Then and now: lessons learned from community- academic partnerships in environmental health research

Toward Language Justice in Environmental Health Sciences in the United States: A Case for Spanish as a Language of Science

BACKGROUND

Increasingly, marginalized communities are disproportionately facing the worsening effects of environmental hazards, including air pollution, water pollution, and climate change. Language isolation and accessibility has been understudied as a determinant of health. Spanish, despite being the second-most common language in the United States with some 41.8 million speakers, has been neglected among environmental health scientists. Building capacity in high-quality Spanish-language science communication, both for scientific and nonscientific audiences, can yield improvements in health disparities research, public health literacy, international collaborations, and diversity and inclusion efforts.

OBJECTIVES

In this article, we discuss the context of language diversity in environmental health sciences and offer recommendations for improving science communication in Spanish.

DISCUSSION

English is currently the predominant language for scientific discourse, but Spanish and other non-English languages are routinely used by many environmental health science students and professionals, as well as much of the public. To more effectively conduct and communicate environmental health work in Spanish, we suggest that researchers and scientific institutions a) foster structural changes, b) train emerging scholars and support established researchers, c) tap into community ways of knowing, and d) leverage emerging technologies. https://doi.org/10.1289/EHP12306.

Challenges and opportunities in rapid disaster research: lessons from the field in New Mexico and Vanuatu

Rapid research is essential to assess impacts in communities affected by disasters, particularly those communities made "hard-to-reach" due to their active marginalization across history and in contemporary practices. In this article, we describe two rapid research projects developed to assess needs for and experiences of communities hard-hit by disasters. The first is a project on the COVID-19 pandemic in southern New Mexico (USA) that was developed to provide information to local agencies that are deploying programs to rebuild and revitalize marginalized communities. The second is a project on population displacement due to a volcanic eruption in Vanuatu, a lower-middle income country in the South Pacific, with mental and physical health outcomes data shared with the Vanuatu Ministry of Health. We describe the similar and unique challenges that arose doing rapid research in these two different contexts, the potential broader impacts of the research, and a synthesis of lessons learned. We discuss the challenges of rapidly changing rules and regulations, lack of baseline data, lack of survey instruments validated for specific populations and in local languages, limited availability of community partners, finding funding for rapid deployment of projects, rapidly training and working with research assistants, health and safety concerns of researchers and participants, and communicating with local and international partners. We also specifically discuss how we addressed our own personal challenges while also conducting time-intensive rapid research. In both studies, researchers shared results with governmental and non-governmental partners who may use the data to inform the design of their own relief programs. While different in context, type of disaster, and research strategy, our discussion of these projects provides insights into common lessons learned for working with communities at elevated risk for the worst outcomes during disasters, such as the need for flexibility, compromise, and good working relationships with community partners.

Enhancing community participation for environmental health improvement in rural Tanzania: Evidence from Bukombe district

Community participation has become a dominant approach in environmental health-related projects, yet, its enhancement has remained a challenge. This study examines ways of enhancing community participation in environmental health-related initiatives in rural areas of Tanzania. A total of one hundred people (n = 100) were engaged in this study. An embedded case study design was employed, in which multiple methods such as household questionnaires, in-depth interviews, focus group discussions, and document analysis were used in collecting empirical data. Findings show that integration of the community into the development agenda and facilitating communities to access required equipment and tools is vital for enabling participation in environmental health-related matters. Effective and efficient leadership, mobilisation, and sensitisation of communities are operational and functioning strategies to improve environmental health through community participation, while retribution measures may prevent environmental pollution. There is a definite need for the integration of community participation as a key aspect of environmental-related projects and programs in the development policy aiming at improving the environmental health of communities.

Environmental contaminants and child development: Developmentally-informed opportunities and recommendations for integrating and informing child environmental health science

Child environmental health (CEH) science has identified numerous effects of early life exposures to common, ubiquitous environmental toxicants. CEH scientists have documented the costs not only to individual children but also to population-level health effects of such exposures. Importantly, such risks are unequally distributed in the population, with historically marginalized communities and the children living in these communities receiving the most damaging exposures. Developmental science offers a lens and set of methodologies to identify nuanced biological and behavioral processes that drive child development across physical, cognitive, and socioemotional domains. Developmental scientists are also experts in considering the multiple, hierarchically-layered contexts that shape development alongside toxicant exposure. Such contexts and the individuals acting within them make up an overarching "child serving ecosystem" spanning systems and sectors that serve children directly and indirectly. Articulating how biobehavioral mechanisms and social-ecological contexts unfold from a developmental perspective are needed in order to inform CEH translation and intervention efforts across this child-serving ecosystem. Developmentalists can also benefit from integrating CEH science findings in their work by considering the role of the physical environment, and environmental toxicants specifically, on child health and development. Building on themes that were laid out by Trentacosta and Mulligan in 2020, this commentary presents recommendations for connecting developmental and CEH science and for translating such work so that it can be used to promote child development in an equitable manner across this child-serving ecosystem. These opportunities include (1) Using Developmentally-Informed Conceptual Models; (2) Applying Creative, Sophisticated, and Rigorous Methods; (3) Integrating Developmentally-Sensitive Intervention Considerations; and (4) Establishing Interdisciplinary Collaborations and Cross-Sector Partnerships.

Self-reported oil spill exposure and birth outcomes among southern Louisiana women at the time of the Gulf oil spill: The GROWH study

BACKGROUND

The chemical, physical, economic, and social effects of a major oil spill might adversely affect pregnancy health.

OBJECTIVES

To examine the relationship between oil spill exposure and birth outcomes in a cohort of women living near the Gulf of Mexico at the time of the 2010 oil spill.

METHODS

Between 2012 and 2016, 1375 women reported their exposure to the oil spill, and at least one livebirth. Five hundred and three had births both before and after the oil spill. Indicators of oil spill exposure included self-reported financial consequences, direct contact with oil, traumatic experiences, loss of use of the coast, and involvement in litigation. Birth outcomes were low birthweight (LBW; birthweight <2500 g) and preterm birth (PTB; >3 weeks early). Women who were not pregnant at the time of the interview (n = 1001) self-reported outcomes, while women who were pregnant (n = 374) primarily had them abstracted from medical records (n = 374). All pregnancies prior to the oil spill were considered unexposed; those after the oil spill were considered exposed or unexposed depending on interview responses. Generalized estimating equations were used to control for clustering within women, with control for confounders.

RESULTS

The most common type of exposure was economic (49%), but 302 women (22.0%) reported some degree of direct contact with the oil. Associations between most indicators of oil spill exposure and pregnancy outcomes were null, although when all pregnancies were examined, associations were seen with high levels of contact with oil for LBW (adjusted Odds Ratio [aOR] 2.19, 95% CI, 1.29-3.71) and PTB (aOR 2.27, 1.34-3.87).

DISCUSSION

In this community-based cohort, we did not find associations between report of exposure to the oil spill, with the possible exception of high oil contact in some analyses, and birth outcomes. Research incorporating specific biomarkers of oil spill exposure and stress biomarkers would be valuable, to allow for assessing both perceived and actual exposure, especially when direct toxicant exposure is minimal.

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.

Using Mixed Methods to Identify the Primary Mental Health Problems and Needs of Children, Adolescents, and Their Caregivers during the Coronavirus (COVID-19) Pandemic

Our understanding of child, adolescent, and caregiver mental health (MH) problems during the coronavirus pandemic, and which interventions are needed, may be advanced by consumer input. 133 general population caregivers reported top MH problems and needs for themselves and their children (M_age = 8.21; SD = 4.94), using standardized and idiographic measures. We applied linear regression models to quantitative data and thematic analysis to qualitative data. Caregivers' COVID-era depression and anxiety symptom means fell within the clinical range, as did their children's MH symptoms. Caregiver-reported child and adolescent symptoms were positively associated with number of children in the home. Caregiver and caregiver-reported child and adolescent symptoms were more pronounced in regions with more lenient COVID-19 restrictions. Among the kinds of help most urgently needed, MH services were ranked #1 for caregivers and adolescents, #2 for 6-12 year-olds, and #3 for 1-5 year-olds. Top problems identified for each age group highlight pressing pandemic-related intervention targets.

Exploration of Psychological Well-Being, Resilience, Ethnic Identity, and Meaningful Events Among a Group of Youth in Northern England: An Autobiographical Narrative Intervention Pilot Study

Background:

Autobiographical narrative (i.e., the process through writing or storytelling where one recalls life experiences and their impact on identity) has been found to effectively help adolescents cope with a range of medical and psychological issues.

Objective. :

The current study addressed the overall preliminary research question: How does implementing an autobiographical narrative approach promote resilience, psychological well- being, and ethnic identity among adolescents? A secondary study aim was to explore how central the memories evoked by each workshop were to participant identity. The study’s third goal was to promote life skill development and self-awareness through participation in the autobiographical narrative intervention.

Methods:

The intervention incorporated a community-based participatory research (CBPR) framework in its partnership with a community centre in Northern England. The intervention consisted of an 8-week autobiographical program with youth participants from working and lower middle-class backgrounds. Socioeconomic status was operationalized by self-report on a demographic data sheet completed by participants.

Results.:

Analyses indicated that participants viewed the events discussed in the 8-week program as being more central to their lives after their participation. Maladaptive coping appeared to decrease after participation in the intervention.

Conclusion:

Results suggest interventions that incorporate an autobiographical narrative approach within a CBPR framework may promote positive outcomes among adolescents with limited economic resources.

Translational data analytics in exposure science and environmental health: a citizen science approach with high school students

BACKGROUND

Translational data analytics aims to apply data analytics principles and techniques to bring about broader societal or human impact. Translational data analytics for environmental health is an emerging discipline and the objective of this study is to describe a real-world example of this emerging discipline.

METHODS

We implemented a citizen-science project at a local high school. Multiple cohorts of citizen scientists, who were students, fabricated and deployed low-cost air quality sensors. A cloud-computing solution provided real-time air quality data for risk screening purposes, data analytics and curricular activities.

RESULTS

The citizen-science project engaged with 14 high school students over a four-year period that is continuing to this day. The project led to the development of a website that displayed sensor-based measurements in local neighborhoods and a GitHub-like repository for open source code and instructions. Preliminary results showed a reasonable comparison between sensor-based and EPA land-based federal reference monitor data for CO and NOx.

CONCLUSIONS

Initial sensor-based data collection efforts showed reasonable agreement with land-based federal reference monitors but more work needs to be done to validate these results. Lessons learned were: 1) the need for sustained funding because citizen science-based project timelines are a function of community needs/capacity and building interdisciplinary rapport in academic settings and 2) the need for a dedicated staff to manage academic-community relationships.

Broadening the Mandate of the Incident Command System to Address Community Mental and Behavioral Health Effects as Part of the Federal Response to Disasters

PURPOSE OF REVIEW

In the United States, the Federal Incident Command System (ICS) directs response to major oil spills. Its initial imperative is to prevent immediate impacts on human health and safety. Subsequently, the ICS primarily turns its attention to environmental concerns, including considering vulnerable ecosystems. There is a growing body of evidence that disasters such as major oil spills lead to adverse psychosocial effects; yet, preventing such effects has not been formally incorporated into ICS disaster mitigation considerations.

RECENT FINDINGS

Community mental and behavioral effects are increasingly recognized as a significant impact of disasters. Standardized ecosystem analytical frameworks are key to ICS responses to its mandate for environmental protection. Similar frameworks have only begun to be developed for mental and behavioral effects. Providing the ICS with a formal mandate would likely lead to the prevention of community mental and behavioral effects being more systematically incorporated into ICS disaster responses.

Making Open Science Work for Science and Society

BACKGROUND

The open science movement is transforming scientific practice with the goal of enhancing the transparency, productivity, and reproducibility of research. Nevertheless, transparency is a complex concept, and efforts to promote some forms of transparency may do relatively little to advance other important forms of transparency.

OBJECTIVES

Drawing from the literature in history, philosophy, and sociology of science, we aim to distinguish between different forms of scientific transparency. Our goal is to identify strategies for achieving forms of transparency that are relevant not only to scientists but also to decision makers and members of the public.

DISCUSSION

We draw a distinction between "scientifically relevant transparency" and "socially relevant transparency." Most of the prominent strategies associated with the open science movement (e.g., making data publicly available and registering studies) are designed primarily to promote scientifically relevant transparency. To achieve socially relevant transparency, which is particularly important in fields like environmental health, further steps are needed to provide scientific information in ways that are relevant to decision makers and members of the public.

CONCLUSIONS

Promoting socially relevant transparency will require a range of activities by many different individuals and institutions. We propose an array of strategies that can be pursued by scientists and other scholars, journals, universities, funders, government agencies, and members of the public. https://doi.org/10.1289/EHP4808.

Environmental Health Education for Asbestos-Contaminated Communities in Italy: The Casale Monferrato Case Study

BACKGROUND

Environmental health education contributes towards increasing awareness of communities to prevent exposure to hazardous substances. Casale Monferrato, the operating site for the Eternit asbestos-cement factory from 1907 to 1986, is a prioritized asbestos-contaminated site for remediation in Italy. The area is prone to severe asbestos-related diseases. About 50 cases of mesothelioma are diagnosed in Casale Monferrato annually; mesothelioma has been shown to be caused by occupational, environmental and domestic asbestos exposure.

OBJECTIVES

The goal of this paper is to analyze the Casale Monferrato case study in terms of youth engagement in environmental health education initiatives on asbestos risk and health impact. The paper aims at underlining the lessons learned in order to share the success of this initiative with other communities living in asbestos-contaminated sites in different countries.

METHODS

Peer education methodology has been used through the Asbestos Classroom to involve teachers, students and other local stakeholders in training activities, in selection of the contents for educational materials and interactive tools, as well as in choosing the presentation process for the aforementioned knowledge sharing instruments.

FINDINGS

From November 2014 to June 2018, 185 high school students and teachers were trained through the Asbestos Classroom. Through December 2018, they trained 3,241 classroom visitors. The Classroom relies on an inclusive participative process in which young people play a key role in the network of relationships within their community.

CONCLUSIONS

The paper corroborates the importance of engaging the educational system in communication efforts aimed at fostering collective awareness on environmental risk and health-related impacts for communities living in industrially contaminated sites. Considering the global dimension of the asbestos contamination and disease burden, this experience might be of relevance both in countries that banned asbestos and in those where asbestos is not yet prohibited.

Environmental Health Promotion of a Contaminated Site in Mexico

Entangled in complex ecological, sociocultural, and economic systems, current environmental health problems require integrated participatory approaches. Alpuyeca, a semi-urban, highly marginalized community in South-Central Mexico burdened by lead and polychlorinated biphenyl (PCB) contamination, dengue fever, and intestinal diseases, illustrates this. Its residents are distinctive, however, for their concerted actions in the face of environmental problems and the presence of defenders of a prehispanic worldview based on the protection of nature. This article addresses the health impacts of an integrated environmental health promotion strategy implemented through a participatory action research intervention based on qualitative and quantitative methods. Different actors, sectors, dimensions, and knowledge types were harmonized in a collaborative space created specifically for our interdisciplinary research team, community residents and local authorities. Reflections, plans and actions were developed collectively in this space with the view of finding solutions anchored in the local culture. Results included sharp reductions in blood-lead concentrations among children, in entomological indices, and in PCB contamination, as well as capacity strengthening. Medium-level community participation was achieved. This work contributes evidence that participatory environmental health research can be effective in analyzing and reducing problems in communities with multiple environmental health concerns. It complements ecohealth and environmental health literacy approaches.

Communicating environmental exposure results and health information in a community-based participatory research study

Background

Communicating results to participants is a fundamental component of community-based participatory research (CBPR). However, in environmental exposure studies this is not always practiced, partly due to ethical concerns of communicating results that have unknown clinical significance.

Methods

Growing Up Healthy was a community-based participatory research study that sought to understand the relationship between environmental exposures to phthalates and early puberty in young girls. After in-depth consultation with a Community Advisory Board, study investigators provided group summary results of phthalate exposures and related health information to the parents of study participants. Parents’ comprehension and knowledge of the health information provided was then assessed through questionnaires.

Results

After receiving the information from the research team, responders were able to correctly answer comprehension questions about phthalate exposures in their community, were able to identify ways to reduce exposure to phthalates, and indicated plans to do so. Questionnaires revealed that parents wanted more information on phthalates, and that children’s environmental health was an important concern.

Conclusions

We conclude that effective communication of exposure results of unknown clinical significance to participants in environmental health studies can be achieved by providing group summary results and actionable health information. Results suggest that there was an improvement in knowledge of environmental health and in risk reduction behaviors in our study population.

A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context

CONTEXT

Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels.

PROGRAM

This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health.

IMPLEMENTATION

The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues.

EVALUATION

The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories.

DISCUSSION

This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

The Gulf Coast Health Alliance: Health Risks Related to the Macondo Spill (GC-HARMS) Study: Self-Reported Health Effects

The Deepwater Horizon (DWH) explosion in 2010 is the largest oil spill (Macondo) in U.S. history. We focused on gaining an understanding of the physical health and mental health effects attributable to the Macondo oil spill. This is a report of a cross-sectional cohort study (wave 1) to establish ‘baseline’ findings and meant to provide descriptive information to be used for a multi-wave, longitudinal study. Gulf Coast Health Alliance: health Risks related to the Macondo Spill (GC-HARMS) uses a Community-Based Participatory Research approach, thus including multi-disciplinary, multi-institutional academic partners and representatives of three communities impacted by the spill. Three research sites were selected for human sampling along the Gulf of Mexico coast including two from Mississippi and one from Louisiana, with Galveston, Texas, serving as a comparison site, given that it was not directly impacted by the spill. One hundred participants were selected from each community, representing adults, seniors and children, with approximately equal numbers of males and females in each group. Participants completed initial assessments including completion of a ‘baseline’ survey and, rigorous physical assessments. Results from wave 1 data collection reported herein reveal changes in self-reported physical health and mental health status following the oil spill, disparities in access to healthcare, and associations between mental health and emotional conditions related to displacement/unemployment. Few environmental health studies have been conducted in communities impacted by significant oil spills. Results imply potential prolonged effects on mental health and community vulnerability.