- Daniela Friedman, Ph.D., Working with Communities to Improve Health Risk Messaging
- Phil Brown, Ph.D. – Understanding Community Awareness and Actions on Environmental Health Issues
- Keith Pezzoli, Ph.D., – Promoting Healthy Places, Healthy People, and Rooted Communities through a Bioregional Framework
- Nicholas Newman, D.O. – Preparing Doctors to Meet Their Patients' Environmental Health Needs
- Frances K. Barg, Ph.D. – Engaging Community Members to Understand Long-Term Implications of Hazardous Waste
- Carmen M. Vélez-Vega, Ph.D. – Establishing Partnerships to Address Environmental Health Concerns for Pregnant Women and Children in Puerto Rico
- Melanie Pearson, Ph.D. – Working with Atlanta Communities to Address Environmental Health Concerns
- Panagis Galiatsatos, M.D. – Bridging the Gap between Health Care Providers and Residents in Baltimore
- Madeleine Scammell, D.Sc., Connecting Local Environmental Health Concerns to Scientific Research
- Jani Ingram, Ph.D. –Addressing Environmental Health Needs of Navajo Nation
- Tommy Rock – Exposing Years of Uranium Water Contamination in a Navajo Community
Daniela Friedman, Ph.D., Working with Communities to Improve Health Risk Messaging
October 13, 2017
Daniela Friedman, Ph.D., is a professor and chair for the University of South Carolina’s Department of Health Promotion, Education, and Behavior. Since receiving both her masters and doctoral degrees in health studies and gerontology from the University of Waterloo, Friedman has established an extensive research career investigating how diverse populations access and interpret information about health risks.
Focusing initially on prostate cancer in African-American men, Friedman has expanded her focus to investigate how individuals perceive their risk of disease. Her current NIEHS-funded study, Strategies for Communicating the Environmental Risks of Cancer (SCERC), part of the Breast Cancer and the Environment Research Program (BCERP), looks at how African-American women learn about, react to, and process information about breast cancer risk in their environment.
As part of the BCERP Dissemination and Outreach working group, Friedman and other communication specialists are using health communication principles to distribute technical research results to the public, making them more readable for the average person. The working group develops communication tools, such as brochures and fact sheets, for local organizations to customize and distribute.
Involving Communities in Formative Health Communication Research
Breast cancer is the second most commonly diagnosed cancer among American women. In South Carolina, African-American women who receive this diagnosis face a higher mortality rate than their European-American counterparts. For this reason, Friedman and her colleagues chose to focus their current study on African-American women. Since cultural influence often plays a large role in how individuals encounter and learn about environmental risk, Friedman’s work aims to understand factors influencing risk perception in order to develop culturally appropriate, evidence-based messages.
"Understanding community needs and cultural contexts is crucial to creating health messages for a specific group," Friedman said. "We can't accomplish anything in public health if we can’t figure out the best ways to reach people, and that means working closely with the communities from the start."
To better understand how their target audience learns, processes, and understands information about breast cancer risk, Friedman and her multidisciplinary team divided the SCERC project into three phases, each with a different objective in understanding risk perception.
Using a Multi-Step Study to Gather Information
In the first phase of SCERC, African-American women from central South Carolina were invited to participate in focus groups to share and discuss what they already know about breast cancer and environmental risk. This step assessed not only the women’s health literacy but also the readability and cultural sensitivity of information they use. Friedman and her team paid special attention to small details the women shared, including the specific language they use in internet searches and their preferences for how they like to receive information about breast cancer risk.
The team determined that although some participants found credible sources about health risks, they did not always understand or know how to navigate the information. "Health literacy is complex, especially given the vast amount of information available on the internet," Friedman said. "Having access to information doesn't mean you are necessarily going to know how to use it," she explained. Understanding not only what kind of information is available but also how it will realistically be used by the intended audience is a key component of SCERC's first and second phases.
Using information gathered from the first phase, the team will develop visual representations of environmental risks for breast cancer to share with focus group participants. These could include one-page infographics, story maps, posters, or educational campaign videos. The research team will then evaluate how women respond to the information and update the materials based on their information needs. Data collected from this second phase will help shape information outreach for future health education campaigns for breast cancer and other diseases.
For the third phase, the women will be asked to go out into their communities and take photographs of things that they feel are exposure risks, a qualitative research method called PhotoVoice. As part of the final product, the research team will put together a display of the photographs and hold a discussion where women can talk about risks they saw in their communities. Friedman has utilized the PhotoVoice method in other projects and is a proponent of the functional health literacy benefits it provides to research. "PhotoVoice is a great way to see the community and its risks through the eyes of people who know it best," Friedman said.
Moving forward, Friedman hopes that the messaging techniques her team learns from this study can be applied statewide or, possibly, on an even larger scale. Though SCERC is purely an informative project, meaning that there is no intervention aspect, Friedman hopes that the study will inform future projects aimed at improving health literacy for many different health issues, not just breast cancer. "It's just about figuring out the best ways we can get information back to people who need it the most."
Phil Brown, Ph.D. – Understanding Community Awareness and Actions on Environmental Health Issues
September 05, 2017
NIEHS grantee Phil Brown, Ph.D., studies social movements dealing with environmental health. Brown is passionate about integrating social sciences into environmental health, and expanding collaborations between experts in these fields.
A medical sociologist by training, Brown first became interested in environmental health in the 1980s when he connected with colleague Edwin Mikkelsen, M.D., a psychiatrist who served as an expert witness in preparation for the Woburn toxic waste trial. The trial was centered on a civil action lawsuit by community members of Woburn, MA, who alleged that well water contaminated by local industries was responsible for numerous cases of childhood leukemia.
To document stories of affected families and the outcome of the trial, Brown and Mikkelsen wrote a book entitled, "No Safe Place: Toxic Waste, Leukemia, and Community Action." After the book was published, Brown began meeting with different people in academia and research who were interested in learning more about community actions around issues of toxic waste. "Suddenly, my career took a huge shift towards environmental sociology," Brown said. "I became interested in exploring how social factors influence a community’s risk of exposure to environmental contaminants, and understanding the politics associated with these issues."
Expanding Collaborations between Social Scientists and Environmental Health Researchers
From 1980 to 2012, Brown worked as a professor of sociology and environmental studies at Brown University. In 1999, he founded the Contested Illnesses Research Group (CIRG), an interdisciplinary team of environmental sociologists and environmental health experts, to investigate disputes over environmental causation of disease. CIRG was involved in several environmental health initiatives, including community-based participatory research projects through the previously funded NIEHS/EPA Formative Center for the Evaluation of Environmental Impacts on Fetal Development at Brown University, and the NIEHS-funded Brown University Superfund Research Program (SRP) Center.
In 2012, Brown moved to Northeastern University where he founded the Social Science Environmental Health Research Institute (SSEHRI). SSEHRI is a hub for collaboration integrating the disciplines of environmental science, sociology, and technology. Members perform social science oriented research, training, and policy work related to environmental health issues. The institute also provides cross-training opportunities for undergraduate and graduate students through two NIEHS-funded programs – the Research Opportunities for Undergraduates: Training in Environmental Health Science and the Transdisciplinary Training at the Intersection of Environmental Health and Social Science program.
"The institute has helped shift the nature of environmental health research at Northeastern," Brown said. "It has really helped researchers understand the importance of looking at things beyond the laboratory. They are more equipped to address environmental health issues by working with community partners and looking at the community-level impacts of contamination."
Understanding Public Awareness and the Occurrence of Perfluorinated Chemicals
With funding from the National Science Foundation, Brown and colleagues are investigating different factors that impact the general public's awareness and discovery of environmental and health impacts related to per- and polyfluoroalkyl substances (PFAS), also commonly known as perfluorinated chemicals (PFCs). These are a class of manufactured compounds that are widely used by various industries to make everyday products more resistant to stains, grease, and water. They are also used to develop some firefighting foams.
Although discovery of PFC contamination and associated adverse health effects began in the 1960s, the potential hazards of these chemicals often remain invisible to the public.
To promote broader public awareness of PFCs and their potential hazards to health, Brown worked with the Environmental Working Group to develop an interactive, nationwide map of PFC contamination. The map was created by combining data from two sources: drinking water data from the U.S. EPA’s Third Unregulated Contaminant Monitoring Rule, and a database on all publicly documented cases of PFC pollution at different industrial and military sites from Brown’s team. The map was launched one week before the SSEHRI’s June 2017 conference on "Highly Fluorinated Compounds – Social and Scientific Discovery." During the two-day conference, nearly 180 stakeholders from federal agencies, academia, community organizations, and activist groups gathered to discuss the social, scientific, political, economic, and environmental health issues associated with PFCs.
"The map has been really useful in increasing the awareness of PFC contamination," Brown said. "Very often, it is the first time that communities are made aware that their local water supply has levels of PFCs that are above the U.S. EPA’s health advisory."
Communicating Environmental Health Data to Communities
Brown works closely with Julia Brody, Ph.D., long-time collaborator and executive director of the Silent Spring Institute, to refine and improve the process of communicating environmental health data to study participants and communities. "It is also important to understand that different communities have different needs for these types of data – some want to have results reported at the aggregate, or collective, level, and others at the individual level," Brown stated.
Researchers and ethics committees have various perspectives about the benefits and challenges of the report-back process. In a recent article, Brown, Brody, and other colleagues summarize findings from semi-structured interviews with researchers and institutional review board (IRB) members. Researchers reported multiple benefits of the report-back process, including the advancement of environmental health literacy and empowerment of study participants to take actions to reduce harmful exposures. IRB members also reported concerns of potential harm for study participants, such as anxiety and counterproductive behavior changes, resulting from poor communication.
Brown and Brody worked with others to create the Digital Exposure Report-Back Interface (DERBI), a digital interface that facilitates customized report-back of environmental health data to study participants via online materials. A recent article summarizes how the investigators field-tested DERBI, demonstrating its utility to help researchers meet ethical obligations for reporting environmental health data and provide participants with the knowledge they need to make informed decisions. Moving forward, Brown and colleagues will work with Northeastern's SRP Center, PROTECT, to share data with study participants using a new smart phone application that will deliver DERBI data on phthalates, volatile organic compounds, and other contaminants. This application will help Center researchers provide participants with customized reports of environmental health data in a timely, easily accessible, and user-friendly format.
- Cordner A, Richter L, Brown P. Can chemical class approaches replace chemical-by-chemical strategies? Lessons from recent U.S. FDA regulatory action on per- and polyfluoroalkyl substances. Environ Sci Technol 2016 Dec; 50(23): 12584-591. [Abstract]
- Ramirez-Andreotta MD, Brody JG, Lothrop N, Loh M, Beamer PI, Brown P. Improving environmental health literacy and justice through environmental exposures results communication. Int J Environ Res Public Health 2016 Jul; 13(7). [Abstract]
- Hoover E, Renauld M, Edelstein MR, Brown P. Social science collaboration with environmental health. Environ Health Perspect 2015 Nov; 123(11): 1100-6. [Abstract]
Keith Pezzoli, Ph.D., – Promoting Healthy Places, Healthy People, and Rooted Communities through a Bioregional Framework
August 11, 2017
Keith Pezzoli, Ph.D., director of the Urban Studies and Planning Program, and Teaching Professor in the Department of Communication at the University of California, San Diego (UCSD), is committed to community-engaged research and cross-disciplinary partnerships that support bioregional planning. This approach aims to create healthy places and healthy people by recognizing how cities and neighborhoods are embedded in their larger geographical region.
Specifically, bioregional planning highlights the connection between urban areas and their rural counterparts that produce food, wood, and other important resources.
"The social and ecological systems that provide us with food, energy, and water are increasingly stressed–so much so that the National Science Foundation says we face a serious predicament for the security of these resources. Cumulative environmental public health impacts associated with climate change, ecological degradation, pollution, poverty, obesity and poor nutrition are driving up rates of preventable chronic diseases," said Pezzoli.
Considering this complexity, Pezzoli is an advocate for rooted universities that leverage institutional knowledge and expertise to address key issues in their communities. Together with Robert Tukey, Ph.D., Director of the NIEHS-funded UCSD Superfund Research Program Center (SRP Center) and Mirle Bussell, Ph.D., Director of Field Research in UCSD’s Urban Studies and Planning Program, Pezzoli founded the Bioregional Center for Sustainability Science, Planning and Design.
"The Bioregional Center embraces a theory of change that highlights the importance of mobilizing the grassroots and treetops, and the need to promote local yet globally-minded place-based interventions that are attuned to seeking bioregional resilience and justice," noted Pezzoli.
Connecting Science and Community Needs — Ocean View Growing Grounds
Pezzoli leads the Community Engagement and Research Translation Cores of the UCSD SRP Center. In a collaborative effort led by the Global Action Research Center (Global ARC), the Bioregional Center and UC Global Food Initiative, along with local community groups, and private landowner and residents, the UCSD SRP Center has been helping transform a 20,000 square foot vacant lot into the Ocean View Growing Grounds (OVGG).
Located in Southeast San Diego, the OVGG includes a community garden, a food forest, and neighborhood-based environmental research and learning center. OVGG was initiated as a collaboration between researchers and students at UCSD, local nonprofit organizations, and residents to address the combined effects of poverty, obesity, environmental pollution and degradation, and lack of access to fresh fruits and vegetables. This solutions-oriented approach to environmental and public health concerns offers the community a unique place to grow nutritious food, learn about urban agriculture, agroforestry and healthy eating, and to hold community events.
Global ARC, the lead entity establishing the OVGG, won a UCSD Sustainability Award for Outstanding Collaboration. The OVGG collaborative represents the kind of work Pezzoli advocates for in rooting universities to their communities. "OVGG is a shining example of creating a place where residents and non-profits can work with the University on food, water, energy and soil security to create healthy places and healthy people. It provides a platform where collaborating with the community enables research to be a part of their lives and empowers them to make informed decisions or take action to improve their wellbeing. Community engagement also enriches the science by elevating its application in the real world and contributing to the scientific agenda," Pezzoli noted.
Bioregionalism Across Borders
With the UCSD SRP Center, Pezzoli is also involved in partnerships to help reduce exposures to hazardous wastes and to improve environmental public health in the San Diego-Tijuana border region. He uses community-based participatory approaches to engage and learn from community leaders.
This exchange informs approaches for capacity building in vulnerable communities to identify, prioritize, and address Superfund-related environmental health hazards and issues. He also works with government, industry, and non-profits to build their capacity to use novel technologies to detect and remediate Superfund pollutants.
"The work that we do is very mindful of how regions are interconnected around the world and how we can work together to address issues like environmental pollution, food and water insecurity, climate change, and increasing energy demands through the lens of bioregional justice and by linking human health with regional and ecosystem health," said Pezzoli.
Pezzoli's work highlights the importance of rooted community-university partnerships and translating research into action. With this approach, Pezzoli and his collaborators are embracing a framework that considers the linkages among food, water, and energy systems to move scientific research and communities towards healthy, just, and sustainable futures.
Pezzoli K, Leiter RA. 2016. Creating healthy and just bioregions. Rev Environ Health 31(1):103-109. [Abstract]
Pezzoli, K. 2016. Bioregionalism. In: Keywords for Environmental Studies (Adamson J, Gleason WA, Pellow DN, eds.). New York, NY: New York University Press, 25-28.
Pezzoli K, Kozo J, Ferran K, Wooten W, Gomez GR, Al-Delaimy WK. 2014. One Bioregion/One Health: an integrative narrative for transboundary planning along the US-Mexico border. Glob Soc 28(4):419-440. [Full Text]
Nicholas Newman, D.O. – Preparing Doctors to Meet Their Patients' Environmental Health Needs
July 25, 2017
NIEHS grantee Nicholas Newman, D.O., director of the Environmental Health and Lead Clinic at Cincinnati Children’s Hospital, is bridging the gap between how clinicians treat illness related to exposures and on-the-ground prevention strategies in the communities they serve. To do so, he has developed an interactive environmental health curriculum to prepare doctors to meet their patients’ needs.
Newman’s interest in environmental health was encouraged by a simple conversation with other pediatricians during the 2004 annual conference for the Michigan Chapter of the American Academy of Pediatrics. They realized there was a need to link environmental health, public health prevention, and the approach that pediatricians and other clinicians use when treating patients.
Newman and his colleagues began developing an integrated curriculum to help clinicians better understand the link between environmental health and prevention of disease. This curriculum pairs classroom instruction on environmental health issues, such as asthma, with community-based prevention strategies. “This conversation ended up turning into something much bigger – it was pure serendipity,” Newman said. Since that conversation, Newman has been devoted to translating knowledge about environmental health and developing an interactive environmental health curriculum for medical students who are pursuing clinical careers.
Emphasizing the Role of Public and Environmental Health for Clinical Practice
Newman aims to help medical students better understand the importance of public and environmental health for clinical practice by demonstrating the impact environmental exposures can have on a patient’s everyday life. “Clinicians generally do not ask specifics about the patient or their parent’s occupation,” said Newman. “They are typically more focused on treating disease symptoms rather than searching for hidden factors. For example, there is a big difference between exposure risks for a custodian who works at a school versus one who works at a foundry.”
To overcome this knowledge gap, Newman instructs his students to consider how lifestyle factors or social determinants may influence a patient’s risk of exposure to different chemicals. For example, patients from low-income communities may have higher risk of exposure to chemicals, and may have less access to healthcare. Furthermore, these communities may lack the resources needed to change the harmful exposures they face as part of their day-to-day activities at work or at home. Newman feels that it is crucial for medical students to understand the importance of these factors as they prepare to treat people from at-risk communities.
Developing an Interactive Environmental Health Curriculum
Newman developed the dynamic environmental health curriculum in collaboration with colleagues from the NIEHS-funded Center for Environmental Genetics (CEG) and experts within the Pediatric Environmental Health Specialty Units. Designed to align with teaching objectives for departments within the University of Cincinnati College of Medicine, the curriculum is currently being used to teach first- and second-year medical students. For example, “The Physician and Society,” a course within the Department of Family and Community Medicine, assigns medical students to a nearby at-risk community and an associated non-governmental organization (NGO). The students work with these NGOs to identify and assess each community’s health needs, and develop a service learning project to help address these needs. For example, in one service learning project, students work with investigators from the CEG collecting soil samples for a proposed urban garden.
“The importance of these projects is two-fold,” Newman emphasized. “It allows the students to have contact with the communities they will treat and observe the environmental conditions that might be important. It also demonstrates to the communities how medical professionals are working to create a safer, healthier community.”
Next Steps: Meeting the Evolving Needs of Students and Communities
In response to the evolving needs of medical students and the communities they serve, the curriculum content is constantly changing. Though still in early development, it has generated a great deal of interest among medical students. For example, several students have reached out to CEG researchers for continued participation in service learning projects, particularly those related to development of urban gardens.
Moving forward, Newman plans to formally evaluate the curriculum to make it more rigorous. Newman will work with colleagues in the Department of Family and Community Medicine to gather feedback from students on the curriculum, and alter it accordingly. “As we fine-tune the course content and activities, the long-term goal is to integrate this into the established medical training at the University of Cincinnati,” said Newman. “We want to ensure that the curriculum becomes a strong supplement to medical students’ education, which will help them be better prepared to address the environmental health concerns of the communities they serve.”
Frances K. Barg, Ph.D. – Engaging Community Members to Understand Long-Term Implications of Hazardous Waste
July 7, 2017
Frances Barg, Ph.D., Associate Professor of Family Medicine and Community Health , director of the University of Pennsylvania’s (U Penn) Mixed Methods Research Lab and co-lead for the U Penn Superfund Research Program (SRP) Community Engagement Core, has worked diligently to find creative and intuitive ways to engage communities affected by hazardous waste. Barg, a medical anthropologist, uses social science methods to understand the current and long-term impact of exposure to asbestos for residents of Ambler, PA.
Asbestos Exposure and Risk
Prior to the 1990s, asbestos, a naturally occurring mineral, was widely used in commercial products for insulation, sound absorption, and flame resistance. Asbestos use declined in the 1980s after scientific evidence showed exposure was associated with serious health problems, including a rare form of cancer called mesothelioma.
The National Institute of Health estimates that approximately 11 million people were exposed to asbestos between 1940 and 1978. Many of these exposures occurred at work, but families of workers and communities near asbestos operations were also at risk.
Approximately 20 miles from Philadelphia, the BoRit site in Ambler, PA was once a global leader in asbestos production. Although many residents were concerned about asbestos exposure in Ambler when the U.S. EPA designated BoRit as a National Priority Superfund site in 2009, the Ambler residents expressed increased concerns about their health as well as what this designation would mean for the future of their community.
Exploring Community Perception of Hazardous Materials
Barg and her co-investigator, Edward Emmett, Ph.D., (Director of the Community Engagement Core) initiated a pilot project with funding from the University of Pennsylvania Center for Excellence in Environmental Toxicology (CEET) in which Ambler residents interviewed each other about their experience with asbestos. A variety of Ambler residents participated, including those who worked in the asbestos factory and newcomers who arrived long after the industry had left. The interviews highlighted the diverse experiences with asbestos in the community. "It became clear that the main concern was their lack of information about the health effects of asbestos exposure and federal regulation standards. This led to a lot of uncertainty about possible impacts to their health and the town’s future," said Barg.
Based on the information gathered, Barg and her team expanded the pilot project to form a larger initiative called Resources for Education and Action for Community Health in Ambler (REACH Ambler), which connected scientific studies to oral history given by the community. Forming a partnership between the University of Pennsylvania School of Medicine and the Chemical Heritage Foundation, the REACH Ambler team received a $1.2 million Science Education Partnership Award from the NIH to educate the residents of Ambler about asbestos and its risks, and more importantly, tell the story of Ambler and its residents.
Barg was interested in understanding community-level exposure to asbestos, and the various social, lifestyle, and economic factors that influence exposure. Working closely with the community not only provided information about those factors, but helped the researchers understand the perspective of the residents. "Understanding the realities of living with asbestos in the community from the point of view of the residents really helped REACH researchers to understand the anxieties of the townspeople. This is important because perceived risk and government-designated risk can vary dramatically," Barg said.
The REACH Ambler team developed a comprehensive website (link above) detailing the story of Ambler and providing resources for additional information for the community. They also collaborated with local playwrights to incorporate the life histories of several residents into one-act plays. Entitled “White Mountains,” a local nickname for mounds of asbestos waste in the community, these plays offered a creative avenue for communicating issues related to asbestos exposure and the future of Ambler to the community in a creative and informative way.
Continuing Community Involvement
Moving forward, Barg hopes that the work of REACH Ambler will continue through ongoing dedication of the citizens who made the project so successful and the continued efforts of the Community Engagement Core. Barg also hopes to continue her approach to understanding the impact of exposure in other communities affected by hazardous waste. One such community is in Libby, Montana. Though Libby is a vastly different community from Ambler, they share a commonality in their exposure to asbestos. "Expanding this work to a community like Libby will help us better understand the commonalities across communities facing hazardous waste to broaden the application of our work," said Barg.
Clapp JT, Roberts JA, Dahlberg B, Berry LS, Jacobs LM, Emmett EA, Barg FK. Realities of environmental Toxicity and their ramifications for community engagement. Soc Sci Med 2016 Dec; 170: 143-151.
Carmen M. Vélez-Vega, Ph.D. – Establishing Partnerships to Address Environmental Health Concerns for Pregnant Women and Children in Puerto Rico
June 21, 2017
PROTECT and CRECE are multi-project, multi-institution collaborations based at Northeastern University in Boston, Massachusetts. PROTECT is supported by funding through the NIEHS Superfund Research Program, and CRECE is supported by the NIEHS and EPA Children’s Environmental Health and Disease Prevention Research Centers Program.
Carmen Vélez-Vega, Ph.D., has witnessed first-hand how underserved communities are impacted by health disparities, social inequalities, and a lack of public health infrastructure. Vélez-Vega, who spent most of her life in Puerto Rico, has a strong passion for social justice, public health, and equality that is firmly rooted in her own personal experiences. "I have been passionate about these things since I was young, and have always wanted to help people," she said.
Puerto Rico, an island with a rich cultural history and dense population, faces dire public and environmental health concerns. Heavily laden with hazardous industrial waste, Puerto Rico has more than 200 contaminated sites, which includes 17 active Superfund sites. Phthalates, which are often found at these sites, have been associated with adverse health outcomes such as preterm birth. Compared with the rest of the general U.S. population, Puerto Rico experiences an unusually high rate of preterm birth, which is also associated with many chronic health conditions and developmental disabilities.
After obtaining her bachelors and masters of social work degree, Vélez-Vega worked with incarcerated young people and was involved in peer education for the HIV/AIDS movement. She also served as the Director of the Child Development Center within the Puerto Rico Institute on Developmental Disabilities. These experiences motivated her to pursue a doctoral degree in social policy research and analysis. "I really wanted to help give a voice to people who are not typically listened to or included in the policy development and analysis process," she said. Her expertise in social work and social policy offer a promising foundation to inform and create local changes to tackle Puerto Rico's public and environmental health issues.
Enhancing Environmental Health Research in Puerto Rico through Community Engagement
Vélez-Vega and Northeastern colleague Phil Brown, Ph.D., co-lead the community engagement core for the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center and the community outreach and translation core of the newly funded Center for Research on Early Childhood Exposure and Development in Puerto Rico (CRECE). PROTECT studies how environmental exposures during pregnancy are potentially associated with preterm birth, while CRECE follows the children of mothers enrolled in PROTECT to study how complex environmental exposures affect their health and development through age four.
The community engagement and outreach cores perform bidirectional communication and serve as the Centers' interface with study participants, community members, health agencies, and local organizations. As co-leads of these cores, Vélez-Vega and Brown are responsible for building trust with women enrolled in the study, reporting-back individual and aggregate study results, and working with local community health centers and health care professionals to educate families and intervene to reduce health risks associated with environmental exposures.
Educating Health Care Professionals
Collaboration and communication with health care professionals and local community health centers is crucial to make research and community engagement efforts effective, and to create meaningful changes in Puerto Rico's public health infrastructure. Vélez-Vega and colleagues are working to raise health care professionals’ awareness on issues related to environmental exposures. They also offer training for health care professionals to help them develop early interventions for women and children impacted by certain exposures. "Most health care professionals don't receive formal training on environmental health, so it would be nice to have regulations in place that require them to take a certain amount of environmental health credit hours in medical school. This way, they can be more informed to make referrals for the patients and communities they serve," Vélez-Vega said. "The health care professionals we work with are very interested in environmental health, and are very enthusiastic about learning more."
With insights from another colleague, Emily Zimmerman, Ph.D., Vélez-Vega is taking outreach efforts a step further to educate speech and language pathologists in Puerto Rico, who have historically not been included in conversations about environmental health. PROTECT and CRECE researchers anticipate that certain environmental exposures may lead to a behavior in infants called non-nutritive sucking. This behavior is an established measure of newborn central nervous system function, and a novel measure of neonatal development for environmental epidemiological studies.
Raising Awareness on the Zika Virus
More recently, Vélez-Vega has become involved in the ongoing Zika in Infants and Pregnancy (ZIP) study in Puerto Rico. As part of this study, researchers are following pregnant women who are at risk and performing biological sampling. Vélez-Vega and her long-time mentor José Cordero, M.D., co-director of PROTECT, are currently consulting a team of researchers with the Centers for Disease Control and Prevention on how to engage local communities in Zika outreach and education efforts. "Some people are really unaware as to how critical the Zika situation is here in Puerto Rico," she said. "Microcephaly, or an abnormally small head, is indeed the worst consequence of Zika exposure for babies; however, there are many other birth defects and outcomes that we need to be aware of, which could potentially lead to developmental disabilities for the babies later in life."
Moving forward, Vélez-Vega and colleagues will continue these efforts by collaborating with health care professionals at federally qualified community health centers. Their goal is to improve health care professionals' attention to early signs of infant developmental delays that are potentially associated with Zika virus infections and/or exposure to environmental contaminants. Vélez-Vega expressed that every child is entitled to the appropriate protections and support needed to ensure a healthy life.
Melanie Pearson, Ph.D. – Working with Atlanta Communities to Address Environmental Health Concerns
June 9, 2017
Melanie Pearson, Ph.D., a community outreach specialist at Emory University, strives to integrate community voices into exposure science by building collaborations between communities and local scientists.
One of Pearson’s first projects at Emory focused on helping metro-Atlanta communities understand the health impacts of pesticides. After a local soccer field was sprayed with a harmful pesticide, many children became ill and one was hospitalized. Pearson immediately got involved to help the community develop an integrated pest management approach to minimize pesticide use and reduce human and environmental health hazards.
More recently, Pearson helped establish and shape the NIEHS-funded HERCULES Exposome Research Center at Emory. The HERCULES Center focuses on understanding health within the context of an individual’s lifetime of environmental exposures, called the exposome. The exposome includes all routes of exposure to environmental agents, lifestyle factors, and behaviors from conception onward. Center researchers are working to describe the influence of the exposome on health across the lifespan.
Working with Communities to Drive Change
Pearson co-directs the Community Outreach and Engagement Core (COEC) with Michelle Kegler, Dr.P.H., at the HERCULES Center. Community-based research and outreach at the Center is overseen by an active stakeholder advisory board that includes members of the community, non-profit organizations, government agencies, and academic partners. Since the Center was founded in 2013, it has been successful in using community-based participatory research to address a variety of Atlanta’s environmental health concerns.
One example is the Brochure on Proctor Creek Community Collaborative Health Survey, which grew from a community meeting focused on environmental health disparities in Atlanta. During the meeting, HERCULES scientists and Yomi Noibi, Ph.D., executive director of ECO-Action, recognized a common research interest. Two low-income Atlanta neighborhoods were identified as suffering from frequent flooding, indoor mold, and asthma. Joining forces, the groups worked with the community to design and conduct a survey to assess whether the flooding was contributing to household mold and thus exacerbating asthma in the community. Mold was found in 35 percent of the 150 homes surveyed— far above the national average.
Based on the survey’s findings, partners created educational materials and planned interventions to respond. “By building an evidence base, we were able to help the community corroborate the source of their health problems, while guiding them to respond and advocate for themselves,” said Pearson.
Strengthening Community Capacity
To further advance its goals, the HERCULES Center started a highly successful community grant program that awards $2,500 to community-based organizations seeking to collect information about, promote awareness of, or build capacity to address local environmental health concerns. The Center also initiated a pilot project program that seeks applications for community-engaged research projects designed to address environmental health risks of concern. These grant programs have enabled the community to tackle a variety of concerns.
For example, during a community meeting, residents complained about brown, smelly water running from their kitchen and bathroom faucets after heavy rain events. To investigate this problem, local scientists applied for a HERCULES pilot grant to test drinking water for microbial and chemical contaminants following rain events. Residents played an active role by collecting water samples and using chlorine dipsticks to measure chlorine in their drinking water.
“While participating in the data collection and analysis, residents have found a sense of empowerment and ownership, encouraging interest in research findings and building community capacity,” said Pearson.
Other examples of how recipients of HERCULES community grants have helped build capacity to address environmental health concerns include:
- Designing an awareness campaign to educate a large immigrant and refugee community about the second-hand risks of smoking;
- Establishing an urban farm providing healthy food to Atlanta’s homeless; and
- Creating hazardous waste disposal education information for refugee residents.
According to Pearson, the Center’s focus on the exposome has helped give voice to the community’s varied concerns by providing a holistic view of human health and disease. Additionally, the diversity of people and organizations involved in their work has proven a significant asset. “HERCULES is a network of know-how, enabling our group to figure out complex challenges. Learning from each other has been very important,” said Pearson.
Moving forward, Pearson would like to continue building collaborations between communities and local scientists. “There is deep knowledge within the community about the community,” Pearson said. “I’m amazed by how much knowledge comes from the community — not just concerns — but also knowledge.” By harnessing this knowledge, Center researchers can integrate the community voice into exposome science and the way science is conducted, to make it more meaningful to the community residents.
Panagis Galiatsatos, M.D. – Bridging the Gap between Health Care Providers and Residents in Baltimore
May 9, 2017
Panagis Galiatsatos, M.D., a pulmonary and critical care fellow at Johns Hopkins University School of Medicine, studies how environmental exposures and health disparities impact people with lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma. He also encourages academic medical community members to engage with residents of Baltimore through a program that integrates health education, policy, and community empowerment to mitigate health disparities. “The biggest concern is knowledge. People often receive a lot of misinformation, so one of our goals is to not only raise awareness, but to help people separate myth from fact,” said Galiatsatos.
Addressing Health Disparities in Baltimore
An extension of the NIEHS/EPA co-funded Center for Childhood Asthma in the Urban Environment , Galiatsatos is conducting research with the Comparing Urban and Rural Effects of Poverty on COPD (CURE COPD) Center at Johns Hopkins University. The research, comparing communities in urban Baltimore and rural Appalachia, aims to examine how the interaction of obesity, diet, and air pollution increase the susceptibility to COPD in low-income homes. Since indoor air pollution has been shown to be higher in low-income households, and because both communities suffer disproportionate prevalence and morbidity from COPD, obesity, and poor diet, the Center is working to understand the complex interactive effects underlying health disparities in these communities.
In Baltimore, Galiatsatos and his team are exploring obesity and dietary patterns as susceptibility factors to pollutant exposure in low-income adults with COPD. In addition, based on the observation that pollutant concentrations are higher in the homes of smokers, they are working to understand how smoking behaviors or attitudes of residents in public housing units, and accessibility of tobacco products contribute to high levels of indoor air pollution.
“One of the primary questions we’re thinking about at the CURE COPD Center is how researchers can provide culturally sensitive findings to stakeholders, promote engagement with community members, and build capacity in environmental health literacy and risk prevention,” said Galiatsatos.
The information collected by the Center will be used to inform practical targeted interventions to improve COPD health in this high-risk population. In addition, the team is involved in a variety of health promotion activities to address the environmental health disparities of indoor air pollution in low income populations. These include educating people about making healthier choices and communicating with local clinical professionals and policy makers to further protect the health of these impacted communities. Galiatsatos is also collaborating with counselors, physicians, and religious leaders to implement community outreach programs that promote good health practices.
Promoting Community Empowerment through Health Education
Galiatsatos is the co-director and co-founder of the medical education partnership Medicine for the Greater Good (MGG), established in 2013 at the Johns Hopkins Bayview Medical Center.
Aimed at promoting wellness and partnerships beyond the hospital walls, this program creates medical education workshops where MGG volunteers work with schools, churches, and community centers to promote good health practices in the community. The MGG program has completed more than 32 workshops and facilitated over 282 projects that bring health professionals into the community to facilitate discussions about diseases, diet, and exercise, among others. The projects have involved more than 80 medical residents and other students in health professions who worked with over 1000 people in Baltimore communities.
By encouraging physicians to take preventive care to the community and collaborate with local partners, the MGG program is helping to address health disparities in Baltimore. For example, the Caring for a Neighborhood project focuses on access to healthy food, asthma awareness, and mentorship. B’More Asthma Free helps parents overcome barriers to asthma care, and educates families on asthma symptoms, treatments, and environmental factors that can make the disease worse.
Through community engagement, Galiatsatos hopes to use health education to mitigate health disparities in low income populations in Baltimore. Moving forward, Galiatsatos hopes to expand community-based outreach programs like MGG and to use the information acquired from these programs to communicate with decision makers to improve health and address health disparities
Madeleine Scammell, D.Sc., Connecting Local Environmental Health Concerns to Scientific Research
April 12, 2017
Madeleine Scammell, D.Sc., a recent recipient of the competitive NIEHS Outstanding New Environmental Health Science award, is committed to helping communities understand and address the effects of environmental hazards on human health. As an assistant professor at the Boston University (BU) School of Public Health, Scammell has developed and maintained strong partnerships with organizations in the Northeast to provide technical assistance to communities faced with environmental health concerns.
Scammell currently leads the NIEHS BU NIEHS BU Superfund Research Program (SRP) Center Community Engagement Core (CEC), which aims to increase the awareness and utility of BU SRP Center research for communities living near hazardous waste sites or who are affected by other environmental health hazards. She began her work with the BU CEC as a graduate student and has maintained her commitment to fostering community partnerships and working with nearby residents on environmental health issues.
She also leads the CEC for the Center for Research on Environmental and Social Stressors in Housing Across the Life Course (CRESSH), a partnership between the BU School of Public Health and the Harvard T.H. Chan School of Public Health that studies environmental health disparities in low-income communities and throughout Massachusetts.
Responding to community needs
In her capacity as the BU SRP CEC leader, Scammell works primarily with two community partners, Alternatives for Community and Environment (ACE) and Toxics Action Center, to provide information and to empower residents to reduce their exposures to contaminants.
In one project, Scammell is working with partners to determine ambient exposure to polychlorinated biphenyls (PCBs) experienced by residents living near the New Bedford Harbor Superfund site. Between the 1940s and 1970s, PCBs were improperly disposed of directly into the New Bedford Harbor. Cleanup of the harbor is underway, but residents were concerned that dredging of the harbor sediment to remove contaminants could lead to temporary release of PCBs into the air.
"Through ACE, we learned about these specific community concerns about PCB emissions into the air during the harbor cleanup," said Scammell. "The BU SRP Center didn’t have the capacity to respond to their questions about air quality alone, so we partnered with the SRP Center at the University of Iowa, which specializes in ambient PCB air monitoring. We partnered with them to address the community's concerns."
Scammell, along with BU colleagues, students, and CEC community partners, collaborated with residents to place air quality monitors designed by the Iowa SRP Center throughout the communities surrounding the harbor. The researchers and community members have met numerous times over the last year to share and discuss the results. This included prior to a recent publication by the research team, including Scammell, that reported elevated airborne PCB concentrations in the air surrounding New Bedford Harbor and indicated that PCBs are being released into the air from the water. Air measurements have a very strong signature consistent with the two PCB mixtures used in New Bedford that led to contamination of the harbor.
Providing resources to empower communities
From her experience in community-based research, Scammell worked with colleagues to develop a Health Studies Guide to help community groups think through whether a health study may be useful or necessary in their community in response to environmental concerns, such as drinking water contamination. The guide describes a wide range of health studies and walks through the process of choosing and designing a study.
"Scientists who have worked with community groups for many years to address environmental health problems contributed to this guide, as well as community leaders and organizers," said Scammell. "We include insights from focus groups and interviews with community members as well as our own experiences with studies that did or did not resolve community problems."
Scammell also led the launch of the Health and Environment Assistance Resources (HEAR) database, a tool for linking legal, scientific, and technical experts with community groups who have questions or concerns about environmental issues in their neighborhoods. Today, the HEAR database contains more than 400 experts and has led to partnerships between communities and HEAR experts throughout Massachusetts, Maine, Connecticut, Rhode Island, and Vermont.
Scammell and partners have also produced a variety of factsheets and other resources that may be useful to residents facing environmental and health concerns, available on the BU SRP website.
The importance of the community in scientific research
"As an undergraduate, the disconnect between University research and nearby public health, environmental, social, and economic challenges was clear," said Scammell. After completing her undergraduate degree, she worked for five years at a non-profit organization whose mission was to democratize science and technology.
"We ran a community research network where we linked researchers with community groups, and vice versa," said Scammell. "That is where I learned about NIEHS and their work on community-based research and environmental justice. This informed my desire to be the type of scientist that works with communities on the questions of most concern to them."
These early experiences provided perspectives that she brought with her to BU. Through her current work, Scammell recognizes that community groups have valuable skills that can facilitate community engaged research. She has learned a lot from their community partners on how to best engage local residents, as well as how to turn science into action. She continues to develop and maintain productive partnerships with local organizations and communities.
Jani Ingram, Ph.D. –Addressing Environmental Health Needs of Navajo Nation
February 6, 2017
Jani Ingram, Ph.D., professor of chemistry and biochemistry at Northern Arizona University (NAU), encourages students and citizens in the Navajo community to collaborate in scientific research that addresses local environmental health concerns. Throughout the years she has made significant contributions in the research of carcinogenic chemicals in the environment, especially uranium, and its impact to the Navajo community.
Uranium Exposure in the Navajo Nation
Ingram, who is a member of the Navajo Nation, first became interested in studying uranium contamination in the reservation in 2002. Uranium mining was a prominent industry in the southwestern United States, leaving a burden of uranium contamination throughout the region. Sources of uranium exposure include abandoned uranium mines, contaminated structures, and contaminated wells. There are 521 abandoned mines in the reservation, many found to have higher levels of gamma radiation than background levels. Investigating uranium exposure is critical for the Navajo community because a large portion of the population still relies on water from unregulated wells for their consumption, household, and livestock needs. Uranium exposure is known to damage the kidneys and increase the risk of cancer and liver disease.
Given Ingram’s past experience researching chemical contamination with the U.S. Department of Energy, she decided to evaluate the issue of contamination and health impacts in the Navajo lands with a goal of distributing information to tribal leaders to help them assess contamination. As an investigator of the training core at NAU for the Partnership of Native American Cancer Prevention (NACP) and director of the Bridging Native American Students to Bachelor’s Degree (BRIDGES) program, Ingram used her research to provide Native American students the opportunity to experience scientifically challenging research of interest to them and the Navajo community. “My heart and soul is in training students, and I’ve seen how passionate the students get and most importantly how it has encouraged them to continue their studies,” said Ingram.
Ingram is actively involved in creating a system of student empowerment by providing professional development opportunities while engaging the residents and tribal leaders of the Navajo nation. For example, undergraduates can engage in research programs during their first and second year, participate in graduate summer transitional enrichment programs, work with NACP investigators and NAU faculty, and attend seminars, presentations, conferences, and meetings creating a pathway towards a graduate program. “Problems on the reservation are going to be best solved by the Navajo students who help their community by going forward,” said Ingram.
Ingram and the students focused their research on three sites in the Navajo Reservation: Cameron, Blackfalls, and Leupp. They took samples from over 200 water wells, open mine sites, and sheep. In the unregulated wells they found high levels of uranium and arsenic. The results showed that the wells contained arsenic levels 40 percent higher than the EPA drinking water standard of 10 ppb and contained uranium levels 20 percent higher than EPA standard of 30 ppb. In livestock, they found similar uranium levels in the sheep from Leupp and Cameron. In further studies Ingram wants to include sheep off the reservation to have a better comparison group.
The unexpected high levels of arsenic in the water wells has led to a new study of arsenic exposure in water, soil, and livestock. As mutton is a traditional food in the Navajo culture, Ingram’s next steps are to work with the students and community to address the chemical contamination in sheep and to later develop food consumption guidelines in the Navajo community. Tommy Rock, also a featured grantee, is currently working with Ingram in examining uranium exposure and bioaccumulation in sheep near mining sites in the Navajo Nation.
Engaging with the Navajo community to transform her research into policies
Moving forward, Ingram hopes to use the data they have collected to influence behaviors in the community. She wants to apply the “bench to bedside” concept to the people in the Navajo community, which in medical practice refers to applying data from scientific research to patients. In order to assess health impacts through this concept, Ingram and colleagues primarily use the Indigenous Health Indicator, which uses “a holistic approach” by taking into consideration the cultural and social beliefs most important to Native Americans. They have worked closely with the Swinomish tribe, who developed the Indigenous Health Indicator, to discuss their past experience with contamination in their traditional foods and how they overcame and tackled the issue.
Ingram and her colleagues are beginning to speak with different individuals and groups, to acquire further knowledge on the Navajo culture that can be later implemented into the best practices that will help the nation address its health needs. For example, she is collaborating with a political scientist from the Applied Indigenous Studies and Politics & International Affairs programs at NAU, a Navajo doctoral student, and a group of knowledge holders, or “medicine men,” to learn more about how people in the Navajo community would like to approach the issue of arsenic exposure, to then establish the policies based on indigenous knowledge and Navajo law.
- PEPH Webinar: Tribal Ecological Knowledge (TEK) and Its Value for Environmental Health Sciences – Indigenous Health Indicators
- NAU student helps uncover years of water contamination from uranium in Sanders
- Research into Arizona town's uranium-contaminated water supply sparks change
- Cleaning up abandoned uranium mines
Tommy Rock – Exposing Years of Uranium Water Contamination in a Navajo Community
January 9, 2017
Tommy Rock, a doctoral student at Northern Arizona University, grew up in a small community on the Navajo reservation, where he saw firsthand the effects of uranium mining on his relatives. Navajo lands were mined heavily for uranium from 1944 to 1986, leaving more than 500 abandoned uranium mine sites and elevated levels of radiation in homes and drinking water sources.
“My grandfather was a former uranium mine worker who died from cancer about ten years ago,” said Rock. “I wanted to do something about this problem of uranium contamination, and as I learned more and became involved in research, I realized more communities across the Navajo Nation were also affected.”
After completing a master's degree in sustainable communities from Northern Arizona University in 2008, Rock worked as a research scientist at the University of New Mexico and then as an environmental specialist with the Navajo Nation EPA. He is now pursuing a doctorate in Earth Science and Environmental Sustainability at Northern Arizona University.
Last year, Rock helped discover more than a decade of uranium contamination in the drinking water of the small community of Sanders in eastern Arizona. Sanders lies just outside of the Navajo reservation, and about 80 percent of the community is Navajo.
Uranium in the water supply
Rock discovered the contamination while working on a project funded by an EPA Environmental Justice Grant. The project involved testing unregulated wells along the Puerco River, a tributary of the Little Colorado River that flows through Sanders. Rock and his colleagues organized a two-day training for the community and hired community workers to conduct the water testing.
"When conducting this training, one of the community members asked us to sample the public water supply,” said Rock. “We did this, and found elevated levels of uranium in the wells along the river as well as in the pubic water sources."
The results, which came back in June of 2015, showed uranium levels at 43 parts per billion, well above the EPA limit of 30 parts per billion. Exposure to uranium in drinking water can lead to bone cancer and impaired kidney function. When Rock and his colleagues looked deeper to figure out how long the contamination had been taking place, they found records indicating elevated levels of uranium as far back as 2003. All the tests from 2009 to 2015 showed elevated levels of uranium in the public water.
“The sad thing was that the community members were not notified about the contamination by the state or the Arizona Windsong Water Company, which supplied the water,” said Rock. “The water company violated the federal Safe Water Drinking Act by not giving reports to their customers.”
The researchers presented their findings at several community meetings, and while people stopped using the public water, they were not seeing any movement by the state or water company to fix the contamination. During one of these meetings, community members asked the researchers to test the well that supplies water to the elementary and middle schools. “We found elevated uranium in this water supply as well,” said Rock. “The school district shut off water fountains in the schools and started hauling in water from another town.”
It was not until after media coverage of the contamination in April 2016 that the people of Sanders finally saw actions aimed at fixing the problem. After Windsong’s license was not renewed, the new company handling the Sander’s public water system replaced the well that supplies the public water. While some people are using the new water, the entire water system still needs to be upgraded since the water infrastructure is old in the community of Sanders and cannot handle the full pressure from the new waterline.
Although the state isn’t required to notify people of contamination, the Arizona Department of Environmental Quality has changed its policy and will now issue public notices for drinking water violations if the public water system neglects to do so. “I like to think that we helped change this policy,” said Rock. “I am also glad to know I played a part in helping the community of Sanders have better water now than they did before.”
Rock continues to work on his dissertation research, which is examining uranium exposure and bioaccumulation in sheep living around mining sites on Navajo land. By understanding how this traditional indigenous food source accumulates uranium, Rock hopes to develop safe consumption recommendations for tribal members in mining-affected areas. This research project is led by Jani Ingram, Ph.D., of Northern Arizona University, who is funded by the NIEHS through the Native American Research Centers for Health.
After completing his doctoral degree, Rock would like to use his knowledge and experience to help people in other parts of the world. “One day I would like to work for the World Health Organization, so I could help indigenous populations throughout the world find solutions to their contamination problems.”