole Truth, and Nothing but the Ground-Truth: Methods to Advance Environmental Justice and Researcher-Community Partnerships

Current practice and recommendations for advancing how human variability and susceptibility are considered in chemical risk assessment

A key element of risk assessment is accounting for the full range of variability in response to environmental exposures. Default dose-response methods typically assume a 10-fold difference in response to chemical exposures between average (healthy) and susceptible humans, despite evidence of wider variability. Experts and authoritative bodies support using advanced techniques to better account for human variability due to factors such as in utero or early life exposure and exposure to multiple environmental, social, and economic stressors.This review describes: 1) sources of human variability and susceptibility in dose-response assessment, 2) existing US frameworks for addressing response variability in risk assessment; 3) key scientific inadequacies necessitating updated methods; 4) improved approaches and opportunities for better use of science; and 5) specific and quantitative recommendations to address evidence and policy needs.Current default adjustment factors do not sufficiently capture human variability in dose-response and thus are inadequate to protect the entire population. Susceptible groups are not appropriately protected under current regulatory guidelines. Emerging tools and data sources that better account for human variability and susceptibility include probabilistic methods, genetically diverse in vivo and in vitro models, and the use of human data to capture underlying risk and/or assess combined effects from chemical and non-chemical stressors.We recommend using updated methods and data to improve consideration of human variability and susceptibility in risk assessment, including the use of increased default human variability factors and separate adjustment factors for capturing age/life stage of development and exposure to multiple chemical and non-chemical stressors. Updated methods would result in greater transparency and protection for susceptible groups, including children, infants, people who are pregnant or nursing, people with disabilities, and those burdened by additional environmental exposures and/or social factors such as poverty and racism.

A Framework for Interfacing and Partnering with Environmental Justice Communities as a Prelude to Human Health and Hazard Identification in the Vulnerable Census Tracts of Columbus, Ohio

Columbus, Ohio is one of the more prosperous, well-educated, and progressive cities in the United States. However, it ranks as the second worst life expectancy at birth, has a census tract wealth gap (27-year disparity), and one of the higher infant mortality rates in the country. These data suggest that there are likely several high-risk, vulnerable neighborhoods in Columbus with residents experiencing disparate and adverse outcomes. Illustrative of this fact are studies that have examined the social processes and mechanisms through which neighborhood contexts are at the forefront, including exposures to chemical stressors such as particulate matter (PM_2.5) as well as non-chemical stressors including violence, social determinants of health, zoning, and land use policies. It is documented that disparate and adverse outcomes are magnified in the vulnerable neighborhoods on the Near East Side as compared to Columbus city proper, Franklin County and/or the state of Ohio. As such, we developed a nuanced community engagement framework to identify potential environmental hazards associated with adverse pregnancy outcomes in those census tracts. The refined framework uses a blended version of traditional community-based participatory research (CBPR) models and is referred to as E⁶, Enhancing Environmental Endeavors via e-Equity, Education, and Empowerment.

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.

Practical Approaches for Promoting Health Equity in Communities

The Maternal and Child Health workforce, public health practitioners, researchers, and other groups need clear, practical guidance on how to promote health equity in the communities they serve. The National Maternal and Child Health Workforce Development Center’s Health Equity Team synthesized eight approaches for promoting health equity that drew on their experience working with public health practitioners and communities. The approaches are to: Expand the understanding of the drivers of health and work across sectors; Take a systems approach; Reflect on your own organization; Follow the lead of communities who experience injustices; Work with community members, decision-makers, and other stakeholders to prioritize action; Foster agency within individuals and collective action within groups; Identify and collect data to show where health inequities currently exist to inform equitable investment of resources; and Be accountable to outcomes that reflect real improvements in people’s lives. The fields of maternal and child health and public health more broadly is already engaged in the complex work of promoting equity and social justice, and in doing so, should refine, challenge, add to, and build upon these approaches.

Exploring intergroup conflict and community-based participatory research partnerships over time

Community-based participatory research (CBPR) is a growing practice by which academics and community partners conduct collaborative health-based research. While CBPR fosters productive partnerships, there is increasing research on interpersonal group dynamics and the ways that intersecting factors, such as gender and ethnicity, affect the social interactions within CBPR. This paper explores the tensions inherent in large interdisciplinary community-based participatory research partnerships, through the examination of a long-standing community–academic partnership focused on advancing public health. Nine qualitative interviews were conducted between November 2019 and January 2020 with steering committee members from a long-standing collaborative partnership that conducts research to inform public health action. While the collaborative process was generally positive, we also uncovered less pleasant aspects of CBPR projects that are infrequently discussed in the literature, such as role confusion and power dynamics. Leadership style was seen as the driving force shaping how other team concerns were perceived. Not having structures in place to facilitate relationship development, or clear documentation of procedures, rules and norms, led to team complications. Team members suggested that a renewed focus on organisational structure would contribute to role clarity and organisation. The results highlight the complexity of working on interdisciplinary mixed community–academic teams, specifically the ways in which interdisciplinary, collaborative research can be a complicated, meandering process, often without clear-cut answers to sometimes simple questions.

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.

Rethinking of Environmental Health Risks: A Systematic Approach of Physical-Social Health Vulnerability Assessment on Heavy-Metal Exposure through Soil and Vegetables

In the field of environmental health risk assessment and management research, heavy metals in soil are a constant focus, largely because of mining and metallurgical activities, and other manufacturing or producing. However, systematic vulnerability, and combined research of social and physical vulnerability of the crowd, have received less attention in the research literature of environmental health risk assessment. For this reason, tentative design modelling for comprehensive environmental health vulnerability, which includes the index of physical and social vulnerability, was conducted here. On the basis of experimental data of heavy-metal pollution in soil and vegetables, and population and societal survey data in Daye, China, the physical, social, and comprehensive environmental health vulnerabilities of the area were analyzed, with each village as an evaluation unit. First, the polluted and reference areas were selected. Random sampling sites were distributed in the farmland of the villages in these two areas, with two sampling sites per village. Then, 204 vegetable samples were directly collected from the farmland from which the soil samples had been collected, composed of seven kinds of vegetables: cowpea, water spinach, amaranth, sweet potato leaves, tomato, eggplant, and pepper. Moreover, 400 questionnaires were given to the local residents in these corresponding villages, and 389 valid responses were obtained. The results indicated that (1) the average physical vulnerability values of the population in the polluted and reference areas were 3.99 and 1.00, respectively; (2) the village of Weiwang (WW) had the highest physical vulnerability of 8.55; (3) vegetable intake is exposure that should be paid more attention, as it contributes more than 90% to physical vulnerability among the exposure pathways; (4) arsenic and cadmium should be the priority pollutants, with average physical vulnerability value contributions of 63.9% and 17.0%, respectively; (5) according to the social vulnerability assessment, the village of Luoqiao (LQ) had the highest social vulnerability (0.77); (6) for comprehensive environmental health vulnerability, five villages near mining activities and two villages far from mine-affected area had high physical and social vulnerability, and are the urgent areas for environmental risk management. In order to promote environmental risk management, it is necessary to prioritize identifying vulnerable populations in the village-scale dimension as an innovative discovery.

Revealing the racial and spatial disparity in pediatric asthma: A Kansas City case study

Black and other socially disadvantaged children are disproportionately burdened by high rates of pediatric asthma. Intraurban variation in environmental risk factors and limited access to high-resolution health data make it difficult to identify vulnerable patients, communities, or the immediate exposures that may contribute to pediatric asthma exacerbation. This article presents a novel, interdisciplinary health disparities research and intervention strategy applied to the problem of pediatric asthma in Kansas City. First, address-level electronic health records from a major children's hospital in the Kansas City region are used to map the distribution of asthma encounters in 2012 at a high spatial resolution. Census tract Environmental Justice Screening Method (EJSM) indicators are then developed to scan for patterns in both the population health risks and vulnerabilities that may contribute to the burden of asthma in different communities. A Bayesian Profile Regression cluster analysis is used to systematically explore the complex relationships between census tract EJSM indicators and pediatric asthma incidence rates, helping to identify population characteristics and risk factors associated with both high and low rates of pediatric asthma throughout the region. The EJSM scanning exercise and BPR analysis demonstrate that each community faces a distinct set of risks and vulnerabilities that can contribute to the rate of acute pediatric asthma acute care encounters, providing targets for research and intervention. It is clear, however, that different forms of social disadvantage are driving high rates of pediatric asthma, which is closely tied to uneven development patterns and racial residential segregation. The results provide a starting point for designing place-based health disparities research and intervention strategies catered to the unique needs of vulnerable patients and communities; disparities-focused research and intervention strategies that leverage local knowledge and resources through community-based practices.

Towards Smart Campus Management: Defining Information Requirements for Decision Making through Dashboard Design

At universities worldwide, the notion of a ‘smart campus’ is becoming increasingly appealing as a response to the multitude of challenges that impact campus development and operation. Smart campus tools are widely used to support students and employees, optimise space use and save energy. Although smart campus tools are supposed to support campus managers in their decision-making processes, the use of the information delivered by smart campus tools and their application in organisational processes has received little attention. In this paper, we focus on the use of dashboards in the connection of IoT information to strategic decision-making processes in the management of university campuses. To this end, we developed a briefing approach for dashboards that expresses the needs of campus management and matches the structure of decision-making processes. In two cases, dashboards based on this approach were use-tested by stakeholders for defining information requirements for IoT applications. The results suggest that users are able to use dashboards for assessing portfolio performance and determining interventions. Through iteration the usability of the dashboard is improved and information requirements are refined, resulting in a brief for a campus management dashboard. The results suggest that the briefing approach can be used to determine IoT information requirements, though further research is required to study indications and contra-indications of the proposed method.

Risk screening methods for extreme heat: Implications for equity-oriented adaptation

Morbidity and mortality impacts of extreme heat amplified by climate change will be unequally distributed among communities given pre-existing differences in socioeconomic, health, and environmental conditions. Many governments are interested in adaptation policies that target those especially vulnerable to the risks, but there are important questions about how to effectively identify and support communities most in need of heat adaptations. Here, we use an equity-oriented adaptation program from the state of California as a case study to evaluate the implications of the currently used environmental justice index (CalEnviroScreen 3.0) for the identification of socially vulnerable communities with climate change adaptation needs. As CalEnviroScreen is geared towards air and water pollution, we assess how community heat risks and adaptation needs would be evaluated differently under two more adaptation-relevant vulnerability indices: the Social Vulnerability Index and the Heat-Health Action Index. Our analysis considers communities at the census tract scale, as well as the patterns emerging at the regional scale. Using the current index, the state designates 25% of its census tracts as “disadvantaged” communities eligible for special adaptation funds. However, an additional 12.6% of the state’s communities could be considered vulnerable if the two other indices were considered instead. Only 13.4% of communities are vulnerable across all three vulnerability indices studied. Choice of vulnerability index shapes statewide trends in extreme heat risk and is linked to a community’s likelihood of receiving heat-related California Climate Investments (CCI) projects. Tracts that are vulnerable under the current pollution-focused index, but not under the heat-health specific index, received four times the number of heat-related interventions as tracts vulnerable under the reverse scenario. This study demonstrates important nuances relevant to implementing equity-oriented adaptation and explores the challenges, trade-offs, and opportunities in quantifying vulnerability.

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.

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.

Using maps to communicate environmental exposures and health risks: Review and best-practice recommendations

BACKGROUND

Graphical materials can be effective communication tools, and maps in particular are a potentially powerful means of conveying spatial information. Previous reviews have provided insights on the application of cartographic best practices, pitfalls to avoid, and considerations related to risk perception and communication, but none has reviewed primary studies of the effectiveness or utility of maps to users, nor have they addressed the issue from the perspective of health literacy, environmental health literacy, or public health ethics.

OBJECTIVES

To systematically identify and review the literature pertaining to evaluation of maps in general, or specific map features, as environmental exposure and health risk communication tools; to formulate best-practice recommendations; and to identify future research priorities.

METHODS

A health science librarian searched the literature for commentaries, reviews, and primary studies. Titles, abstracts, and full-text papers were screened for inclusion, and details of methods and results were extracted from 4 reviews and commentaries and 18 primary studies. This was supplemented by one additional review and 13 additional primary studies pertaining to use of maps for communication about wildfires and floods. One additional paper was identified by reviewing reference lists of all relevant papers.

RESULTS

and Discussion: While there are significant gaps in the evidence, we formulated best practice recommendations highlighting the perspectives of health literacy and environmental health literacy. Key recommendations include: understanding the map developer's societal role and mental model underlying map design; defining, understanding and iteratively engaging with map users; informing map design using key theoretical constructs; accounting for factors affecting risk perception; adhering to risk communication principles and cartographic best practices; and considering environmental justice and public health ethics implications. Recommendations for future research are also provided.

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.

The State of Public Health Lead Policies: Implications for Urban Health Inequities and Recommendations for Health Equity

Although lead has been removed from paint and gasoline sold in the U.S., lead exposures persist, with communities of color and residents in urban and low-income areas at greatest risk for exposure. The persistence of and inequities in lead exposures raise questions about the scope and implementation of policies that address lead as a public health concern. To understand the multi-level nature of lead policies, this paper and case study reviews lead policies at the national level, for the state of California, and for Santa Ana, CA, a dense urban city in Southern California. Through a community-academic partnership process, this analysis examines lead exposure pathways represented, the level of intervention (e.g., prevention, remediation), and whether policies address health inequities. Results indicate that most national and state policies focus on establishing hazardous lead exposure levels in settings and consumer products, disclosing lead hazards, and remediating lead paint. Several policies focus on mitigating exposures rather than primary prevention. The persistence of lead exposures indicates the need to identify sustainable solutions to prevent lead exposures in the first place. We close with recommendations to reduce lead exposures across the life course, consider multiple lead exposure pathways, and reduce and eliminate health inequities related to lead.

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California.

Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California.

Understanding social and behavioral drivers and impacts of air quality sensor use

BACKGROUND

Lower-cost air quality sensors (hundreds to thousands of dollars) are now available to individuals and communities. This technology is undergoing a rapid and fragmented evolution, resulting in sensors that have uncertain data quality, measure different air pollutants and possess a variety of design attributes. Why and how individuals and communities choose to use sensors is arguably influenced by social context. For example, community experiences with environmental exposures and health effects and related interactions with industry and government can affect trust in traditional air quality monitoring. To date, little social science research has been conducted to evaluate why or how sensors, and sensor data, are used by individuals and communities, or how the introduction of sensors changes the relationship between communities and air quality managers.

OBJECTIVES

This commentary uses a risk governance/responsible innovation framework to identify opportunities for interdisciplinary research that brings together social scientists with air quality researchers involved in developing, testing, and deploying sensors in communities.

DISCUSSION

Potential areas for social science research include communities of sensor users; drivers for use of sensors and sensor data; behavioral, socio-political, and ethical implications of introducing sensors into communities; assessing methods for communicating sensor data; and harnessing crowdsourcing capabilities to analyze sensor data.

CONCLUSIONS

Social sciences can enhance understanding of perceptions, attitudes, behaviors, and other human factors that drive levels of engagement with and trust in different types of air quality data. New transdisciplinary research bridging social sciences, natural sciences, engineering, and design fields of study, and involving citizen scientists working with professionals from a variety of backgrounds, can increase our understanding of air sensor technology use and its impacts on air quality and public health.

Assessing health risks from multiple environmental stressors: Moving from G×E to I×E

Research on disease causation often attempts to isolate the effects of individual factors, including individual genes or environmental factors. This reductionist approach has generated many discoveries, but misses important interactive and cumulative effects that may help explain the broad range of variability in disease occurrence observed across studies and individuals. A disease rarely results from a single factor, and instead results from a broader combination of factors, characterized here as intrinsic (I) and extrinsic (E) factors. Intrinsic vulnerability or resilience emanates from a variety of both fixed and shifting biological factors including genetic traits, while extrinsic factors comprise all biologically-relevant external stressors encountered across the lifespan. The I×E concept incorporates the multi-factorial and dynamic nature of health and disease and provides a unified, conceptual basis for integrating results from multiple areas of research, including genomics, G×E, developmental origins of health and disease, and the exposome. We describe the utility of the I×E concept to better understand and characterize the cumulative impact of multiple extrinsic and intrinsic factors on individual and population health. New research methods increasingly facilitate the measurement of multifactorial and interactive effects in epidemiological and toxicological studies. Tiered or indicator-based approaches can guide the selection of potentially relevant I and E factors for study and quantification, and exposomics methods may eventually produce results that can be used to generate a response function over the life course. Quantitative data on I×E interactive effects should generate a better understanding of the variability in human response to environmental factors. The proposed I×E concept highlights the role for broader study design in order to identify extrinsic and intrinsic factors amenable to interventions at the individual and population levels in order to enhance resilience, reduce vulnerability and improve health.

HIV in Japan: Epidemiologic puzzles and ethnographic explanations

Japan is widely perceived to have a low level of HIV occurrence; however, its HIV epidemics also have been the subject of considerable misunderstanding globally. I used a ground truthing conceptual framework to meet two aims: first, to determine how accurately official surveillance data represented Japan's two largest epidemics (urban Kansai and Tokyo) as understood and experienced on the ground; and second, to identify explanations for why the HIV epidemics were unfolding as officially reported. I used primarily ethnographic methods while drawing upon epidemiology, and compared government surveillance data to observations at community and institutional sites (459 pages of field notes; 175 persons observed), qualitative interviews with stakeholders in local HIV epidemics (n = 32), and document research (n = 116). This revealed seven epidemiologic puzzles involving officially reported trends and conspicuously missing information. Ethnographically grounded explanations are presented for each. These included factors driving the epidemics, which ranged from waning government and public attention to HIV, to gaps in sex education and disruptive leadership changes in public institutions approximately every two years. Factors constraining the epidemics also contributed to explanations. These ranged from subsidized medical treatment for most people living with HIV, to strong partnerships between government and a well-developed, non-governmental sector of HIV interventionists, and protective norms and built environments in the sex industry. Local and regional HIV epidemics were experienced and understood as worse than government reports indicated, and ground-level data often contradicted official knowledge. Results thus call into question epidemiologic trends, including recent stabilization of the national epidemic, and suggest the need for revisions to the surveillance system and strategies that address factors driving and constraining the epidemics. Based upon its utility in the current study, ground truthing has value as a conceptual framework for research and shows promise for future theoretical development.

Improving Latino Youths' Environmental Health Literacy and Leadership Skills Through Participatory Research on Chemical Exposures in Cosmetics: The HERMOSA Study

To increase environmental health literacy (EHL) and leadership skills in Latino youth in Salinas, CA., we worked from 2012-2015 with 15 members of the CHAMACOS Youth Community Council (YCC), an outreach arm of a longitudinal study of impacts of environmental chemicals on children's health. The YCC program provided hands-on research experiences related to Endocrine Disrupting Chemicals (EDCs) in cosmetics and their possible health effects. We use participatory research principles and Bloom's Taxonomy of Educational Objectives to describe the development of EHC and leadership in the youth co-researchers. Using data from multiple qualitative sources, we explore the youths' engagement in a wide range of research and action processes. Promising outcomes, including perceptions of improved youth self-esteem, EHL, leadership, and career orientation are discussed, as are challenges, such as time constraints and high priority youth concerns not addressed by the study. Implications for other youth-engaged participatory science and leadership programs are presented.

Cumulative Environmental Impacts: Science and Policy to Protect Communities

Many communities are located near multiple sources of pollution, including current and former industrial sites, major roadways, and agricultural operations. Populations in such locations are predominantly low-income, with a large percentage of minorities and non-English speakers. These communities face challenges that can affect the health of their residents, including limited access to health care, a shortage of grocery stores, poor housing quality, and a lack of parks and open spaces. Environmental exposures may interact with social stressors, thereby worsening health outcomes. Age, genetic characteristics, and preexisting health conditions increase the risk of adverse health effects from exposure to pollutants. There are existing approaches for characterizing cumulative exposures, cumulative risks, and cumulative health impacts. Although such approaches have merit, they also have significant constraints. New developments in exposure monitoring, mapping, toxicology, and epidemiology, especially when informed by community participation, have the potential to advance the science on cumulative impacts and to improve decision making.

Youth Participatory Action Research (YPAR) 2.0: how technological innovation and digital organizing sparked a food revolution in East Oakland

This article argues that technological innovation is transforming the flow of information, the fluidity of social action, and is giving birth to new forms of bottom up innovation that are capable of expanding and exploding old theories of reproduction and resistance because 'smart mobs', 'street knowledge', and 'social movements' cannot be neutralized by powerful structural forces in the same old ways. The purpose of this article is to develop the concept of YPAR 2.0 in which new technologies enable young people to visualize, validate, and transform social inequalities by using local knowledge in innovative ways that deepen civic engagement, democratize data, expand educational opportunity, inform policy, and mobilize community assets. Specifically this article documents how digital technology (including a mobile, mapping and SMS platform called Streetwyze and paper-mapping tool Local Ground) - coupled with 'ground-truthing' - an approach in which community members work with researchers to collect and verify 'public' data - sparked a food revolution in East Oakland that led to an increase in young people's self-esteem, environmental stewardship, academic engagement, and positioned urban youth to become community leaders and community builders who are connected and committed to health and well-being of their neighborhoods. This article provides an overview of how the YPAR 2.0 Model was developed along with recommendations and implications for future research and collaborations between youth, teachers, neighborhood leaders, and youth serving organizations.

Ground-Truthing Validation to Assess the Effect of Facility Locational Error on Cumulative Impacts Screening Tools

Researchers and government regulators have developed numerous tools to screen areas and populations for cumulative impacts and vulnerability to environmental hazards and risk. These tools all rely on secondary data maintained by government agencies as part of the regulatory and permitting process. Stakeholders interested in cumulative impacts screening results have consistently questioned the accuracy and completeness of some of these datasets. In this study, three cumulative impacts screening tools used in California were compared, and ground-truth validation was used to determine the effect database inaccuracy. Ground-truthing showed substantial locational inaccuracy and error in hazardous facility databases and statewide air toxics emission inventories of up to 10 kilometers. These errors resulted in significant differences in cumulative impact screening scores generated by one screening tool, the Environmental Justice Screening Method.

Park Density Impacts Weight Change in a Behavioral Intervention for Overweight Rural Youth

Currently, over 30% of youth are overweight or obese. Limited access to parks and recreational facilities is related to physical inactivity and obesity. Environmental factors may also impact the effectiveness of pediatric weight management interventions. Most research concerning the built environment and child weight status has been conducted in urban settings, despite rural children being disproportionately overweight and obese compared to their urban peers. The current study examined the relationship between park density and weight change among 93 overweight rural youth (ages 8-14) participating in a randomized controlled trial examining the effectiveness of a behavioral family weight management intervention. Results revealed that increased park density was associated with decreases in BMI z-score over time for youth in the behavioral family weight management intervention, but not those in the wait-list control group. In rural communities it is important to consider the environmental context when designing prevention and treatment programs addressing childhood obesity.