Improving Environmental Health Literacy and Justice through Environmental Exposure Results Communication

Ethical, Legal, and Social Implications of Gene-Environment Interaction Research

Many complex disorders are impacted by the interplay of genetic and environmental factors. In gene-environment interactions (GxE), an individual's genetic and epigenetic makeup impacts the response to environmental exposures. Understanding GxE can impact health at the individual, community, and population levels. The rapid expansion of GxE research in biomedical studies for complex diseases raises many unique ethical, legal, and social implications (ELSIs) that have not been extensively explored and addressed. This review article builds on discussions originating from a workshop held by the National Institute of Environmental Health Sciences (NIEHS) and the National Human Genome Research Institute (NHGRI) in January 2022, entitled: "Ethical, Legal, and Social Implications of Gene-Environment Interaction Research." We expand upon multiple key themes to inform broad recommendations and general guidance for addressing some of the most unique and challenging ELSI in GxE research. Key takeaways include strategies and approaches for establishing sustainable community partnerships, incorporating social determinants of health and environmental justice considerations into GxE research, effectively communicating and translating GxE findings, and addressing privacy and discrimination concerns in all GxE research going forward. Additional guidelines, resources, approaches, training, and capacity building are required to further support innovative GxE research and multidisciplinary GxE research teams.

Participant perspectives related to individual chemical exposure report-back approaches in three environmental health studies

Returning results to participants of environmental exposure studies has become more common in recent years. Despite evidence of benefits for study participants, there are challenges in communicating results to people with limited resources or capacity to mitigate chemical exposures. We interviewed N = 54 participants and compared exposure report-back conducted in 2010-2013 across three susceptible study populations: 1) low-income pregnant individuals in the Chemicals in Our Bodies (CIOB) study; 2) the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort; and 3) early childhood educators (ECE). Report-back differed between the cross-sectional studies (CIOB and ECE), which offered an opportunity to consult with research staff by phone or email, and the prospective cohort study (CHAMACOS), which allowed for participants to discuss individual and group-level results directly with researchers at a community meeting. Participants in all three studies were motivated to participate by children's health and wanted more information about health implications and exposure reduction strategies, with cost and limited resources cited as common barriers to change. We observed overall positive experiences with report-back across studies, with improved environmental health literacy and constructive learning experiences that were most evident in CHAMACOS. While many noted individual actions they had made or intended to make to reduce exposures, CHAMACOS participants were more likely to mention systems-level changes achieved through actions such as contacting decision-makers and raising community awareness. Our findings suggest that researchers may have a unique opportunity to support environmental health literacy and informed action at both the individual and community or policy levels through long-term study engagement, various forms of direct consultation with study participants, and thoughtful report-back methods that leverage existing tools and are sensitive to barriers faced by specific study populations. This work informs best practices for communicating chemical exposure results among sensitive or highly exposed communities.

Evaluating the portable X-ray fluorescence reliability for metal(loid)s detection and soil contamination status

Marginalized communities experience barriers that can prevent soil monitoring efforts and knowledge transfer. To address this challenge, this study compared two analytical methods: portable X-ray fluorescence spectroscopy (pXRF, less time, cost) and inductively coupled plasma mass spectrometry (ICP-MS, "gold standard"). Surface soil samples were collected from residential sites in Arizona, USA (N = 124) and public areas in Troy, New York, USA (N = 33). Soil preparation differed between groups to account for community practice. Statistical calculations were conducted, paired t test, Bland-Altman plot, and a two-way ANOVA indicated no significant difference for As, Ba, Ca, Cu, Mn, Pb, and Zn concentrations except for Ba in the t test. Iron, Ni, Cr, and K were statistically different for Arizona soils and V, Ni, Fe, and Al concentrations were statistically different for New York soils. Zinc was the only element with high R2 and low p value. Pollution load index (PLI), enrichment factors (EF), and geo-accumulation index (Igeo) were calculated for both methods using U.S. Geological Survey data. The PLI were > 1, indicating soil pollution in the two states. Between pXRF and ICP-MS, the Igeo and EF in Arizona had similar degree of contamination for most elements except Zn in garden and Pb in yard, respectively. For New York, the Igeo of As, Cu, and Zn differed by only one classification index between the two methods. The pXRF was reliable in determining As, Ba, Ca, Cu, Mn, Pb, and Zn in impacted communities. Therefore, the pXRF can be a cost-effective alternative to using ICP-MS techniques to screen soil samples for several environmentally relevant contaminants to protect environmental public health.

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

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

A Personalized Intervention to Increase Environmental Health Literacy and Readiness to Change in a Northern Nevada Population: Effects of Environmental Chemical Exposure Report-Back

BACKGROUND

Interventions are needed to help people reduce exposure to harmful chemicals from everyday products and lifestyle habits. Report-back of individual exposures is a potential pathway to increasing environmental health literacy (EHL) and readiness to reduce exposures.

OBJECTIVES

Our objective was to determine if report-back of endocrine-disrupting chemicals (EDCs) can reduce EDC exposure, increase EHL, and increase readiness to change (i.e., to implement EDC exposure-reduction behaviors).

METHODS

Participants in the Healthy Nevada Project completed EHL and readiness-to-change surveys before (n = 424) and after (n = 174) a report-back intervention. Participants used mail-in kits to measure urinary biomarkers of EDCs. The report-back of results included urinary levels, information about health effects, sources of exposure, and personalized recommendations to reduce exposure.

RESULTS

EHL was generally very high at baseline, especially for questions related to the general pollution. For questions related to chemical exposures, responses varied across several demographics. Statistically reliable improvements in EHL responses were seen after report-back. For readiness to change, 72% were already or planning to change their behaviors. Post-intervention, women increased their readiness (p = 0.053), while men decreased (p = 0.007). When asked what challenges they faced in reducing exposure, 79% cited not knowing what to do. This dropped to 35% after report-back. Participants with higher propylparaben were younger (p = 0.03) and women and participants who rated themselves in better health had higher levels of some phthalates (p = 0.02-0.003 and p = 0.001-0.003, respectively). After report-back, monobutyl phthalate decreased among the 48 participants who had valid urine tests before and after the intervention (p < 0.001).

CONCLUSIONS

The report-back intervention was successful as evidenced by increased EHL behaviors, increased readiness to change among women, and a decrease in monobutyl phthalate. An EHL questionnaire more sensitive to chemical exposures would help differentiate high and low literacy. Future research will focus on understanding why men decreased their readiness to change and how the intervention can be improved for all participants.

[Environmental risks and health literacy: a systematic review]

BACKGROUND

Environmental factors can play an important role in pathogenesis. However, the understanding of the relationship between environmental risks and health in the general population appears to be poor. The aim of this systematic review is to describe the state of research on the relationship between health literacy (HL) or environmental health literacy (EHL) and environmental risks differentiated by the researched environmental risks, the affected population, the measurement and level of HL or EHL, and their interaction with other variables.

METHODS

A systematic literature search was conducted using the Pubmed, Scopus, and LIVIVO databases. Original studies in German or English that investigated HL or EHL in the context of an environmental risk or pollutant in a population were included. The Navigation Guide was used to assess the methodological quality of the studies.

RESULTS

Twenty-four studies were included in the qualitative analysis. The operationalization of HL or EHL was heterogeneous in 22 studies. Nine studies referred to environmental issues in general, and 15 studies analyzed individual environmental risks. Eleven studies referred to the general population, 12 to specified target groups, and 1 study examined both. The level of HL or EHL proved to be in need of improvement in all populations. Interventions such as trainings were able to increase HL or EHL.

DISCUSSION

The heterogeneous operationalizations impede the comparability of the studies. Future work should target the standardization of methodological aspects. Overall, it appears that interventions such as trainings were conducive to improving HL or EHL. In practice, this should therefore be given greater focus in order to increase HL or EHL.

Moving Forward with Reporting Back Individual Environmental Health Research Results

BACKGROUND

The practice of reporting back individual results to participants in environmental health research has evolved significantly over the past 20 years. Research findings support the potential of report-back to enhance the ethics, quality, and impact of environmental health research. Nonetheless, implementation of environmental health report-back practices is not yet routine.

OBJECTIVES

We propose a framework for institutionalizing appropriate report-back to participants of their individual results across the environmental health research enterprise. We provide a brief overview of the rationales for report-back, social science research on report-back experiences over the past two decades, and recent efforts to synthesize guidance in this field. We also describe barriers to be addressed in moving toward widespread implementation of report-back.

DISCUSSION

Report-back of individual results is increasingly recognized as an ethical responsibility and essential component of impactful environmental health research. Experience shows that when personal results are returned with appropriate contextual information, report-back can increase environmental health literacy, promote individual actions, and enhance engagement in policy change. Therefore, report-back can promote environmental justice and reduce disparities in access to science. Despite this evidence base, report-back is not widely implemented. We recommend the collaborative development of guidelines, training, and resources to build capacity for appropriate report-back to study participants across the environmental health research enterprise, and we identify research priorities to advance the field. Development of tools and shared infrastructure for report-back holds promise for reducing barriers while ensuring high-quality personalized reports. Disseminating successful case studies could also advance excellence. We recommend including diverse scientific disciplines, community partners, representatives of study populations, clinicians, institutional review boards (IRBs), legal experts, public health professionals, and government officials in further developing this critical aspect of environmental health research. https://doi.org/10.1289/EHP12463.

Health and Psychological Concerns of Communities Affected by Per- and Poly-Fluoroalkyl Substances: The Case of Residents Living in the Orange Area of the Veneto Region

Residents of an extensive area of the Veneto Region (Italy) face one of the largest technological disasters due to per- and polyfluoroalkyl substances (PFAS). On the basis of a risk gradient of contamination, the affected territories were divided into 4 areas: Red (of maximum exposure, where a human biomonitoring programme (HBM) was activated), Orange, Yellow, and Green. This article presents a case study of residents who live in the Orange Area, the second area in terms of contamination, excluded from the HBM. Semi-structured interviews were conducted with 17 residents engaged in promoting a legal procedure to exercise their right to know. Grounded theory and a thematic analysis method were used. Overall, the findings revealed that experiencing contamination causes a negative psychosocial impact on the residents' lives; difficulty accessing information; living with uncertainty, caused by the lack of institutional and health support and medical consultation; a sense of abandonment; difficulty managing preventive and protective actions; and the deterioration of relationships, on the basis of the social comparison with residents of the Red Area, to whom HBM was granted and where the concept of health ostracism has emerged. This study demonstrated that biomonitoring may help reduce discomfort in the case of contamination by informing people of their chemical exposure.

Integrating participant feedback and concerns to improve community and individual level chemical exposure assessment reports

BACKGROUND

As exposure assessment has shifted towards community-engaged research there has been an increasing trend towards reporting results to participants. Reports aim to increase environmental health literacy, but this can be challenging due to the many unknowns regarding chemical exposure and human health effects. This includes when reports encompass a wide-range of chemicals, limited reference or health standards exist for those chemicals, and/or incompatibility of data generated from exposure assessment tools with published reference values (e.g., comparing a wristband concentration to an oral reference dose).

METHODS

Houston Hurricane Harvey Health (Houston-3H) participants wore silicone wristbands that were analyzed for 1,530 organic compounds at two time-points surrounding Hurricane Harvey. Three focus groups were conducted in separate neighborhoods in the Houston metropolitan area to evaluate response to prototype community and individual level report-backs. Participants (n = 31) evaluated prototype drafts using Likert scales and discussion prompts. Focus groups were audio-recorded, and transcripts were analyzed using a qualitative data analysis program for common themes, and quantitative data (ranking, Likert scales) were statistically analyzed.

RESULTS

Four main themes emerged from analysis of the transcripts: (1) views on the report layout; (2) expression of concern over how chemicals might impact their individual or community health; (3) participants emotional response towards the researchers; and (4) participants ability to comprehend and evaluate environmental health information. Evaluation of the report and key concerns differed across the three focus groups. However, there was agreement amongst the focus groups about the desire to obtain personal exposure results despite the uncertainty of what the participant results meant.

CONCLUSIONS

The report-back of research results (RBRR) for community and individual level exposure assessment data should keep the following key principles in mind: materials should be accessible (language level, data visualization options, graph literacy), identify known information vs unknown (e.g., provide context for what exposure assessment data means, acknowledge lack of current health standards or guidelines), recognize and respect community knowledge and history, and set participant expectations for what they can expect from the report.

Using environmental health dialogue in a Diné-centered approach for individualized results reporting in an environmental exposure study following the Gold King Mine Spill

BACKGROUND

On August 5, 2015, the Gold King Mine Spill (GKMS) resulted in 3 million gallons of acid mine drainage spilling into the San Juan River impacting the Diné Bikeyah (traditional homelands of the Navajo people). The Gold King Mine Spill Diné Exposure Project was formed to understand the impacts of the GKMS on the Diné (Navajo). Reporting individualized household results in an exposure study is becoming more common; however, materials are often developed with limited community input with knowledge flowing in one direction - from researcher to participant. In this study we examined the development, dissemination, and evaluation of individualized results materials.

METHODS

In August 2016, Navajo Nation Community Health Representatives (Navajo CHRs) sampled household water, dust, and soil, and resident blood and urine for lead and arsenic, respectively. From May-July 2017, iterative dialogue with a wide range of community partners and a community focus groups guided the development of a culturally-based dissemination process. In August 2017, Navajo CHRs reported individualized results and they surveyed the participants on the report-back process at that time.

RESULTS

All of the 63 Diné adults (100%) who participated in the exposure study received their results by a CHR in person and 42 (67%) completed an evaluation. Most of those participants (83%) were satisfied with the result packets. Respondents ranked the individual and overall household results as the most important information they received (69% and 57%, respectively), while information on metals exposures and their health effects were the least helpful.

CONCLUSIONS

Our project illustrates how a model of environmental health dialogue, defined by iterative, multidirectional communication among Indigenous community members, trusted Indigenous leaders, Indigenous researchers, non-Indigenous researchers, can improve reporting individualized study results. Findings can inform future research to encourage multi-directional environmental health dialogue to craft more culturally responsive and effective dissemination and communication materials.

The Role of Understanding, Trust, and Access in Public Engagement with Environmental Activities and Decision Making: A Qualitative Study with Water Quality Practitioners

Advancing environmental health literacy in support of environmental management requires inclusive science communication, especially with environmental justice communities. In order to understand experiences of environmental practitioners in the realm of science communication, the Center for Oceans and Human Health and Climate Change Interactions at the University of South Carolina conducted two studies on science communication and research translation with the center's researchers and partners. This qualitative case study follows up with a select group of environmental practitioners on emergent themes from the initial work. It explores the specific topics of understanding, trust, and access and how those can become barriers or facilitators of public engagement with environmental activities and decision making. The authors conducted seven in-depth qualitative interviews with center partners whose work focuses on environmental water quality and impacts on human and environmental health. Key results indicate that the public may have limited understanding of scientific processes, establishing trust takes time, and access should be incorporated into the design of programs and activities to ensure broader reach. Findings from this research are relevant to other partner-engaged work and environmental management initiatives and provide insights on experiences, practices, and actions for equitable and effective stakeholder engagement and collaborative partnerships.

Communicating Results of Drinking Water Tests From Private Wells: Designing Report-Back Materials to Facilitate Understanding

This evaluation assessed the effectiveness of graphic-based (i.e., pictorial) report-back materials in communicating the presence of toxic metals in private well water and soil samples. It also explored associations between recommendations in the report-back materials and appropriate actions to protect health taken by a subset of participants in an environmental monitoring pilot study. Overall, 39 residents of Stokes County, North Carolina, participated in the Well Empowered pilot study, which included water and soil testing and analysis. All participants received materials explaining the extent to which toxic metals were present in their well water and soil. A subset of participants (n = 14) responded to a follow-up evaluation, which showed that many found at least one component of their test results "very easy to understand." The existence of a federal standard for comparison appeared to influence participant recall of results, which was more accurate for contaminants with a federal maximum contaminant level. Our evaluation results suggest that a simple pictorial format, in combination with more detailed supporting text, can be useful in highlighting results that require action.

Participant engagement to develop report-back materials for personal air monitoring

Background

Studies that measure environmental exposures in biological samples frequently provide participants their results. In contrast, studies using personal air monitors do not typically provide participants their monitoring results. The objective of this study was to engage adolescents who completed personal air sampling and their caregivers to develop understandable and actionable report-back documents containing the results of their personal air sampling.

Methods

Adolescents and their caregivers who previously completed personal air sampling participated in focus groups to guide the development of report-back materials. We conducted thematic analyses of focus group data to guide the design of the report-back document and convened experts in community engagement, reporting study results, and human subjects research to provide feedback. Final revisions to the report-back document were made based on follow-up focus group feedback.

Results

Focus groups identified critical components of an air-monitoring report-back document to include an overview of the pollutant being measured, a comparison of individual personal sampling data to the overall study population, a guide to interpreting results, visualization of individual data, and additional information on pollution sources, health risks, and exposure reduction strategies. Participants also indicated their desire to receive study results in an electronic and interactive format. The final report-back document was electronic and included background information, participants' results presented using interactive maps and figures, and additional material regarding pollution sources.

Conclusion

Studies using personal air monitoring technology should provide research participants their results in an understandable and meaningful way to empower participants with increased knowledge to guide exposure reduction strategies.

Mi PROTECT: A personalized smartphone platform to report back results to participants of a maternal-child and environmental health research cohort program in Puerto Rico

BACKGROUND

The PROTECT Center is a multi-project initiative that studies the relationship between exposure to environmental contaminants and preterm births during the prenatal and postnatal period among women living in Puerto Rico. PROTECT's Community Engagement Core and Research Translation Coordinator (CEC/RTC) play a key role in building trust and capacity by approaching the cohort as an engaged community that provides feedback about processes, including how personalized results of their exposure to chemicals should be reported back. The goal of the Mi PROTECT platform was to create a mobile-based application of DERBI (Digital Exposure Report-Back Interface) for our cohort that provides tailored, culturally appropriate information about individual contaminant exposures as well as education on chemical substances and approaches to exposure reduction.

METHODS

Participants (N = 61) were presented with commonly used terms in environmental health research related to collected samples and biomarkers, followed by a guided training on accessing and exploring the Mi PROTECT platform. Participants evaluated the guided training and Mi PROTECT platform answering a Likert scale in separated surveys that included 13 and 8 questions, respectively.

RESULTS

Participants provided overwhelmingly positive feedback on the clarity and fluency of presenters in the report-back training. Most participants reported that the mobile phone platform was both accessible and easy to navigate (83% and 80%, respectively) and that images included in the platform facilitated comprehension of the information. Overall, most participants (83%) reported that language, images, and examples in Mi PROTECT strongly represented them as Puerto Ricans.

CONCLUSIONS

Findings from the Mi PROTECT pilot test informed investigators, community partners and stakeholders by demonstrating a new way to promote stakeholder participation and foster the "research right-to-know."

A GeoHealth Call to Action: Moving Beyond Identifying Environmental Injustices to Co-Creating Solutions

As marginalized communities continue to bear disproportionate impacts from environmental hazards, we urgently call for researchers and institutions to elevate the principles of Environmental Justice. The American Geophysical Union (AGU) GeoHealth section supports members' engagement in health-related community-engaged and community-led transdisciplinary research. We highlight intersectional research that provides examples and actions for both individuals and organizations on community science and trust building, removing barriers created by scientific agency priorities and career expectations, and opportunities in education and policy. Justice does not start or end at one meeting; this is ongoing work that is active, evolving, and an ethical responsibility of AGU's membership.

Perspectives of peripartum people on opportunities for personal and collective action to reduce exposure to everyday chemicals: Focus groups to inform exposure report-back

Participants in biomonitoring studies who receive personal exposure reports seek information to reduce exposures. Many chemical exposures are driven by systems-level policies rather than individual actions; therefore, change requires engagement in collective action. Participants' perceptions of collective action and use of report-back to support engagement remain unclear. We conducted virtual focus groups during summer 2020 in a diverse group of peripartum people from cohorts in the Environmental influences on Child Health Outcomes (ECHO) Program (N = 18). We assessed baseline exposure and collective action experience, and report-back preferences. Participants were motivated to protect the health of their families and communities despite significant time and cognitive burdens. They requested time-conscious tactics and accessible information to enable action to reduce individual and collective exposures. Participant input informed the design of digital report-back in the cohorts. This study highlights opportunities to shift responsibility from individuals to policymakers to reduce chemical exposures at the systems level.

A process for creating data report-back tools to improve equity in environmental health

BACKGROUND

Although there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience.

METHODS

Relying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials.

RESULTS

The resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience.

CONCLUSIONS

We outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.

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.

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.

Environmental Health Literacy as Knowing, Feeling, and Believing: Analyzing Linkages between Race, Ethnicity, and Socioeconomic Status and Willingness to Engage in Protective Behaviors against Health Threats

This study investigates the relationships between environmental health literacy, the characteristics of people (race, ethnicity, and socioeconomic status) associated with health disparities, and people's willingness to engage in protective behaviors against environmental health threats. Environmental health literacy is a framework for capturing the continuum between the knowledge of environmental impacts on public health, and the skills and decisions needed to take health-protective actions. We pay particular attention to three dimensions of environmental health literacy: factual knowledge (knowing the facts), knowledge sufficiency (feeling ready to decide what to do), and response efficacy (believing that protective behaviors work). In June 2020, we collected survey data from North Carolina residents on two topics: the viral infection COVID-19 and industrial contaminants called per- and polyfluoroalkyl substances (PFAS). We used their responses to test stepwise regression models with willingness to engage in protective behaviors as a dependent variable and other characteristics as independent variables, including environmental health literacy. For both topics, our results indicated that no disparities emerged according to socioeconomic factors (level of education, household income, or renting one's residence). We observed disparities in willingness according to race, comparing Black to White participants, but not when comparing White to American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander participants nor Hispanic to non-Hispanic participants. The disparities in willingness between Black and White participants persisted until we introduced the variables of environmental health literacy, when the difference between these groups was no longer significant in the final regression models. The findings suggest that focusing on environmental health literacy could bridge a gap in willingness to protect oneself based on factors such as race/ethnicity and socioeconomic status, which have been identified in the environmental health literature as resulting in health disparities.

Characterizing the Environmental Health Literacy and Sensemaking of Indoor Air Quality of Research Participants

This study is based on in-depth semi-structured interviews with the participants of an indoor air quality monitoring study. The purpose of the interviews was to capture participants’ perceptions of indoor air quality and engage them in a discussion of those factors that influenced their behavior. Interview study participants (n = 20) noted the importance of family health concerns and their own sensory awareness of possible contaminants. They discussed their level of personal control over their home environment as well as their access to needed resources. This study is based on grounded theory and applies interpretivist epistemological methods. Study findings offer insights into how people perceive their home environment and what influences their decision making and action. Analyses indicate that perceived agency, risk perception, access to resources, and information all influenced participants’ sense of ability to take action as well as their interest in taking action. These insights serve to challenge some of the current work in environmental health literacy which tends to focus on and measure an individual’s knowledge or skills. Our analysis suggests that consideration be given to a number of factors that include perceived agency, access to resources, and the quality of information provided.

Developing a Short Assessment of Environmental Health Literacy (SA-EHL)

Environmental health literacy (EHL) is defined as the understanding of how the environment can impact human health, yet there are few tools to quantify EHL. We adapted the Short Assessment of Health Literacy (SAHL) to create the Short Assessment of Environmental Health Literacy (SA-EHL). Using the Amazon mTurk platform, users (n = 864) completed the 18-item SAHL and the 17-item SA-EHL. The SA-EHL was originally tested with 30 items; 13 items were removed because they were outside the acceptable difficulty parameters (DIFF: −0.4–4.0) or because of limited variance (>90% correct or incorrect), resulting in the final 17 items. Overall, participants scored highly on the SAHL, with 89.9% exhibiting high literacy. In contrast, the majority had low EHL (<1.0% high literacy, 99.2% low literacy) measured by the SA-EHL. The two scales were not correlated with each other (R² = 0.013) as measured via linear regression and dichotomous variables. Scores on the SAHL and the SA-EHL were positively correlated with education. The SAHL was positively correlated with age, gender and marital status, whereas the SA-EHL was not. The SA-EHL can be used to gauge EHL for communities, and the results used to improve interventions and research translation materials.

Returning Individual Tap Water Testing Results to Research Study Participants after a Wildfire Disaster

After the devastating wildfire that destroyed most of the town of Paradise, California in 2018, volatile organic compounds were found in water distribution pipes. Approximately 11 months after the fire, we collected tap water samples from 136 homes that were still standing and tested for over 100 chemicals. Each participant received a customized report showing the laboratory findings from their sample. Our goal was to communicate individual water results and chemical information rapidly in a way that was understandable, scientifically accurate, and useful to participants. On the basis of this process, we developed a framework to illustrate considerations and priorities that draw from best practices of previous environmental results return research and crisis communication, while also addressing challenges specific to the disaster context. We also conducted a follow-up survey on participants’ perceptions of the results return process. In general, participants found the results return communications to be understandable, and they felt less worried about their drinking water quality after receiving the information. Over one-third of the participants reported taking some kind of action around their water usage habits after receiving their results. Communication with participants is a critical element of environmental disaster research, and it is important to have a strategy to communicate results that achieves the goals of timeliness, clarity, and scientific accuracy, ultimately empowering people toward actions that can reduce exposure.

Defining Environmental Health Literacy

"Environmental Health Literacy" (EHL) is embraced as important for improving public health by preventing disability and disease from our environment. This study aimed to determine knowledge and skill items identified by Environmental Health (EH) professionals as being associated with EHL and to understand how these items rank by importance. Such a coordinated effort to tease out skills and knowledge needed for EHL had not previously been made. We utilized a mixed-methods approach of semi-structured interviews of 24 EH professionals and a quantitative survey with 275 EH professionals across the United States. Interviews identified 37 skill and 69 knowledge items, which were used to create the survey questions. Survey results indicate 32 knowledge items and six skill items considered essential by >50% of respondents where consensus was reached between professional groups (chi square test: p > 0.05). We further identified six knowledge items, which >70% of EH professionals agreed were essential for EHL. The identification of these knowledge and skill items sets the stage for further research that includes exploring agreement with more diverse stakeholders, developing comprehensive measures of EHL and evaluation of methods and materials designed to improve EHL.

Outcomes from Returning Individual versus Only Study-Wide Biomonitoring Results in an Environmental Exposure Study Using the Digital Exposure Report-Back Interface (DERBI)

BACKGROUND

Study participants want to receive their biomonitoring results for environmental chemicals, and ethics guidelines encourage reporting back. However, few studies have quantitively assessed participants' responses to individual exposure reports, and digital methods have not been evaluated.

OBJECTIVES

We isolated effects of receiving personal results vs. only study-wide findings and investigated whether effects differed for Black participants.

METHODS

We randomly assigned a subset of 295 women from the Child Health and Development Studies, half of whom were Black, to receive a report with personal environmental chemical results or only study-wide (aggregate) findings. Reports included results for 42 chemicals and lipids and were prepared using the Digital Exposure Report-Back Interface (DERBI). Women were interviewed before and after viewing their report. We analyzed differences in website activity, emotional responses, and intentions to participate in future research by report type and race using Wilcoxon rank sum tests, Wilcoxon-Pratt signed ranks tests, and multiple regression.

RESULTS

The personal report group spent approximately twice as much time on their reports as the aggregate group before the post-report-back interview. Among personal-report participants (n=93), 84% (78) viewed chemical group information for at least one personal result highlighted on their home page; among aggregate-report participants (n=94), 66% (62) viewed any chemical group page. Both groups reported strong positive feelings (curious, informed, interested, respected) about receiving results before and after report-back and mild negative feelings (helpless, scared, worried). Although most participants remained unworried after report-back, worry increased by a small amount in both groups. Among Black participants, higher post report-back worry was associated with having high levels of chemicals.

CONCLUSIONS

Participants were motivated by their personal results to access online information about chemical sources and potential health effects. Report-back was associated with a small increase in worry, which could motivate appropriate action. Personal report-back increased engagement with exposure reports among Black participants. https://doi.org/10.1289/EHP9072.

Assessing Children's Lead Exposure in an Active Mining Community Using the Integrated Exposure Uptake Biokinetic Model

Lead exposure has been shown to be harmful to humans in various settings and there are no safe levels of blood lead in children. At an Alternative Superfund site in Hayden-Winkelman, Arizona, with an active copper smelter and concentrator, lead exceedances in air and soil have been measured in the past 20 years. In this work, the U.S. Environmental Protection Agency's Integrated Exposure Uptake Biokinetic (IEUBK) model was used to estimate Hayden-Winkelman children's (age 6 months-7 years) blood lead levels (BLLs) using site-specific lead concentrations measured in indoor and outdoor air, soil, indoor dust, and drinking water. Values used by a state agency's airborne lead risk forecast program were also evaluated to determine whether their forecasting program is useful in protecting children's public health. Using site-specific values in the model, the results demonstrated that lead ingested via indoor dust was the major contributor to children's BLLs. In addition, the output of the IEUBK model overestimated actual BLLs of children sampled in the community. The IEUBK model was particularly sensitive to high indoor dust levels, and these site-specific measures increased modeled BLL values. This finding is of significance as the IEUBK model is used worldwide in communities with industrial contamination. This study confirmed that the chief contributor to lead exposure in children is household dust. Thus, for lead exposure risk reduction, agencies working at Superfund sites should focus efforts on decontaminating outdoor soil and dust and indoor lead decontamination.

MCR: Open-Source Software to Automate Compilation of Health Study Report-Back

Sharing individualized results with health study participants, a practice we and others refer to as "report-back," ensures participant access to exposure and health information and may promote health equity. However, the practice of report-back and the content shared is often limited by the time-intensive process of personalizing reports. Software tools that automate creation of individualized reports have been built for specific studies, but are largely not open-source or broadly modifiable. We created an open-source and generalizable tool, called the Macro for the Compilation of Report-backs (MCR), to automate compilation of health study reports. We piloted MCR in two environmental exposure studies in Massachusetts, USA, and interviewed research team members (n = 7) about the impact of MCR on the report-back process. Researchers using MCR created more detailed reports than during manual report-back, including more individualized numerical, text, and graphical results. Using MCR, researchers saved time producing draft and final reports. Researchers also reported feeling more creative in the design process and more confident in report-back quality control. While MCR does not expedite the entire report-back process, we hope that this open-source tool reduces the barriers to personalizing health study reports, promotes more equitable access to individualized data, and advances self-determination among participants.

Participant Experiences in a Human Biomonitoring Study: Follow-Up Interviews with Participants of the Flemish Environment and Health Study

Communicating individual human biomonitoring results to study participants has been the subject of debate for some time. This debate is dominated by ethical considerations from a researchers’ perspective on whether or not to communicate, thereby overlooking more practice-based questions from a participants’ perspective on what and how to communicate. We conducted a small scale follow-up study based on eleven face-to-face interviews with mothers participating in the third cycle of the Flemish Environment and Health Study (FLEHS III 2012–2015) to investigate how they experienced and interpreted individual biomonitoring results. Key findings indicate that respondents were generally satisfied with participating in the biomonitoring study, but the report-back process especially lacked contextualized information and interactive communication options to better comprehend and cope with personal results. These findings also argue in favor of a more tailored approach in which report-back methods, formats and content are diversified according to the type of results and the preferences of participants. A reflexive research practice with active engagement in follow-up research is crucial to improve participants’ understanding and use of personal biomonitoring results.

Environmental, public health, and economic development perspectives at a Superfund site: A Q methodology approach

Environmental remediation and restoration at hazardous waste sites is important for reducing risks and sustaining local economies. Navigating trade-offs between diverse and conflicting stakeholder perspectives to identify practical and affordable ways forward is important for sustaining objectives and goals. Differences in stakeholder perspectives are informed by their affiliations and roles and their views towards environmental, economic development, and public health issues. We used Q methodology, an approach that combines priority sorting and interviews, to elicit and interpret the perspectives of 28 stakeholders, representing government entities, non-profits, and industries at a mining-impacted Superfund site in the Coeur d'Alene Basin of Idaho, USA. Four primary perspectives were distinguished by their prioritization of: 1) government intervention, 2) the Superfund remediation, 3) local concerns, and 4) public-private partnerships. Participants' roles and affiliations played an influential role in informing primary perspectives. Overall, collaboration was viewed more favorably when it was associated with concrete implementation pathways.

Perceived Risk and Intentions to Practice Health Protective Behaviors in a Mining-Impacted Region

Effective risk communication strategies are critical to reducing lead exposure in mining-impacted communities. Understanding the strength of the associations between perceived risk and individuals' behavioral intentions to protect their health is important for developing these strategies. We conducted a survey within three communities of northern Idaho, USA (n = 306) in or near a Superfund Megasite with legacy mining contamination. Survey data were used to test a theoretical model based on the Health Belief Model. Respondents had higher intentions to practice health protective behaviors when they perceived the risk of lead contamination as severe and recognized the benefits of practicing health protective behaviors. Women reported higher behavioral intentions than men, but age and mining affiliation were not significantly associated with behavioral intentions. Although managing lead hazards in communities impacted by mining is challenging due to widely distributed contamination, effective health risk messages, paired with remediation, are powerful tools to protect the health and safety of residents.

Identifying Issues and Priorities in Reporting Back Environmental Health Data

Experts recommend reporting environmental exposure results back to research participants and communities, yet environmental health researchers need further guidance to improve the practice of reporting back. We present the results of a workshop developed to identify pertinent issues and areas for action in reporting back environmental health research results. Thirty-five attendees participated, brainstorming responses to the prompt: “What are some specific issues that are relevant to reporting back research results to individuals or the larger community?”, and then grouping responses by similarity and rating their importance. Based on a combined theoretical foundation of grounded theory and qualitative content analysis, we used concept mapping to develop a collective understanding of the issues. Visual maps of the participants’ responses were created using nonmetric multidimensional scaling and hierarchical cluster analysis. The resulting concept map provided a spatial depiction of five issue areas: Effective Communication Strategies, Community Knowledge and Concerns, Uncertainty, Empowering Action, and Institutional Review and Oversight (listed from highest to lowest rating). Through these efforts, we disentangled the complex issues affecting how and whether environmental health research results are reported back to participants and communities, by identifying five distinct themes to guide recommendations and action. Engaging community partners in the process of reporting back emerged as a unifying global theme, which could improve how researchers report back research results by understanding community context to develop effective communication methods and address uncertainty, the ability to act, and institutional concerns about beneficence and justice.

A Collaborative Approach to Assess Legacy Pollution in Communities Near a Lead-Acid Battery Smelter: The "Truth Fairy" Project

Advocates for civil rights, environmental justice, and movements promoting social justice require data and may lack trust in public authorities, turning instead to academic scientists to help address their questions. Assessing historical exposure to toxic chemicals, especially in situations of a specific industrial source of pollution affecting a community, is critical for informing appropriate public health and policy responses. We describe a community-driven approach to integrate retrospective environmental hazard exposure assessment with community organizing to address concerns about the extent of exposure to toxic metals in a predominantly working-class, Latinx community living near a now-closed lead-acid battery smelter facility. Named the "Truth Fairy Project" by leaders of the community organization East Yard Communities for Environmental Justice, this community-university partnership aimed to assess prenatal and early-life exposures to toxic metals through biomarkers of exposure in baby/deciduous teeth. This partnership integrated community mobilization with empirical research, informing residents about toxic metal exposures and improving the community's capacity to respond to a public health crisis.

Developing Youth Environmental Health Literacy and Civic Leadership through Community Air Monitoring in Imperial County, California

With a rapidly changing climate, new leaders must be trained to understand and act on emerging environmental threats. In California’s Imperial Valley, a collaborative of community members, researchers, and scientists developed a community air monitoring network to provide local residents with better air quality information. To expand the reach of the project and to prepare the next generation of youth leaders we developed an internship program to increase environmental health literacy and civic leadership. In the 10-week program, high school students learned about air quality science, respiratory health, community air monitoring, and policies intended to improve air quality. The students learned to present this information to their peers, neighbors, family, and community leaders. The program used participatory approaches familiar to community-engaged research to center the students’ experience. Surveys and interviews with the students were used to assess the program and found that the students became more familiar with air quality policies, increased their ability to use air monitoring resources, and increased their own confidence in their ability to effect change. With the growing threats related to environmental hazards, it is vital to prepare youth leaders to understand, communicate, and act.

A Mixed Methods Evaluation of Sharing Air Pollution Results with Study Participants via Report-Back Communication

We implemented a concurrent triangulation mixed-methods evaluation of an air pollution data report-back to study participants in Chelsea, Massachusetts. We aimed to determine whether the report-back was effective in the following three ways: engagement, understandability, and actionability for the participants. We also evaluated participants' valuation of the report-back information and process. The evaluation involved both qualitative components, such as ethnographic observation, and quantitative components, such as closed-ended questionnaires and demographic data. The participants who engaged in the report-back process were significantly different from those who did not engage both in terms of their demographics, and in their indoor air pollutant concentrations. Participant understanding generally corresponded with the intended meaning of the research team, suggesting successful data communication. Additionally, many of the participants reported that they were inspired to take action in order to reduce their indoor air pollutant exposure as a result of the report-back process and information provided. These results identify areas of improvement for engagement, particularly regarding populations that may have higher exposures. This work outlines a framework with which to contextualize and evaluate the success of engagement with report-back efforts. Such evaluations can allow research teams to assess whether they are providing information that is equitably useful and actionable for all participants.

Nutrition and Environmental Pollution Extension Curriculum Improved Diet-Related Behaviors and Environmental Health Literacy

Kentucky experiences some of the nation's worst health outcomes related to obesity, diabetes, high blood pressure, and other age-related chronic diseases linked with oxidative stress and inflammation, which in turn are associated with poor diet, lack of physical activity, and exposure to certain environmental pollutants. In the Commonwealth, deteriorating infrastructure, inappropriate waste disposal, and potential occupational injury related to mining, agriculture, and other regionally important industries exacerbate the need for residents to have basic knowledge of potential environmental health threats. Unfortunately, community-level understanding of the complex connections between environmental exposures and health is limited, with many Kentuckians unaware that the Commonwealth is home to 13 hazardous waste sites included in the United States Environmental Protection Agency Superfund National Priorities List (NPL). The NPL highlights priority sites for long-term remedial action to reduce environmental contaminants. To enhance the understanding of environmental health and protective actions, the University of Kentucky Superfund Research Center Community Engagement Core developed a 9-lesson extension curriculum "Body Balance: Protect Your Body from Pollution with a Healthy Lifestyle" (Body Balance) and partnered with Kentucky's Family and Consumer Sciences (FCS) Cooperative Extension Service to pilot the curriculum in Kentucky communities. FCS agents in 4 Kentucky counties delivered the Body Balance pilot study (18-31 participants per lesson). Pre- and post-lesson questionnaires revealed increased knowledge and awareness of the effects of environmental pollution on health and the protective role of dietary strategies. Focus group participants (n = 18) self-reported positive behavior changes because of increases in knowledge and leadership from their FCS agent. The Body Balance curriculum appeared to be a promising mechanism for raising environmental health and diet knowledge, as well as for promoting positive behavior changes among white, middle/older-aged women in rural Kentucky communities.

Cyclists’ Multiple Environmental Urban Exposures—Comparing Subjective and Objective Measurements

Citizens in urban areas are exposed to multiple environmental stressors like noise, heat, and air pollution, with impact on human health. There is a great deal of evidence that connects human health, objective environmental exposure, and place of residence. However, little is known about subjective and objective multiple personal exposures while being mobile. To address this research gap, this paper presents results from a mixed-methods exploratory study with cyclists in the City of Leipzig, Germany. In the summer of 2017, cyclists (n = 66) wore a unique combination of sensors that measured particle number counts (PNC), noise, humidity, temperature, geolocation, and the subjective perception of each exposure on everyday routes for one week (n = 730). A smartphone application was developed to question participants about their perception of subjective exposure. The data were analyzed with three aims: (i) to compare the multiple exposure profiles of the cyclists, (ii) to contrast the objective data and subjective individual perception, and (iii) to examine the role of route decision-making and awareness of health impacts for healthier route choices. The results indicate distinct differences between the exposure profiles of cyclists. Over 80% of the cyclists underestimated their exposure to noise and air pollution. Except for heat, no significant associations between the objective and subjective data were found. This reveals an exposure awareness gap that needs to be considered in urban health planning and risk communication. It is argued that knowledge about health impacts and route characteristics plays a crucial role in decision-making about route choices. The paper concludes with suggestions to harness smart sensing for exposure mitigation and research in health geography.

Detecting Indicators for Startup Business Success: Sentiment Analysis Using Text Data Mining

The main aim of this study is to identify the key factors in User Generated Content (UGC) on the Twitter social network for the creation of successful startups, as well as to identify factors for sustainable startups and business models. New technologies were used in the proposed research methodology to identify the key factors for the success of startup projects. First, a Latent Dirichlet Allocation (LDA) model was used, which is a state-of-the-art thematic modeling tool that works in Python and determines the database topic by analyzing tweets for the #Startups hashtag on Twitter (n = 35.401 tweets). Secondly, a Sentiment Analysis was performed with a Supervised Vector Machine (SVM) algorithm that works with Machine Learning in Python. This was applied to the LDA results to divide the identified startup topics into negative, positive, and neutral sentiments. Thirdly, a Textual Analysis was carried out on the topics in each sentiment with Text Data Mining techniques using Nvivo software. This research has detected that the topics with positive feelings for the identification of key factors for the startup business success are startup tools, technology-based startup, the attitude of the founders, and the startup methodology development. The negative topics are the frameworks and programming languages, type of job offers, and the business angels’ requirements. The identified neutral topics are the development of the business plan, the type of startup project, and the incubator’s and startup’s geolocation. The limitations of the investigation are the number of tweets in the analyzed sample and the limited time horizon. Future lines of research could improve the methodology used to determine key factors for the creation of successful startups and could also study sustainable issues.

A Case Study Describing a Community-Engaged Approach for Evaluating Polycyclic Aromatic Hydrocarbon Exposure in a Native American Community

In 2015, the Swinomish Indian Tribal Community (SITC) was impacted by an air toxic release from one of two nearby oil refineries. This experience motivated SITC members to learn more about their exposure to air toxics. On the invitation of SITC, this community-based study measured personal exposure to polycyclic aromatic hydrocarbons (PAHs) and conducted interviews with the volunteers to evaluate perceptions of the data and experience of participating. Non-smoking SITC members were recruited in March 2016 (N = 10) and January 2017 (N = 22) with seven volunteers participating both times. Volunteers wore a wristband passive sampler for 7 days and completed daily activity diaries. Wristbands were analyzed for 62 PAHs using gas chromatography mass spectrometry. Wilcoxon exact tests determined if the sum total PAHs (ΣPAH) differed by activity, proximity to the refineries, and time. Aggregated results were shared during community meetings, and volunteers received individual reports. Volunteers (N = 9) participated in individual interviews. All volunteers were exposed to different amounts and types of PAHs. Burning candles or using a wood stove and/or propane heating were associated with higher ΣPAH exposures. While ΣPAH was similar in both sampling periods, the composition of PAHs differed. More priority listed PAHs were detected in January (N = 17) versus March (N = 10). Among volunteers who participated in both sampling events, exposure to four PAHs significantly differed between seasons. Overall, volunteers reported that the study made them more aware of air pollution sources in their community. They also commented that the chemical nomenclature was difficult to understand, but appreciated the individual reports that allowed them to visually compare their data to the distribution of data collected in their community. For volunteers with lower exposures, these comparisons gave them relief. However, volunteers with higher exposures reported concern and several changed their behaviors to reduce their exposure to known PAH sources. This study provided an opportunity for SITC members to learn about their personal exposure to a class of air toxics within the context of their community. While the limitations of the study hindered the ability to identify sources of air toxics in the community, this activity appeared to raise awareness about ambient and indoor air pollution among the volunteers.

Public Participation, Trust and Data Sharing: Gardens as Hubs for Citizen Science and Environmental Health Literacy Efforts

Gardenroots: A Citizen Science Project (2015) is the product of a needs assessment, revealing environmental quality concerns of gardeners living near hazardous waste or resource extraction activities. Participants were trained, collected garden samples for analysis, and later received their data visualized (individual and aggregated) via community events or mail. This article describes participant motivations, changes in knowledge and efficacy, and whether these depend on the mode of data sharing and visualization. Motivations were internal, and self-efficacy increased, while knowledge and satisfaction were higher in event attendees due to increased researcher contact. This reveals importance of data-sharing events, data visualizations, and participatory research processes.

Increasing Environmental Health Literacy through Contextual Learning in Communities at Risk

Environmental health literacy (EHL) has recently been defined as the continuum of environmental health knowledge and awareness, skills and self-efficacy, and community action. In this study, an interdisciplinary team of university scientists, partnering with local organizations, developed and facilitated EHL trainings with special focus on rainwater harvesting and water contamination, in four communities with known environmental health stressors in Arizona, USA. These participatory trainings incorporated participants' prior environmental health risk knowledge and personal experiences to co-create training content. Mixed methods evaluation was conducted via pre-post participant surveys in all four trainings (n = 53). Participants who did not demonstrate baseline environmental science knowledge pre-training demonstrated significant knowledge increase post-training, and participants who demonstrated low self-efficacy (SE) pre-training demonstrated a significant increase in SE post-training. Participants overall demonstrated a significant increase in specific environmental health skills described post-training. The interdisciplinary facilitator-scientist team also reported multiple benefits, including learning local knowledge that informed further research, and building trust relationships with community members for future collaboration. We propose contextual EHL education as a valuable strategy for increasing EHL in environmental health risk communities, and for building academia-community partnerships for environmental health research and action.

Do Online Comments Affect Environmental Management? Identifying Factors Related to Environmental Management and Sustainability of Hotels

The main aim of this study was to identify the key indicators related to environmental management and sustainability of hotels as perceived by travelers during their trips. The methodology used was a sentiment analysis with an algorithm developed in Python trained with data mining and machine learning, with the MonkeyLearn library in the hotel industry sector under the eWOM model (e-Word of Mouth). The results with negative, positive and neutral feelings were submitted to a textual analysis with the qualitative analysis software Nvivo Pro 12. The sample consisted of the 25 best hotels in Switzerland according to Traveler’s Choice from TripAdvisor ranking 2018 that draws from more than 500,000 reviews. For data extraction, we connected to the TripAdvisor API, obtaining a sample of n = 8331 reviews of the hotels that made up the ranking. The results of the study highlight the key factors related to environmental management detected by travelers during their stay in hotels and can be meaningfully used by managers or hotel managers to improve their services and enhance the value provided by their policies of sustainability and respect for the environment. The limitations of the present study relate to the size of the sample and the number of hotels included in the present analysis.

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.

Reporting to parents on children's exposures to asthma triggers in low-income and public housing, an interview-based case study of ethics, environmental literacy, individual action, and public health benefits

BACKGROUND

Emerging evidence about the effects of endocrine disruptors on asthma symptoms suggests new opportunities to reduce asthma by changing personal environments. Right-to-know ethics supports returning personal results for these chemicals to participants, so they can make decisions to reduce exposures. Yet researchers and institutional review boards have been reluctant to approve results reports in low-income communities, which are disproportionately affected by asthma. Concerns include limited literacy, lack of resources to reduce exposures, co-occurring stressors, and lack of models for effective reporting. To better understand the ethical and public health implications of returning personal results in low-income communities, we investigated parents' experiences of learning their children's environmental chemical and biomonitoring results in the Green Housing Study of asthma.

METHODS

The Green Housing Study measured indoor chemical exposures, allergens, and children's asthma symptoms in "green"-renovated public housing and control sites in metro-Boston and Cincinnati in 2011-2013. We developed reports for parents of children in the study, including results for their child and community. We observed community meetings where results were reported, and metro-Boston residents participated in semi-structured interviews in 2015 about their report-back experience. Interviews were systematically coded and analyzed.

RESULTS

Report-back was positively received, contributed to greater understanding, built trust between researchers and participants, and facilitated action to improve health. Sampling visits and community meetings also contributed to creating a positive study experience for participants. Participants were able to make changes in their homes, such as altering product use and habits that may reduce asthma symptoms, though some faced roadblocks from family members. Participants also gained access to medical resources, though some felt that clinicians were not responsive. Participants wanted larger scale change from government or industry and wanted researchers to leverage study results to achieve change.

CONCLUSIONS

Report-back on environmental chemical exposures in low-income communities can enhance research benefits by engaging residents with personally relevant information that informs and motivates actions to reduce exposure to asthma triggers. Ethical practices in research should support deliberative report-back in vulnerable communities.

Attitudes Expressed in Online Comments about Environmental Factors in the Tourism Sector: An Exploratory Study

The object of this exploratory study is to identify the positive, neutral and negative environment factors that affect users who visit Spanish hotels in order to help the hotel managers decide how to improve the quality of the services provided. To carry out the research a Sentiment Analysis was initially performed, grouping the sample of tweets (n = 14459) according to the feelings shown and then a textual analysis was used to identify the key environment factors in these feelings using the qualitative analysis software Nvivo (QSR International, Melbourne, Australia). The results of the exploratory study present the key environment factors that affect the users experience when visiting hotels in Spain, such as actions that support local traditions and products, the maintenance of rural areas respecting the local environment and nature, or respecting air quality in the areas where hotels have facilities and offer services. The conclusions of the research can help hotels improve their services and the impact on the environment, as well as improving the visitors experience based on the positive, neutral and negative environment factors which the visitors themselves identified.

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.

Researcher and institutional review board perspectives on the benefits and challenges of reporting back biomonitoring and environmental exposure results

As the number of personal exposure studies expands and trends favor greater openness and transparency in the health sciences, ethical issues arise around reporting back individual results for contaminants without clear health guidelines. Past research demonstrates that research participants want their results even when the health implications are not known. The experiences of researchers and institutional review boards (IRBs) in studies that have reported personal chemical exposures can provide insights about ethical and practical approaches while also revealing areas of continued uncertainty. We conducted semi-structured interviews with 17 researchers and nine IRB members from seven personal exposure studies across the United States to investigate their experiences and attitudes about the report-back process. Researchers reported multiple benefits of report-back, including increasing retention and recruitment, advancing environmental health literacy, empowering study participants to take actions to reduce exposures, encouraging shifts in government and industry practices, and helping researchers discover sources of exposure through participant consultation. Researchers also reported challenges, including maintaining ongoing contact with participants, adopting protocols for notification of high exposures to chemicals without health guidelines, developing meaningful report-back materials, and resource limitations. IRB members reported concern for potential harm to participants, such as anxiety about personal results and counterproductive behavior changes. In contrast, researchers who have conducted personal report-back in their studies said that participants did not appear overly alarmed and noted that worry can be a positive outcome to motivate action to reduce harmful exposures. While key concerns raised during the early days of report-back have been substantially resolved for scientists with report-back experience, areas of uncertainty remain. These include ethical tensions surrounding the responsibility of researchers to leverage study results and resources to assist participants in policy or community-level actions to reduce chemical exposures, and how to navigate report-back to vulnerable populations.

Environmental Justice Research: Contemporary Issues and Emerging Topics

Environmental justice (EJ) research seeks to document and redress the disproportionate environmental burdens and benefits associated with social inequalities. Although its initial focus was on disparities in exposure to anthropogenic pollution, the scope of EJ research has expanded. In the context of intensifying social inequalities and environmental problems, there is a need to further strengthen the EJ research framework and diversify its application. This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) incorporates 19 articles that broaden EJ research by considering emerging topics such as energy, food, drinking water, flooding, sustainability, and gender dynamics, including issues in Canada, the UK, and Eastern Europe. Additionally, the articles contribute to three research themes: (1) documenting connections between unjust environmental exposures and health impacts by examining unsafe infrastructure, substance use, and children’s obesity and academic performance; (2) promoting and achieving EJ by implementing interventions to improve environmental knowledge and health, identifying avenues for sustainable community change, and incorporating EJ metrics in government programs; and (3) clarifying stakeholder perceptions of EJ issues to extend research beyond the documentation of unjust conditions and processes. Collectively, the articles highlight potentially compounding injustices and an array of approaches being employed to achieve EJ.