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

A Community-Based Participatory Research Program to Assess Community Lead Exposure Risk: Establishing Research Priorities

Background

Lead is an environmental health hazard that disproportionately impacts communities of color across the United States. Recent incidents of widespread lead exposure have been linked to aging infrastructure, historical land use, and challenges in lead remediation.

Purpose

To determine community research priorities for a subsequent lead exposure assessment in a primarily Latino community.

Methods

Four focus groups were conducted with community members (n= 73) in Norristown, PA and data were collected from Fall 2022 to Spring 2023. Open coding was used to conduct a thematic analysis of the transcript data.

Results

Four themes were identified: 1) sources of concern, 2) lack of information surrounding lead, 3) systemic neglect, and 4) financial implications. Future research priorities include identifying contamination sources through testing of the household water supply, household paint, and soil as well as personal blood lead levels.

Conclusions & Implications

There was broad community support for a lead exposure risk assessment that investigated soil, tap water, and paint sources of lead, as well as the prevalence of elevated blood lead levels in all generations. The study also highlighted the lack of information about lead exposure in non-English speaking communities, the need for providing language-appropriate information, and the necessity for multiple lead exposure assessment methods.

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.

Associations Between Daily-Use Products and Urinary Biomarkers of Endocrine-Disrupting Chemicals in Adults of Reproductive Age

BACKGROUND

Daily-use products, including personal care products, household products, and dietary supplements, often contain ingredients that raise concerns regarding harmful chemical exposure. Endocrine-disrupting chemicals (EDCs) found in daily-use products are associated with numerous adverse health effects.

METHODS

This pilot study explores the relationship between concentrations of EDCs in urine samples and products used 24 h prior to sample collection, and ingredients of concern in those products, in 140 adults of reproductive age in Northern Nevada.

RESULTS

Having higher numbers of products and ingredients of concern, especially in the personal care category, was associated with higher levels of mono-(-ethyl-5-carboxypentyl) phthalate (MECPP). Similarly, taking more supplements was associated with higher levels of methylparaben (MePB). In contrast, using household products with more ingredients of concern was associated with lower levels of monobutyl phthalate (MBP). Generally, women used more products, were exposed to more ingredients of concern and had higher urinary metabolites than men. Participants who rated themselves as being in poor/fair health were exposed to more personal care and supplement ingredients of concern than those in better health. Interestingly, those in excellent health also took supplements with more ingredients of concern.

CONCLUSIONS

Greater product use and more ingredients of concern are associated with urinary metabolites of known EDCs and self-ratings of poor health. Women and people who take supplements are at greater risk, and even people who consider themselves to be healthy can be highly exposed. More education among the general public is needed to make people aware of the presence of these chemicals in their everyday products so they can make efforts to avoid them.

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.

Supporting knowledge justice through community science air quality monitoring and a reciprocal reporting process

In community science on air quality, low-cost air monitors have emerged as an opportunity to democratize data reporting and support knowledge justice by providing participants with instantaneous access to air quality data. In this study, we equipped residents in four environmental justice communities in North Denver with low-cost air monitors to collect real-time air quality data for four separate 30-day field deployments over two years. We conceptualize an improvement to conventional report-back processes by suggesting a 3-part approach - a reciprocal reporting process that includes 1) bidirectional open channels of communication with participants, 2) democratized data access via instant monitor data and written data summaries, and 3) responsive intervention opportunities to respond in real-time to participants air quality concerns. Through 120 interviews with 30 air quality monitor users after each of the four field deployments, we identify how this reciprocal reporting process increased Air Quality (AQ) awareness and supported distinct modes of environmental learning, which we term data-driven, health-conscious, and progressive logics of inquiry. In addition, this non-prescriptive approach centered participants' alternative ways of knowing, such as sensory experiences to understand pollution exposure, and fostered collective learning that ultimately furthered knowledge justice. Our study highlights the potential for a more robust and holistic approach to report-back processes within community science projects to foster flexibility, reciprocity, and responsiveness.

[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.

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.

Promoting condom negotiation self-efficacy among young women in China: the effects of traditional sexual values and descriptive norms

This study attempts to design effective messages to promote condom negotiation self-efficacy and safer sex intent among young women in China. An online experiment with 2 (descriptive norm: present versus absent) × 2 (traditional sexual value: high versus low) between-subjects factorial design was conducted on a purposive sample of 241 female Chinese college students. The results demonstrated that culturally tailored messages incorporating descriptive norms information on the popularity of condom negotiation can increase participants' self-efficacy (F(1,237) = 9.01, partial η2 = 0.04, P = 0.003) but not safer sex intent (F(1,237) = 2.80, partial η2 = 0.01, P = 0.096). Participants with a lower level of traditional sexual values had similar levels of condom negotiation self-efficacy as those with a higher level of values: F(1,237) = 2.85, partial η2 = 0.01, P = 0.09. There were no significant interaction effects of traditional sexual value and descriptive norm on condom negotiation self-efficacy and safer sex intent. The findings contribute to the cultural sensitivity perspective in health education in an Eastern context and have implications for public health practitioners and policymakers.

How Do African-American Community Members' Perceptions About Environmental Risks of Breast Cancer Compare with the Current State of the Science?

African-American (AA) women experience higher mortality from breast cancer than any other racial group. Understanding community-held perceptions of environmental contaminants as risk factors for breast cancer can inform the development of tailored prevention and education efforts for improve health outcomes. Six focus groups were conducted with AA participants in two counties in South Carolina, and themes were identified using open and axial coding. Perceived environmental risks for breast cancer most frequently discussed by participants were compared to findings from published systematic reviews. Frequently discussed environmental risk factors by participants were deodorants containing aluminum, plastics, pesticides, and air and water pollution. While perceptions of aluminum and air pollution as risk factors did not align with the state of the science, perceived risk factors of chemicals in plastics and pesticides were found to be in alignment. There is some congruence between perceived environmental risks for breast cancer within the AA community and the current state of the science; however, there is a need to communicate information that reflects current science regarding commonly held misconceptions. Development of evidence-based, clear, and culturally appropriate messaging that reflects the current state of the science is warranted.

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.

"Talk About Cancer and Build Healthy Communities": How Visuals Are Starting the Conversation About Breast Cancer Within African-American Communities

African-American (AA) women are at higher risk of breast cancer mortality than women of other races. Factors influencing breast cancer risk, including exogenous environmental exposures, and debate around timing of exposure and dose-response relationship, can cause misunderstanding. Collaboration with priority populations encourages culturally relevant health messaging that imparts source reliability, influences message adoption, and improves understanding. Through six focus groups with AA individuals in rural and urban counties in the southeastern United States, this study used a community-engaged participatory approach to design an innovative visual tool for disseminating breast cancer information. Results demonstrated that participants were generally aware of environmental breast cancer risks and were willing to share new knowledge with families and community members. Recommended communication channels included pastors, healthcare providers, social media, and the Internet. Participants agreed that a collaboratively designed visual tool serves as a tangible, focused "conversation starter" to promote community prevention and education efforts.

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.

Participatory Research for Environmental Justice: A Critical Interpretive Synthesis

BACKGROUND

Environmental health risks are disproportionately colocated with communities in poverty and communities of color. In some cases, participatory research projects have effectively addressed structural causes of health risk in environmental justice (EJ) communities. However, many such projects fail to catalyze change at a structural level.

OBJECTIVES

This review employs Critical Interpretive Synthesis (CIS) to theorize specific elements of participatory research for environmental health that effectively prompt structural change in EJ communities.

METHODS

Academic database search was used to identify peer-reviewed literature describing participatory research with EJ communities to address environmental health. Synthetic constructs were developed iteratively related to study characteristics, design elements, and outcomes; and data were extracted for included records. Statistical analyses were performed to assess correlations between study design elements and structural change outcomes. Through critical, comparative, and contextual analyses of the "structural change" case study group and "non- structural change" group, informed by relevant theoretical literature, a synthesizing argument was generated.

RESULTS

From 505 total records identified, eligibility screening produced 232 case study articles, representing 154 case studies, and 55 theoretical articles for synthesis. Twenty-six case studies resulted in a structural change outcome. The synthesizing argument states that participatory research with EJ communities may be more likely to result in structural change when a) community members hold formal leadership roles; b) project design includes decision-makers and policy goals; and c) long term partnerships are sustained through multiple funding mechanisms. The assumption of EJ community benefit through research participation is critically examined.

DISCUSSION

Recommended future directions include establishing structural change as a goal of participatory research, employing participatory assessment of community benefit, and increased hiring of faculty of color at research institutions. The power, privilege, and political influence that academic institutions are able to leverage in partnership with EJ communities may be as valuable as the research itself. https://doi.org/10.1289/EHP6274.

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.

Shifting from "Community-Placed" to "Community-Based" Research to Advance Health Equity: A Case Study of the Heatwaves, Housing, and Health: Increasing Climate Resiliency in Detroit (HHH) Partnership

Extreme summertime heat is a significant public health threat that disproportionately impacts vulnerable urban populations. Research on health impacts of climate change (including increasing intensity, duration, and frequency of hot weather) is sometimes designed and implemented without the involvement of the communities being studied, i.e., "community-placed" not "community-based." We describe how the Heatwaves, Housing, and Health: Increasing Climate Resiliency in Detroit (HHH) partnership engaged relevant communities by integrating a community-based participatory research (CBPR) approach into an existing, academic-designed research project through a steering committee of community and academic partners. Using a case study approach, we analyze program documentation, partnership evaluation questionnaires, and HHH steering committee meeting notes. We describe the CBPR process by which we successfully collected research data in Detroit during summer 2016, engaged in collaborative analysis of data, and shared results with Detroit residents. Evaluations of the partnership over 2 years show community involvement in research; enhanced capacities; success in securing new grant funding; and ways that CBPR strengthened the validity, relevance, and translation of research. Engaging communities as equal partners using CBPR, even after a study is underway, can strengthen research to understand and address the impacts of extreme heat on health and equity in urban communities.

Results Communication in Breast Milk Biomonitoring Studies: A Scoping Review and Stakeholder Consultation

Researchers investigating breast milk contamination face substantive ethical dilemmas regarding how biomonitoring results should be conveyed, with limited guidance available to help them. To identify effective processes for undertaking such research, we sought to critically assess practices being followed in reporting results. To consider how researchers have reported on this and related ethical issues, we searched three English-language databases for articles published between 2010-2016 on measuring presence of pesticides in breast milk. Data on report-back processes and discussed ethical issues were charted from retained articles (n=102). To deepen our understanding of issues, we further consulted authors (n=20) of retained articles through an online survey. Quantitative data from surveys were tabulated and qualitative data were analyzed thematically. Of 102 articles, only two mentioned sharing results with subjects, while 10 out of 20 survey participants confirmed that they had indeed conducted report-back in their studies. Articles discussing ethical considerations were few (n=5), although researchers demonstrated awareness of common ethical debates to inform report-back decisions. Our review suggests that greater explicit attention should be given to practices of engaging study subjects and their communities in contamination studies so that an evidence base on best ethical practices can be more readily available.

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.