Increasing Environmental Health Literacy through Contextual Learning in Communities at Risk

[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.

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

BACKGROUND

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

OBJECTIVES

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

DISCUSSION

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

Patterns of contamination and burden of lead and arsenic in rooftop harvested rainwater collected in Arizona environmental justice communities

As climate change exacerbates water scarcity, rainwater harvesting for household irrigation and gardening becomes an increasingly common practice. However, the use and quality of harvested rainwater are not well studied, and the potential pollutant exposures associated with its use are generally unknown. There are currently no federal standards in the United States to assess metal(loid)s in harvested rainwater. Project Harvest, a community science research project, was created to address this knowledge gap and study the quality of harvested rainwater, primarily used for irrigation, in four environmental justice communities in Arizona, USA. Community scientists collected 577 unique rooftop harvested rainwater samples from 2017 to 2020, which were analyzed for metal(loid)s, where arsenic (As) concentrations ranged from 0.108 to 120 μg L^-1 and lead (Pb) concentrations ranged from 0.013 to 350 μg L^-1 and compared to relevant federal/state standards/recommendations. Community As and Pb concentrations decreased as: Hayden/Winkelman > Tucson > Globe/Miami > Dewey-Humboldt. Linear mixed models were used to analyze rooftop harvested rainwater data and results indicated that concentrations of As and Pb in the summer monsoon were significantly greater than winter; and contamination was significantly greater closer to extractive industrial sites in three of the four study communities (ASARCO Hayden Plant Superfund Alternative site in Hayden/Winkelman, Davis-Monthan United States Air Force Base in Tucson - Pb only, and Freeport McMoRan Copper and Gold Mine in Globe/Miami). Based on models, infrastructure such as proximity to roadway, roof material, presence of a cistern screen, and first-flush systems were not significant with respect to As and Pb when controlling for relevant spatiotemporal variables; whereas, cistern age was associated with Pb concentrations. These results however, indicate that concentrations vary seasonally and by proximity to industrial activity, not by decisions made regarding collection system infrastructures at the individual home level. This study shows that generally, individuals are not responsible for environmental contamination of rooftop harvested rainwater, rather activities and decisions of government and corporate industries control contaminant release.

Organic micropollutants measured in roof-harvested rainwater from rural and urban environmental justice communities in Arizona

Due to global water scarcity and population growth, multiple solutions are needed to conserve and collect water, especially in arid and semi-arid regions of the planet. As the practice of harvesting rainwater grows, it is important to assess the quality of roof-harvested rainwater (RHRW). This study measured twelve organic micropollutants (OMPs) in RHRW samples collected between 2017 and 2020 by community scientists, with approximately two hundred RHRW samples and corresponding field blank analyzed annually. The OMPs analyzed were atrazine, pentachlorophenol (PCP), chlorpyrifos, 2,4-dichlorophenoxyacetic acid (2,4-D), prometon, simazine, carbaryl, nonylphenol (NP), perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorobutane sulfonic acid (PFBS), and perfluorononanoic acid (PFNA). OMP concentrations measured in RHRW were below the following existing standards: US EPA Primary Drinking Water Standard, Arizona Department of Environmental Quality (ADEQ) Partial Body Contact for Surface Waters, and ADEQ Full Body Contact for Surface Waters for analytes in this study. At the time the study was conducted, 28 % of RHRW samples exceeded the non-enforceable US EPA Lifetime Health Advisory (HA) of 70 ng L^-1 for the combined sum of PFOS and PFOA with a mean exceedance concentration of 189 ng L^-1. When comparing PFOA and PFOS to the June 15, 2022 interim updated HAs of 0.004 ng L^-1 and 0.02 ng L^-1, respectively, all samples exceeded these values. No RHRW samples exceeded the final proposed HA of 2000 ng L^-1 for PFBS. The limited number of state and federal standards established for the contaminants highlighted in this study indicate potential regulatory gaps and that users need to be aware that OMPs may be present in RHRW. Based on these concentrations, domestic activities and intended uses should be carefully considered.

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

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

Data to Action: Community-Based Participatory Research to Address Concerns about Metal Air Pollution in Overburdened Neighborhoods near Metal Recycling Facilities in Houston

BACKGROUND

Exposures to environmental contaminants can be influenced by social determinants of health. As a result, persons living in socially disadvantaged communities may experience disproportionate health risks from environmental exposures. Mixed methods research can be used to understand community-level and individual-level exposures to chemical and nonchemical stressors contributing to environmental health disparities. Furthermore, community-based participatory research (CBPR) approaches can lead to more effective interventions.

OBJECTIVES

We applied mixed methods to identify environmental health perceptions and needs among metal recyclers and residents living in disadvantaged neighborhoods near metal recycling facilities in Houston, Texas, in a CBPR study, Metal Air Pollution Partnership Solutions (MAPPS). Informed by what we learned and our previous findings from cancer and noncancer risk assessments of metal air pollution in these neighborhoods, we developed an action plan to lower metal aerosol emissions from metal recycling facilities and enhance community capacity to address environmental health risks.

METHODS

Key informant interviews, focus groups, and community surveys were used to identify environmental health concerns of residents. A diverse group from academia, an environmental justice advocacy group, the community, the metal recycling industry, and the local health department collaborated and translated these findings, along with results from our prior risk assessments, to inform a multifaceted public health action plan.

RESULTS

An evidence-based approach was used to develop and implement neighborhood-specific action plans. Plans included a voluntary framework of technical and administrative controls to reduce metal emissions in the metal recycling facilities, direct lines of communication among residents, metal recyclers, and local health department officials, and environmental health leadership training.

DISCUSSION

Using a CBPR approach, health risk assessment findings based on outdoor air monitoring campaigns and community survey results informed a multipronged environmental health action plan to mitigate health risks associated with metal air pollution. https://doi.org/10.1289/EHP11405.

Dissolved arsenic and lead concentrations in rooftop harvested rainwater: Community generated dataset

Here, we detail arsenic (As) and lead (Pb) concentrations in community science generated rooftop harvested rainwater data from Project Harvest (PH), a co-created community science study, and National Atmospheric Deposition Program (NADP) National Trends Network wet-deposition AZ samples as analyzed by Palawat et al. [1]. 577 field samples were collected in PH and 78 field samples were collected by NADP. All samples were analyzed via inductively coupled plasma mass spectrometry (ICP-MS) for dissolved metal(loid)s including As and Pb by the Arizona Laboratory for Emerging Contaminants after 0.45 um filtration and acidification. Method limits of detection (MLOD) were assessed and sample concentrations above MLODs were considered detects. Summary statistics and box and whisker plots were generated to assess variables of interest such as community and sampling window. Finally, As and Pb data is provided for potential reuse; the data can be used to assess contamination of harvested rainwater in AZ and to inform community use of natural resources.

Advancing women's participation in climate action through digital health literacy: gaps and opportunities

Exploring the contribution of health informatics is an emerging topic in relation to addressing climate change, but less examined is a body of literature reporting on the potential and effectiveness of women participating in climate action supported by digital health. This perspective explores how empowering women through digital health literacy (DHL) can support them to be active agents in addressing climate change risk and its impacts on health and well-being. We also consider the current definitional boundary of DHL, and how this may be shaped by other competencies (eg, environmental health literacy), to strengthen this critical agenda for developed nations and lower-resource settings.

Shared Purpose: Leveraging a Community-Academic Partnership to Increase Local Environmental Health Awareness via Community Science

Environmental factors can lead to disease and health disparities when the places where people live, learn, work, play and pray are burdened by social inequities. Non-formal programs that explicitly connect local environmental exposures and human health could be of great value to communities at greatest risk. The purpose of this work was to co-create relevant and engaging education with youth and community stakeholders of all ages that more explicitly emphasizes the link between the local environment and community members' health through a hands-on community science experience. Our experiences helped strengthen our community-academic partnership and establish a route to create and tailor informal programming to meet local needs and engage people in community science with academic partners. We generated two distinctly different community science neighborhood audit tools designed to differently engage our community partners and inform community participants of their local environments and its role on their health. Through community meetings, we garnered critical insight from our stakeholders. While neither of the tools and accompanying data collected were deemed to be scientifically generalizable, our ongoing and future work has benefited from important lessons learned from their creation and sharing.

Psychometric Properties of the Korean Version of the Environmental Health Literacy Scale

The environmental health literacy (EHL) scale evaluates media-specific and general EHL levels in three domains: knowledge, attitude, and behavior. This study aimed to adapt the EHL scale developed by Lichtveld et al. into the Korean language (K-EHL scale) and to verify its reliability and validity. Survey data was collected from 492 adults (19–65 years) residing in Korea. The study process included translation procedures, content validity verification, pre-testing, the actual survey, and statistical analysis for validation and selection of the final items. The scale-level content validity index was 0.92, and one item was removed. Multiple exploratory factor analyses condensed the K-EHL into 2 factors and 38 items. The “Environmental health knowledge and attitude” factor (14 items) measures information, feelings, and thoughts about environmental health. The “Environmental health behavior” factor (24 items) comprises behaviors responding to environmental health. A construct validity (criterion and discriminant validity) was verified using confirmatory factor analysis for goodness of fit (CFI = 0.901, TLI = 0.863, GFI = 0.923, NFI = 0.862, and RMSEA = 0.08). Internal consistency reliability test results showed a Cronbach’s α of 0.81 for the total items. This study is the first to introduce the EHL in Korea, and it also presents a validated evaluation tool. The K-EHL is expected to elucidate EHL levels in Korea. In the future, the EHL scale can be enhanced using this tool.

Health concerns among waste collectors during pandemic crisis

The COVID-19 pandemic has negatively affected the economic, social, and psychological aspects globally. COVID-19 can possibly spread through municipal solid waste (MSW) if it is collected, bagged, transported, and disposed inappropriately. Such situation has posed significant challenges to MSW management (MSWM), which has led waste personnel under massive pressure. This study aims to examine the health-protective behavior of sanitation workers/MSW collectors (MSWCs) during the COVID-19 crisis. Quantitative data were collected by using a self-administered survey from 418 MSWCs working in Mainland China. The study extended the traditional health-belief model and proposed education and training as a facet of the behavioral model. Result showed that education and training were a significant predictor of health-protective behavior. Moreover, the moderating incremental influence of regulative assistance significantly affected the behavioral mapping of MSWCs. This study contributes to the literature by mapping the concerns, risks, and challenges experienced by MSWCs in times of a health crisis. Policymakers should specially consider the safety and hygiene concerns of frontline workforce in the whole chain of waste management (including the outsourced operations of MSWM). Lastly, the adoption of smart communication with the frontline workforce (i.e., MSWCs) is in dire need to maintain trust and avoid rumors and misconceptions during the time of a pandemic situation.

Knowledge and Beliefs Associated with Environmental Health Literacy: A Case Study Focused on Toxic Metals Contamination of Well Water

Environmental health literacy (EHL) is developing as a framework that can inform educational interventions designed to facilitate individual and collective action to protect health, yet EHL measurement poses several challenges. While some studies have measured environmental health knowledge resulting from interventions, few have incorporated skills and self-efficacy. In this study, a process-focused EHL instrument was developed, using the Newest Vital Sign (NVS) health literacy instrument as a model and tailoring it for the context of private well contamination with toxic metals. Forty-seven (47) participants, including undergraduate students and residents of communities with contaminated well water, piloted a prototype EHL instrument alongside NVS. Results suggested a moderate degree of correlation between NVS and the EHL prototype, and significant differences in scores were observed between students and residents. Responses to a self-efficacy survey, tailored for drinking water contaminated with arsenic, revealed significant differences between students and residents on items related to cost and distance. In response to open-ended questions, participants identified a range of potential environmental contaminants in drinking water and deemed varied information sources as reliable. This study highlights differences in knowledge and self-efficacy among students and residents and raises questions about the adequacy of EHL assessments that mimic formal education approaches.

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

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

Balancing incomplete COVID-19 evidence and local priorities: risk communication and stakeholder engagement strategies for school re-opening

In the midst of the COVID-19 pandemic, United States (U.S.) educational institutions must weigh incomplete scientific evidence to inform decisions about how best to re-open schools without sacrificing public health. While many communities face surging case numbers, others are experiencing case plateaus or even decreasing numbers. Simultaneously, some U.S. school systems face immense infrastructure challenges and resource constraints, while others are better positioned to resume face-to-face instruction. In this review, we first examine potential engineering controls to reduce SARS-CoV-2 exposures; we then present processes whereby local decision-makers can identify and partner with scientists, faculty, students, parents, public health officials, and others to determine the controls most appropriate for their communities. While no solution completely eliminates risks of SARS-CoV-2 exposure and illness, this mini-review discusses engaged decision and communication processes that incorporate current scientific knowledge, school district constraints, local tolerance for health risk, and community priorities to help guide schools in selecting and implementing re-opening strategies that are acceptable, feasible, and context-specific.

"You Gotta Choose Your Words Carefully": Findings from Interviews with Environmental Health Scientists about Their Research Translation Perceptions and Training Needs

Scientists are trained to communicate research in a technical manner but often lack the skills to communicate scientific findings to the general public. Effective communication and research translation are increasingly important competencies for researchers and have broader benefits to scientists and society. The aim of the study was to assess the perceptions, experiences, and training needs relative to science communication and research translation of project investigators associated with the Center for Oceans and Human Health and Climate Change Interactions at the University of South Carolina. In-depth, semi-structured interviews were conducted with the Center's investigators. Interview transcripts were coded and analyzed for emergent themes related to science communication and research translation. Investigator descriptions of their research varied in length, and researchers mentioned multiple target audiences. Most investigators preferred in-person and written communication channels and felt "comfortable" communicating uncertain findings to the public despite no formal science communication training. Investigators suggested training focused on plain language development for target communities, assessment of audience needs, and formatting research findings for various groups. Working with multiple target audiences that have preferred communication channels necessitates a comprehensive approach to science communication training to enhance two-way communication between scientists and stakeholders.

Culturally Adapted Mobile Technology Improves Environmental Health Literacy in Laurentian, Great Lakes Native Americans (Anishinaabeg)

The presence of persistent bioaccumulative toxics (PBT) in aquatic food chains complicates decision processes of people with a strong culture of fish consumption. This environmental contamination is especially problematic for Native American populations in the Laurentian Great Lakes region (Anishinaabeg). Pursuing the growing discipline of environmental health literacy (EHL) may help reduce toxic exposures, support healthy decision-making, and combat health deficits. Our goals for this research were first to improve environmental health literacy using novel technologies and second to help define environmental health literacy metrics that can be tracked over time, especially regarding culturally-contextualized health interests. We recently reported that a mobile app (Gigiigoo'inaan App) presenting personalized, culturally-contextualized fish consumption advice may improve EHL for the Anishinaabeg. Gigiigoo'inaan App safely supports desired fish consumption rates by putting local data into the hands of the Anishinaabeg. We conducted a pre-test post-test evaluation with 103 Aninishinaabe adults. Participants estimated their current fish meal consumption over a hypothetical month before exposure to the software and then planned their future consumption of fish meals in a month after using the mobile app. Significantly more monthly traditional fish meals on average (Median: 4 vs 2, p=0.0005) were selected when using the app versus pre-exposure to the app. Significantly more traditional grams of fish were also selected during use of the app relative to the pretest (Median: 680.39g vs 453.59g, p=0.0007). These increases were accompanied by widespread (97%) adherence to conventional advice that minimizes PBT exposure health effects (ATSDR minimum risk levels).