Strengthening community capacity to participate in making decisions to reduce disproportionate environmental exposures

Promotion of environmental public health and environmental justice in communities affected by large and long lasting industrial contamination: methods applied and lessons learned from the case study of Porto Torres (Italy)

Introduction

Communities affected by large scale and long lasting industrial contamination are often keen to understand whether their health has been impaired by such contamination. This requires answers that integrate environmental public health and environmental justice perspectives. At these sites, exposure scenarios from environmental contamination over time by multiple chemicals, often involving different environmental matrices, are complex and challenging to reconstruct.

Methods

An approach for describing the health of such communities in association with environmental contamination is presented, with the methods applied across the three domains of environmental contamination, population exposure and toxicology, environmental and social epidemiology, and environmental public health communication. The approach is described with examples from its application to the case study of Porto Torres, a town with a substantial industrially conditioned evolution.

Results

Activities in the field of environmental contamination, population exposure and toxicology focus on the collection and systematization of available contamination data, the identification of priority pollutants based on their toxicological profiles, the qualitative assessment of the likelihood of exposure for the population to priority pollutants and their known health effects. Environmental and social epidemiology methods are applied to describe the health profiles and socioeconomic conditions of the local population, taking into account multiple health outcomes from local information systems and considering specific diseases based on exposure and toxicological assessments. The environmental public health communication methods are directed to produce a communication plan and for its implementation through interaction with local institutional and social actors. The interpretation of health profiles benefits from a transdisciplinary analysis of the results.

Discussion

The proposed approach combines the needs of environmental public health and environmental justice allowing the integration of multidisciplinary knowledge to define recommendations for reducing and/or preventing hazardous environmental exposures and adverse health effects, stimulating the interactions between stakeholders, and making the study results more accessible to citizens.

Leptospirosis and the Environment: A Review and Future Directions

Leptospirosis is a zoonotic disease of global importance with significant morbidity and mortality. However, the disease is frequently overlooked and underdiagnosed, leading to uncertainty of the true scale and severity of the disease. A neglected tropical disease, leptospirosis disproportionately impacts disadvantaged socioeconomic communities most vulnerable to outbreaks of zoonotic disease, due to contact with infectious animals and contaminated soils and waters. With growing evidence that Leptospira survives, persists, and reproduces in the environment, this paper reviews the current understanding of the pathogen in the environment and highlights the unknowns that are most important for future study. Through a systematic Boolean review of the literature, our study finds that detailed field-based study of Leptospira prevalence, survival, and transmission in natural waters and soils is lacking from the current literature. This review identified a strong need for assessment of physical characteristics and biogeochemical processes that support long-term viability of Leptospira in the environment followed by epidemiological assessment of the transmission and movement of the same strains of Leptospira in the present wildlife and livestock as the first steps in improving our understanding of the environmental stage of the leptospirosis transmission cycle.

Oral histories document community mobilisation to participate in decision-making regarding a hazardous waste thermal treatment facility

Colfax, Louisiana hosts a commercial hazardous waste thermal treatment (TT) facility, which treats fireworks, explosives, and military ordnances by open-burn/open-detonation one mile from the edge of the nearest community. Seventy-one percent of Colfax's residents are Black, and forty-six percent live below poverty, indicating the community's structural vulnerability. This community-based study originated at the behest of Colfax community members. We hypothesized that the close relationships among members of this enclave may have enhanced the community's ability to mobilize in opposition to the TT facility. We conducted semi-structured oral history interviews with nineteen community members and examined the social and interorganizational networks used by the Colfax community to claim its role in decision-making regarding the TT facility after years of exclusion from this process. Interview transcripts were analyzed through the lens of community capacity theory to gain insight into how interactions among community members about the environmental hazards led to social mobilization and improved participation in the decision-making process using codes for communication, organization, and outcome. Additionally, we reviewed Louisiana Department of Environmental Quality records for complaints about the facility to gauge public participation. One notable theme across several interviews was exclusion from the initial decision-making process related to the facility. However, interviewees noted a sustained effort was made among community members to educate themselves about the facility, organize a response through neighbor-to-neighbor contact, and take action by submitting formal complaints and participating in public hearings. Through the lens of environmental justice, this study illustrates an evolving condition of procedural justice.

"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.

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.

Exploring prospects of deliberation in intractable natural resource management conflicts

Deliberative processes are increasingly advocated as means to handle intractable natural resource management (NRM) conflicts. Research shows that disputing actors can deliberate and achieve higher degrees of mutual understanding and working agreements under ideal conditions, but the transferability of these findings to real-world intractable NRM conflicts can be questioned. This paper explores the possibilities of designing and realizing deliberation and its expected outcomes in real-world NRM conflicts. We used recommended design principles to set up deliberative processes in two intractable mining conflicts involving indigenous peoples in Northern Sweden and assessed the actors' communication and outcomes using frame analysis. The results show that the recommended design principles are hard, but not impossible, to fully implement in intractable NRM conflicts. Both conflicts proved difficult to deliberate and resolve in the sense of reaching agreements. However, the findings suggest that deliberation, as well as meta-consensus, or structured disagreement, is possible to achieve in settings with favorable conditions, e.g. good and established inter-group relations prior to the conflict. In the absence of these conditions, where relations were hostile and shaped by historical and institutional injustices, deliberation was not achieved. In both cases, polarization among the participants remained, or increased, in spite of the deliberative activities. The study highlights the importance of understanding deliberation as embedded in place specific historical and institutional contexts which shape both process and outcomes in powerful ways. More efforts should focus on alternative, or complementary, ways to handle intractable NRM conflicts, including how contested experiences of history, institutions and Indigenous rights can be addressed.

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.

Structural and social determinants of inequities in violence risk: A review of indicators

There is disproportionate risk for violence conditioned on inequities due to race, socioeconomic status, gender, and where people live. Consequently, some communities are more vulnerable to violence and its repercussions than other communities. This study aims to share indicators that might be useful for violence prevention researchers interested in measuring structural or social determinants that position communities for differential risk of experiencing violence. An existing database of indicators identified in a previous review was reassessed for measures of factors that shape community structures and conditions, which place people at risk for violence. Indicators of 86 community constructs are reported. These indicators may help to advance the field by offering innovative metrics that can be used to investigate further the structural and social determinants that serve as root causes of inequities in violence risk.

Environmental Engineering for the 21st Century: Increasing Diversity and Community Participation to Achieve Environmental and Social Justice

Communities of color are disproportionately burdened by environmental pollution and by obstacles to influence policies that impact environmental health. Black, Hispanic, and Native American students and faculty are also largely underrepresented in environmental engineering programs in the United States. Nearly 80 participants of a workshop at the 2019 Association of Environmental Engineering and Science Professors (AEESP) Research and Education Conference developed recommendations for reversing these trends. Workshop participants identified factors for success in academia, which included adopting a broader definition for the impact of research and teaching. Participants also supported the use of community-based participatory research and classroom action research methods in engineering programs for recruiting, retaining, and supporting the transition of underrepresented students into professional and academic careers. However, institutions must also evolve to recognize the academic value of community-based work to enable faculty, especially underrepresented minority faculty, who use it effectively, to succeed in tenure promotions. Workshop discussions elucidated potential causal relationships between factors that influence the co-creation of research related to academic skills, community skills, mutual trust, and shared knowledge. Based on the discussions from this workshop, we propose a pathway for increasing diversity and community participation in the environmental engineering discipline by exposing students to community-based participatory methods, establishing action research groups for faculty, broadening the definition of research impact to improve tenure promotion experiences for minority faculty, and using a mixed methods approach to evaluate its impact.

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.

Evidence-Informed strategies for promoting equitability in brownfields redevelopment

Brownfields redevelopment creates opportunities for enhanced environmental conditions, improved physical and mental health, community cohesion, and economic prosperity. However, brownfields cleanup and recycling projects sometimes fail due to a lack of community engagement. Recent research suggests that such failures can stem from a lack of equitability in the planning process, especially when it comes to decision making. This paper examines issues of equitability in a recent brownfields redevelopment project in Tampa, Florida funded by the U.S. Environmental Protection Agency. The project focused on an underserved and under-resourced community with long-term environmental burdens and health disparities. Our ethnographic research shows that, while the project engaged in multiple and intersecting efforts to include a diversity of community voices in the decision-making process, ultimately structural and organizational power imbalances in sustainability transitions influenced participation in redevelopment initiatives. This study suggests that attending to issues of power articulated through expressions of local and authoritative knowledge about environmental cleanup and redevelopment can lead to deeper levels of community engagement.

The Washington State Environmental Health Disparities Map: Development of a Community-Responsive Cumulative Impacts Assessment Tool

Communities across Washington State have expressed the need for neighborhood-level information on the cumulative impact of environmental hazards and social conditions to illuminate disparities and address environmental justice issues. Many existing mapping tools have not explicitly integrated community voice and lived experience as an integral part of their development. The goals of this project were to create a new community–academic–government partnership to collect and summarize community concerns and to develop a publicly available mapping tool that ranks relative environmental health disparities for populations across Washington State. Using a community-driven framework, we developed the Washington Environmental Health Disparities Map, a cumulative environmental health impacts assessment tool. Nineteen regularly updated environmental and population indicators were integrated into the geospatial tool that allows for comparisons of the cumulative impacts between census tracts. This interactive map provides critical information for the public, agencies, policymakers, and community-based organizations to make informed decisions. The unique community–academic–government partnership and the community-driven framework can be used as a template for other environmental and social justice mapping endeavors.

Green Infrastructure Solutions to Health Impacts of Climate Change: Perspectives of Affected Residents in Detroit, Michigan, USA

Cities worldwide are incorporating green infrastructure to mitigate climate change and achieve health cobenefits. However, green infrastructure projects are often distributed inequitably based on race and class. Residents’ perspectives are necessary to develop and enact effective and equitable ‘green’ strategies to address climate change and its health impacts. This study reports findings from interviews and ethnographic observations with diverse residents of Detroit, Michigan, USA, who have experience with both green infrastructure projects and intense weather events (flooding). Residents expressed widespread support for green infrastructure solutions, while also sharing concerns about unintended health consequences from unsatisfactory governance of green spaces and climate change itself. Residents also held differing perspectives regarding their responsibility for, and capacity to enact, these solutions compared to businesses, city government, and nonprofit organizations. These findings illuminate key factors that city governments and partnering institutions should incorporate into planning processes with residents to achieve greater environmental justice through green infrastructure strategies to mitigate climate change and related health impacts.

Implications of the GC-HARMS Fishermen's Citizen Science Network: Issues Raised, Lessons Learned, and Next Steps for the Network and Citizen Science

This paper is intended to complement our extended documentation and analysis of the activities of the Gulf Coast Health Alliance: Health Risks related to the Macondo Spill project Community Outreach and Dissemination Core entitled, "Building and maintaining a citizen science network with fishermen and fishing communities after the Deepwater Horizon oil disaster using a Community-Based Participatory Research (CBPR) approach." We discuss nuances of CBPR practice, including trust-building, clarification of stakeholder expectations, balancing timelines and agendas, cultural fluency, and the importance of regional history-political-economic context, regulatory practices, and cultural life-ways-in creating social dynamics that overarch and underpin the entire process. We examine the unique role of knowledge-making hybrid structures like the project's Fishermen's citizen science network and compare/contrast this structure with other models of participatory science or deliberation. Finally, we reiterate the importance of environmental health literacy efforts, summarize project outcomes, and offer thoughts on the future roles of collaborative efforts among communities and institutional science in environmental public health.

Mapping the Hidden Hazards: Community-Led Spatial Data Collection of Street-Level Environmental Stressors in a Degraded, Urban Watershed

We utilized a participatory mapping approach to collect point locations, photographs, and descriptive data about select built environment stressors identified and prioritized by community residents living in the Proctor Creek Watershed, a degraded, urban watershed in Northwest Atlanta, Georgia. Residents (watershed researchers) used an indicator identification framework to select three watershed stressors that influence urban livability: standing water, illegal dumping on land and in surface water, and faulty stormwater infrastructure. Through a community⁻university partnership and using Geographic Information Systems and digital mapping tools, watershed researchers and university students designed a mobile application (app) that enabled them to collect data associated with these stressors to create a spatial narrative, informed by local community knowledge, that offers visual documentation and representation of community conditions that negatively influence the environment, health, and quality of life in urban areas. By elevating the local knowledge and lived experience of community residents and codeveloping a relevant data collection tool, community residents generated fine-grained, street-level, actionable data. This process helped to fill gaps in publicly available datasets about environmental hazards in their watershed and helped residents initiate solution-oriented dialogue with government officials to address problem areas. We demonstrate that community-based knowledge can contribute to and extend scientific inquiry, as well as help communities to advance environmental justice and leverage opportunities for remediation and policy change.

From Content Knowledge to Community Change: A Review of Representations of Environmental Health Literacy

Environmental health literacy (EHL) is a relatively new framework for conceptualizing how people understand and use information about potentially harmful environmental exposures and their influence on health. As such, information on the characterization and measurement of EHL is limited. This review provides an overview of EHL as presented in peer-reviewed literature and aggregates studies based on whether they represent individual level EHL or community level EHL or both. A range of assessment tools has been used to measure EHL, with many studies relying on pre-/post-assessment; however, a broader suite of assessment tools may be needed to capture community-wide outcomes. This review also suggests that the definition of EHL should explicitly include community change or collective action as an important longer-term outcome and proposes a refinement of previous representations of EHL as a theoretical framework, to include self-efficacy.

Cognitive-Motivational Determinants of Residents' Civic Engagement and Health (Inequities) in the Context of Noise Action Planning: A Conceptual Model

The Environmental Noise Directive expects residents to be actively involved in localising and selecting noise abatement interventions during the noise action planning process. Its intervention impact is meant to be homogeneous across population groups. Against the background of social heterogeneity and environmental disparities, however, the impact of noise action planning on exposure to traffic-related noise and its health effects is unlikely to follow homogenous distributions. Until now, there has been no study evaluating the impact of noise action measures on the social distribution of traffic-related noise exposure and health outcomes. We develop a conceptual (logic) model on cognitive-motivational determinants of residents’ civic engagement and health (inequities) by integrating arguments from the Model on household’s Vulnerability to the local Environment, the learned helplessness model in environmental psychology, the Cognitive Activation Theory of Stress, and the reserve capacity model. Specifically, we derive four hypothetical patterns of cognitive-motivational determinants yielding different levels of sustained physiological activation and expectancies of civic engagement. These patterns may help us understand why health inequities arise in the context of noise action planning and learn how to transform noise action planning into an instrument conducive to health equity. While building on existing frameworks, our conceptual model will be tested empirically in the next stage of our research process.

How can health systems research reach the worst-off? A conceptual exploration

BACKGROUND

Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined.

METHODS AND RESULTS

By applying existing work on disadvantage from political philosophy, the paper demonstrates that (at least) two options exist for how to define the worst-off upon whom equity-oriented health systems research should focus: those who are worst-off in terms of health or those who are systematically disadvantaged. The paper describes in detail how both concepts can be understood and what metrics can be relied upon to identify worst-off countries and research populations at the sub-national level (groups, communities). To demonstrate how each can be used, the paper considers two real-world cases of health systems research and whether their choice of country (Uganda, India) and research population in 2011 would have been classified as amongst the worst-off according to the proposed concepts.

CONCLUSIONS

The two proposed concepts can classify different countries and sub-national populations as worst-off. It is recommended that health researchers (or other actors) should use the concept that best reflects their moral commitments-namely, to perform research focused on reducing health inequalities or systematic disadvantage more broadly. If addressing the latter, it is recommended that they rely on the multidimensional poverty approach rather than the income approach to identify worst-off populations.

Housing code violation density associated with emergency department and hospital use by children with asthma

Local agencies that enforce housing policies can partner with the health care system to target pediatric asthma care. These agencies retain data that can be used to pinpoint potential clusters of high asthma morbidity. We sought to assess whether the density of housing code violations in census tracts-the in-tract asthma-relevant violations (such as the presence of mold or cockroaches) divided by the number of housing units-was associated with population-level asthma morbidity and could be used to predict a hospitalized patient's risk of subsequent morbidity. We found that increased density in housing code violations was associated with population-level morbidity independent of poverty, and that the density explained 22 percent of the variation in rates of asthma-related emergency department visits and hospitalizations. Children who had been hospitalized for asthma had 1.84 greater odds of a revisit to the emergency department or a rehospitalization within twelve months if they lived in the highest quartile of housing code violation tracts, compared to those living in the lowest quartile. Integrating housing and health data could highlight at-risk areas and patients for targeted interventions.

Multidirectional Translation of Environmental Health Science in Community Settings: The Case of Oxidative Stress Pathways

BACKGROUND

Translation of environmental health science in vulnerable communities is particularly important to promote public health and reduce health inequities.

METHODS

We describe a structured, multidirectional process used to develop a suite of health promotion tools (e.g., fact sheets, video, maps) documenting patterning of local air pollution sources and availability of antioxidant-rich foods in Detroit, Michigan as factors that jointly affect oxidative stress (OS). OS underlies many pathological processes associated with air pollution, including asthma, metabolic syndrome, cancer, diabetes, and obesity. This translational effort involved a 2-year dialogue among representatives from community-based and environmental organizations, health service providers, and academic researchers.

RESULTS

This dialogue led to development of tools, as well as new opportunities to inform related policies and research.

CONCLUSIONS

Through this example, we highlight how collaborative partnerships can enhance multidirectional dialogue to inform translation of environmental health science by promoting consideration of multilevel risk factors, local priorities and context, and diverse audiences.

Village Voices: Lessons about Processes for Disease Prevention from a Qualitative Study of Family Health Leaders in a Community in Northeastern Thailand

BACKGROUND

Cancer is a primary source of concern in Thailand and other countries around the world, including the Asian-Pacific region. Evidence supports that an important contributing cause of cancer and other chronic illnesses such as stroke, diabetes, and hypertension is excessive alcohol consumption. Studies conducted in Thailand reveal a worrisome rise in the number of new and regular drinkers in communities. Therefore, actions for primary, secondary and tertiary prevention of problem drinking are necessary. In recent years nurses in North East Thailand have been developing and implementing the Khon Kaen Family Health Nursing model to embed disease prevention in communities through the actions of family health nurses and local family health leaders.

AIM

The aim of this qualitative research was to better understand the experiences of the local family health leaders using this model and to synthesize lessons learned.

MATERIALS AND METHODS

As part of a participatory action research approach involving analysis of focus group discussions and individual interviews, the experiences of 45 family health leaders were synthesized.

RESULTS

Four main themes were identified, namely: i) Family first: role modeling beginning at the personal and family level. ii) Local leverage: using village community forums to reduce alcohol drinking. iii) Gentle growth: making the first step and treading gently; and iv) Respect, Redemption, Rehabilitation: valuing the person to re-integrate them in the village society.

CONCLUSIONS

As alcohol consumption in the village declined significantly following the prevention program, these findings illuminate how low-tech integrated prevention approaches may be very useful, particularly in rural communities. The lessons learned may have relevance not only in Thailand but in other countries seeking to prevent and mitigate behavior that conduces to diseases such as cancer.

Assessing Feasibility and Readiness to Address Obesity through Policy in American Indian Reservations

The Institute of Medicine and Centers for Disease Control and Prevention (CDC) have identified policy and environmental strategies as critical to the prevention and control of obesity. However such strategies are rare in American Indian communities despite significant obesity-related disparities. Tribal policymaking processes differ by tribal nation and are often poorly understood by researchers and public health practitioners, hindering the dissemination, implementation, and successful scale-up of evidence-base obesity strategies in tribal communities. To address these gaps in knowledge we surveyed 138 diverse stakeholders in two American Indian reservations to assess the feasibility of and readiness to implement CDC-recommended obesity policy strategies within their communities. We assessed general community readiness to address obesity using 18 questions from the Community Readiness Handbook. Means and standard deviations were evaluated and scores ranged from 1 (no readiness) to 9 (high readiness). We then assessed stakeholder attitudes regarding the feasibility of implementing specific strategies given tribal culture, infrastructure, leadership, and funding support. Average scores were calculated and mean values ranked from highest (best strategy) to lowest. Despite significant differences in their geographic and sociodemographic characteristics, both communities identified increasing the availability of healthy foods in tribal venues as the most feasible strategy and scored in the "preplanning" readiness stage. The survey design, implementation process, and findings generated significant community interest and discussion. Health planners in one of the communities used the survey findings to provide tribal decision-makers with measurable information to prioritize appropriate strategies for implementation.

Engaging Communities in Research on Cumulative Risk and Social Stress-Environment Interactions: Lessons Learned from EPA's STAR Program

Studies have documented cumulative health effects of chemical and nonchemical exposures, particularly chronic environmental and social stressors. Environmental justice groups have advocated for community participation in research that assesses how these interactions contribute to health disparities experienced by low-income and communities of color. In 2009, the U.S. Environmental Protection Agency issued a request for research applications (RFA), "Understanding the Role of Nonchemical Stressors and Developing Analytic Methods for Cumulative Risk Assessments." Seven research projects were funded to help address this knowledge gap. Each engaged with communities in different ways. We describe the community engagement approaches of the seven research projects, which ranged from outreach through shared leadership/participatory. We then assess the experiences of these programs with respect to the community engagement goals of the RFA. We present insights from these community engagement efforts, including how the grants helped to build or enhance the capacity of community organizations in addition to contributing to the research projects. Our analysis of project proposals, annual grantee reports, and participant observation of these seven projects suggests guidelines for the development of future funding mechanisms and for conducting community-engaged research on cumulative risk involving environmental and social stressors including: 1) providing for flexibility in the mode of community engagement; 2) addressing conflict between research timing and engagement needs, 3) developing approaches for communicating about the uniquely sensitive issues of nonchemical stressors and social risks; and 4) encouraging the evaluation of community engagement efforts.

Polycyclic aromatic hydrocarbons, brachial artery distensibility and blood pressure among children residing near an oil refinery

BACKGROUND

Polycyclic aromatic hydrocarbons (PAH) are produced by the burning and processing of fuel oils, and have been associated with oxidant stress, insulin resistance and hypertension in adults. Few studies have examined whether adolescents are susceptible to cardiovascular effects of PAHs.

OBJECTIVE

To study associations of PAH exposure with blood pressure (BP) and brachial artery distensibility (BAD), an early marker of arterial wall stiffness, in young boys attending three schools in Jeddah, Saudi Arabia in varying proximity to an oil refinery.

METHODS

Air samples collected from the three schools were analyzed for PAHs. PAH metabolites (total hydroxyphenanthrenes and 1-hydroxypyrene) were measured in urine samples from 184 adolescent males, in whom anthropometrics, heart rate, pulse pressure, brachial artery distensibility and blood pressure were measured. Descriptive, bivariate and multivariable analyses were performed to assess relationships of school location and urinary PAH metabolites with cardiovascular measures.

RESULTS

Total suspended matter was significantly higher (444 ± 143 μg/m(3)) at the school near the refinery compared to a school located near a ring road (395 ± 65 μg/m(3)) and a school located away from vehicle traffic (232 ± 137 μg/m(3)), as were PAHs. Systolic (0.47 S D units, p = 0.006) and diastolic (0.53 SD units, p < 0.001) BP Z-scores were highest at the school near the refinery, with a 4.36-fold increase in prehypertension (p = 0.001), controlling for confounders. No differences in pulse pressure, BAD and heart rate were noted in relationship to school location. Urinary total hydroxyphenanthrenes and 1-hydroxypyrene were not associated with cardiovascular outcomes.

CONCLUSIONS

Proximity to an oil refinery in Saudi Arabia is associated with prehypertension and increases in PAH and particulate matter exposures. Further study including insulin resistance measurements, better control for confounding, and longitudinal measurement is indicated.

Comparing disproportionate exposure to acute and chronic pollution risks: a case study in Houston, Texas

While environmental justice (EJ) research in the United States has focused primarily on the social distribution of chronic pollution risks, previous empirical studies have not analyzed disparities in exposure to both chronic (long-term) and acute (short-term) pollution in the same study area. Our article addresses this limitation though a case study that compares social inequities in exposure to chronic and acute pollution risks in the Greater Houston Metropolitan Statistical Area, Texas. The study integrates estimates of chronic cancer risk associated with ambient exposure to hazardous air pollutants from the Environmental Protection Agency's National-Scale Air Toxics Assessment (2005), hazardous chemical accidents from the National Response Center's Emergency Response Notification System (2007-2011), and sociodemographic characteristics from the American Community Survey (2007-2011). Statistical analyses are based on descriptive comparisons, bivariate correlations, and locally derived spatial regression models that account for spatial dependence in the data. Results indicate that neighborhoods with a higher percentage of Hispanic residents, lower percentage of homeowners, and higher income inequality are facing significantly greater exposure to both chronic and acute pollution risks. The non-Hispanic black percentage is significantly higher in neighborhoods with greater chronic cancer risk, but lower in areas exposed to acute pollution events. Households isolated by language--those highly likely to face evacuation problems during an actual chemical disaster--tend to reside in areas facing significantly greater exposure to high-impact acute events. Our findings emphasize the growing need to examine social inequities in exposure to both chronic and acute pollution risks in future EJ research and policy.

Investigating the role of state permitting and agriculture agencies in addressing public health concerns related to industrial food animal production

Objectives

Industrial food animal production (IFAP) operations adversely impact environmental public health through air, water, and soil contamination. We sought to determine how state permitting and agriculture agencies respond to these public health concerns.

Methods

We conducted semi-structured qualitative interviews with staff at 12 state agencies in seven states, which were chosen based on high numbers or rapid increase of IFAP operations. The interviews served to gather information regarding agency involvement in regulating IFAP operations, the frequency and type of contacts received about public health concerns, how the agency responds to such contacts, and barriers to additional involvement.

Results

Permitting and agriculture agencies’ responses to health-based IFAP concerns are constrained by significant barriers including narrow regulations, a lack of public health expertise within the agencies, and limited resources.

Conclusions

State agencies with jurisdiction over IFAP operations are unable to adequately address relevant public health concerns due to multiple factors. Combining these results with previously published findings on barriers facing local and state health departments in the same states reveals significant gaps between these agencies regarding public health and IFAP. There is a clear need for regulations to protect public health and for public health professionals to provide complementary expertise to agencies responsible for regulating IFAP operations.

Exploring the distribution of park availability, features, and quality across Kansas City, Missouri by income and race/ethnicity: an environmental justice investigation

BACKGROUND

Parks are key community assets for physical activity, but some evidence suggests these resources are not equitably distributed.

PURPOSE

This study examined disparities by income and race/ethnicity in the availability, features, and quality of parks across Kansas City, Missouri.

METHODS

All parks and census tracts (CTs) were mapped using geographical information systems, and park features and quality were determined via audits. Multivariate analyses of covariance analyzed differences in park availability, features, and quality across low-, medium-, and high-income and race/ethnicity CT tertiles.

RESULTS

Low-income CTs contained significantly more parks, but also had fewer parks with playgrounds and more quality concerns per park. High minority CTs had more parks with basketball courts, but fewer parks with trails. Medium-income CTs contained more aesthetic features per park.

CONCLUSIONS

Future research should examine policies that contribute to and that might rectify disparities in park features and quality, especially in low-income and high minority areas.

Evidence, power, and policy change in community-based participatory research

Meaningful improvements in health require modifying the social determinants of health. As policies are often underlying causes of the living conditions that shape health, policy change becomes a health goal. This focus on policy has led to increasing interest in expanding the focus of community-based participatory research (CBPR) to change not only communities but also policies. To best realize this potential, the relationship between evidence and power in policy change must be more fully explored. Effective action to promote policies that improve population health requires a deeper understanding of the roles of scientific evidence and political power in bringing about policy change; the appropriate scales for policy change, from community to global; and the participatory processes that best acknowledge the interplay between power and evidence.

The main advantages of community based participatory health programs: an experience from the islamic republic of iran

Introduction:

Community based participatory program is an approach that emphasize on community empowerment as an important tool in health promotion especially in low and middle income countries. The aim of this study is in-depth understanding the strengths point of active community based participatory programs in Iran in order to develop a scientific foundation and basis for future policy and decision making.

Methods:

This study was a qualitative study using focus group discussions. Thirteen community based programs related to health that were active for last five years were selected and assessed. Data analysis was based on deductive-inductive content analysis approach considering the predetermined structure according to study questions.

Results:

In this study, strengths points of community participatory health programs based on the locality of the implementation of the programs; governmental organization and nongovernmental organizations (NGO’s) were evaluated. The main strengths of these programs were the presence of the spirit of empathy and high motivation in working for community, absorbing the community assistance, community empowerment, presence of female volunteers, using local volunteers, creation of social prestige and evidence based decision making for community problem solving.

Conclusion:

Capacity building of the community, NGOs and policymakers plays key role in participation mechanisms, partnership, team working and mobilizing of necessary resources in the promotion of participatory community based health programs.

Symposium on integrating the science of environmental justice into decision-making at the Environmental Protection Agency: an overview

In March 2010, the Environmental Protection Agency (EPA) collaborated with government and nongovernmental organizations to host a groundbreaking symposium, "Strengthening Environmental Justice Research and Decision Making: A Symposium on the Science of Disproportionate Environmental Health Impacts." The symposium provided a forum for discourse on the state of scientific knowledge about factors identified by EPA that may contribute to higher burdens of environmental exposure or risk in racial/ethnic minorities and low-income populations. Also featured were discussions on how environmental justice considerations may be integrated into EPA's analytical and decision-making frameworks and on research needs for advancing the integration of environmental justice into environmental policymaking. We summarize key discussions and conclusions from the symposium and briefly introduce the articles in this issue.