Determinants of Knowledge, Attitudes, Perceptions and Behaviors Regarding Air Pollution in Schoolchildren in Pristina, Kosovo

Air pollution poses a significant public health challenge, and Kosovo, a low-middle-income country in the Balkan peninsula, suffers from particularly poor air quality, especially around the area of the capital Pristina. The availability of accurate and timely information is crucial in mitigating the adverse effects of air pollution. This study aimed at evaluating the knowledge, attitudes, behaviors, and perceptions (KAPB) related to poor air quality in Pristina's low-middle schools. Furthermore, the study explored the connections between these factors and socio-demographic and health attributes and provided valuable inputs for the development of future strategies and policies in air pollution mitigation. Regression analysis provided insights into how these various factors interacted with KAPB scores. The results revealed limited knowledge about air pollution sources and risks among pupils, with insufficient awareness of reliable information sources. While attitudes were generally positive, they declined with higher grade levels. Parental education significantly influenced knowledge and attitudes, and better health correlated with more positive attitudes. Perceptions of air pollution risks were influenced by grade, gender, and parental education, with better-educated parents associated with improved perceptions. Overall behavior scores increased with higher levels of parental education. Understanding the factors that shape pupils' responses to air pollution is critical for strategy and policy development. These findings can guide strategies to enhance environmental awareness and promote healthy behavior, helping address the pressing issue of air pollution in the country.

Air Pollution Health Literacy among Active Commuters in Hamilton, Ontario

The promotion of active transportation (AT), which has been broadly defined as a physical effort performed by the traveller to produce motion, has been a popular strategy to reduce vehicular emissions, improve air quality, and promote physical activity. However, individuals who engage in AT may incur increased exposure to air pollutants and thus potential health impacts. This research sought to determine how active commuters understand the health risks associated with air pollution during their commutes, and whether they engage in any behaviours to limit exposure. An online survey was adapted from the Environmental Health Literacy framework to assess air pollution health literacy among active commuters in Hamilton, ON, and generated a sample size of 192 AT users. Analyses involved the use of frequency tables and cross-tabulations for the quantitative data, and the Health Belief Model and thematic analysis to interpret the qualitative data. Results revealed that most AT users do not adopt behaviours that would limit air pollution exposure on commutes and exhibited low self-rated knowledge of the health impacts of air pollution exposure. Issues of perceived susceptibility and severity, barriers, cues to action, and self-efficacy all further impacted the likelihood of adopting health protective behaviours. Conclusively, air pollution is an often-neglected consideration among active commuters, with air pollution knowledge predicting the likelihood of behavioural modification.

The Environmental Health Literacy of Italian General Population: The SPeRA Cross-Sectional Study

Environmental health literacy (EHL) includes knowledge of health effects due to environmental exposure and skills to protect health from environmental risks. This study investigated some aspects about EHL of the Italian adult population. Data were collected through questionnaires (n = 672) and analysed through multivariable logistic regression models. Results showed that participants with incomplete/insufficient self-perceived knowledge of health effects due to environmental risks verified less information about this topic (adjOR = 0.38 (CI95% 0.25-0.59)/0.09 (0.04-0.21); p < 0.001/<0.001), potentially spreading fake news. The self-perceived exposure to pollution was higher in participants living in towns than in rural areas (small, medium, big towns adjOR = 2.37 (1.41-3.97), 2.10 (1.11-3.96), 3.11 (1.53-6.31); p = 0.001, 0.022, 0.002) and lower in participants with incomplete/insufficient knowledge about pollution effects (adjOR = 0.54 (0.32-0.92)/0.30 (0.13-0.67); p = 0.022/0.004), confirming that knowledge is essential to achieve awareness. Since insufficient self-perceived knowledge of pollution effects was negatively associated with the adoption of pro-environmental behaviours (adjOR = 0.37 (0.15-0.90); p = 0.028), EHL was proven to be a virtuous behaviour promoter. Finally, a lack of institutional support, time and cost were identified as barriers to pro-environmental behaviours. This study provided useful data to design prevention programmes, underlined some barriers to pro-environmental behaviours and highlighted the need to promote attitudes and behaviours aimed at contrasting environmental pollution, thus protecting human health.

[The concept map of SENTIERI Project: a communication interactive digital tool of the national epidemiological surveillance system of Italian contaminated sites]

This paper describes the development and the envisioned use of concept maps in the framework of the SENTIERI communication strategies as an information and scientific communication tool applied to epidemiological surveillance in contaminated sites. The concept map of SENTIERI 2019-2022 was designed and implemented to foster access to complex scientific information ensuring usability of the contents and communication with the various stakeholders. The concept map aims to promote environmental health literacy in contaminated sites. The methodology adopted to create the map includes the following phases: 1. choice of a dynamic focus question; 2. selection of the representative terms of the addressed topics; 3. elaboration of the glossary of the selected terms; 4. representation of the links among the selected terms; 5. identification of the significant propositions that make explicit the meaning of each link. Online access to the map is guaranteed by the Mindomo software. The use of the concept map promotes active learning of the topics that characterize SENTIERI 2019-2022 through knowledge paths chosen because of the specific interests and learning purposes. The concept map derives from the integration of specific approaches of the epidemiological discipline with those of the social sciences and offers the possibility of developing site-specific maps through the interactions with local actors and the integration of elements related to emerging problems as well as institutional and local interests.

"They Kept Going for Answers": Knowledge, Capacity, and Environmental Health Literacy in Michigan's PBB Contamination

The Michigan PBB Oral History Project documented community residents' descriptions of a large-scale chemical contamination-the PBB contamination-that occurred in Michigan in 1973. These oral histories document residents' and others' experiences during and after the contamination. We conducted a grounded theory qualitative analysis of 31 oral histories to examine the experiences of community members, researchers, lawyers, and others who actively sought out and contributed essential information about the contamination and its impacts. Our findings highlight several challenges encountered in the development of this knowledge including four central themes-contested knowledge, community skills, inaction, and uncertainty. Integrating environmental health literacy, community capacity, and contested illness frameworks, we examine the contributions of community residents, scientists (from inside and outside the community), and others to the development of knowledge to inform decisions and sustain action regarding this large-scale contamination. We close with a discussion of lessons learned regarding efforts to build environmental health knowledge within uncertain and often contested contexts and for promoting environmental health and action related to large-scale chemical contaminations. Our findings suggest the importance of integrated frameworks for examining and promoting the critical role of community skills, leadership, participation, sense of community, and community power in promoting environmental health.

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.

Psychometric properties of a novel instrument for evaluating indoor air pollution health literacy in adults

This study aimed to develop and validate the psychometric properties of a novel instrument that measures Indoor Air Pollution Health Literacy (IAPHL). The qualitative phase was conducted to design questions based on the conceptual model of the European Health Literacy Survey Questionnaire. We developed a 38-item instrument covering 12 constructs, that is, four information competencies within three health domains to assess IAPHL. A cross-sectional online video survey of 647 adults aged 20 years and above in Taiwan was conducted. Various measures of validity and reliability coefficients were assessed to indicate the psychometric properties of the IAPHL instrument. The content validity indices for relevance, importance, and clarity of the 38 questions were 0.97, 0.96, and 0.89, respectively. The model fit indices obtained from the confirmatory factor analysis supported the acceptable structures of the theoretically hypothetical 12-factor model (standardized root mean square residual = 0.055; root mean square error of approximation = 0.065). Internal consistency for the instrument showed a Cronbach's alpha of 0.96. The IAPHL instrument developed in this study showed satisfactory validity and reliability and can be used in future fieldwork.

Insights into Improving Risk and Safety Communication through Environmental Health Literacy

Messages and materials developed to communicate risk to the public are often misunderstood because the public misperceives risk, science information is too complex, leading to audience misunderstandings, and an overarching focus on the details of the problem without supplying solutions or actions to keep the public safe. This article describes the creation of a communication model to improve risk communication that includes safety information. The authors describe essential components of Risk and Safety Communication based on features of Environmental Health Literacy (EHL), which informed the creation of a protocol for developing risk communication messages and materials. An online training module was developed to aid communicators in creating information to enable the public to protect themselves, their family, and their community, leading to improved comprehension of how the environment impacts health. These principles were developed in a series of focus groups, identifying how the public perceives risk, how they prefer to receive communication, and how participants respond to materials developed using the principles. Important topics discussed are understanding the literacy levels of the target audience, applying that understanding to developing messages, how risk perception leads to misperceptions and how to address those misperceptions by using plain language when developing focused messages and materials.

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.

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

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

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

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

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

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

Engaged communication of environmental health science: Processes and outcomes of urban academic-community partnerships

Those who bear the greatest environmental burdens often have the least access to information, and explanations for engaging communities to develop solutions are lacking. We describe, and use a case study to depict, a participatory process of urban academic and community members to co-produce educational and communication tools. Over five years, we interfaced with 763 individuals at eleven events and three times that (n=2,273) through attendees' networks at 109 small group events using snowball methods. The resulting communication tools, paired resources, and mobile dissemination were responsive to residents' circumstances and enhanced their ability to access health protecting information and resources.

Efficacy of Communication Techniques and Health Outcomes of Bushfire Smoke Exposure: A Scoping Review

Public health officials communicate the relevant risks of bushfire smoke exposure and associated health protection measures to affected populations. Increasing global bushfire incidence in the context of climate change motivated this scoping review. English-language publications related to adverse health outcomes following bushfire smoke exposure and publications relating to communication during natural disasters were included. Bushfire smoke events potentially increase healthcare contact, especially presentations triggered by respiratory illness. At-risk populations include those with underlying cardiorespiratory disease, elderly, paediatric, pregnant persons, and First Nations people. We found that social media, television, and radio are among the most common information sources utilised in bushfire smoke events. Message style, content, and method of delivery can directly influence message uptake and behaviour modification. Age, rurality, and geographical location influence information source preferences. Culturally and linguistically diverse groups and those with hearing, vision, and mobility-related disabilities may benefit from targeted health recommendations. This review emphasises the health effects of bushfire smoke exposure and related communication recommendations during and after bushfire smoke events. Additional investigation may further clarify the health effects of bushfire smoke exposure and efficacy of related health messaging, particularly in at-risk populations. Quantitative comparison of communication methods may yield more specific recommendations for future bushfire smoke events.

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.

What Do Childcare Providers Know about Environmental Influences on Children's Health? Implications for Environmental Health Literacy Efforts

Children are uniquely vulnerable to toxicant exposures in their environment, which can have long-lasting impacts on their health. Childcare providers are an important population to target for environmental health literacy, as most children in the United States under five years of age spend a significant number of waking hours in non-parental care. There is an increasing body of evidence that children are exposed to toxicants in the childcare environment, and yet little is known about what childcare providers know about environmental influences on the health of children in their care. We conducted semi-structured interviews with 36 home- and center-based Illinois childcare providers to better understand their knowledge, attitudes, and behaviors as they relate to environmental influences on children’s health. We found that the majority of providers had a low level of understanding of potential sources of exposure in the childcare environment, and they did not feel that environmental exposures posed a significant risk to children. Future efforts to increase environmental health literacy should focus on raising awareness and knowledge of environmental health issues for childcare providers before addressing ways that providers can reduce or prevent toxicant exposures to children in their care.

An Evaluation of an Environmental Health Infographic in Community Settings

Background: Infographics are an effective way of communicating complex information due to their reliance on concise language and clear, uncluttered visuals. Research indicates that traffic-related ultrafine particles (UFPs) in air pollutions adversely affect human health, including respiratory and cardiovascular diseases. In this study, we work with community-based adult literacy programs to develop an infographic about UFPs in air pollution with the goal of community-driven problem solving related to traffic-related UFPs within affected neighborhoods. Objective: In this paper, we discuss the development and evaluation of an infographic about the dangers of UFPs from traffic pollution, and actions that readers in affected communities can take to protect their health. We used the infographic format to conceptualize UFP pollution and its health effects visually for community members many of whom are new immigrants and do not speak English as their first language. Methods: We conducted 1 focus group and 4 interviews over Zoom, and collected 74 anonymous surveys among Boston Chinatown and Somerville, MA residents. Community partner organizations assisted us in recruiting participants by sending a recruitment flyer to their email contacts and identifying specific people who were interested in participating. Key Results: Data from the surveys, focus group, and interviews yielded 8 themes that guided the revision of the infographic. The majority of the participants responded positively to the infographic: 95.9% (n = 71) of respondents reported that the purpose of the infographic was clear, that the infographic contained a clear message, and that the infographic uses images to explain important points. Conclusions: Our experience developing and evaluating an infographic about near highway pollution in environmental justice communities suggests that infographics can be a viable communication tool in this context. Further research with infographics of a similar nature but in diverse communities is needed to strengthen our conclusion.

Media Reporting on Air Pollution: Health Risk and Precautionary Measures in National and Regional Newspapers

Exposure to air pollution is one of the primary global health risk factors, yet individuals lack the knowledge to engage in individual risk mitigation and the skills to mobilize for the change necessary to reduce such risks. News media is an important tool for influencing individual actions and support for public policies to reduce environmental threats; thus, a lack of news coverage of such issues may exacerbate knowledge deficits. This study examines the reporting of health risks and precautionary measures regarding air pollution in national and regional print news. We conducted a content analysis of two national and two local newspapers covering the USA's most polluted region during a 5-year period. Coders identified information on threat, self-efficacy, protective measures and information sources. Nearly 40% of air pollution news articles mentioned human health risks. Fewer than 10% of news stories about air pollution provided information on the precautionary measures necessary for individuals to take action to mitigate their risk. Local newspapers did not report more threat (Χ² = 1.931, p = 0.165) and efficacy (Χ² = 1.118, p = 0.209) information. Although air pollution levels are high and continue to rise at alarming rates, our findings suggest that news media reporting is not conducive to raising environmental health literacy.

Fostering Health Literacy Responsiveness in a Remote Primary Health Care Setting: A Pilot Study

Primary healthcare organisations have an important role in addressing health literacy as this is a barrier to accessing and utilising health care. Until recently, no organisational development tool operationalising health literacy in an Australian context existed. This research evaluated the efficacy of the Organisational Health Literacy Responsiveness (Org-HLR) tool and associated assessment process in a primary healthcare organisation in the Pilbara region of Western Australia. This study utilised a sequential explanatory mixed methods research design incorporating the collection and analysis of data in two phases: (1) Pre- and post-survey data and; (2) seven semi-structured interviews. Survey results showed that participants’ confidence in core health literacy concepts improved from baseline following the intervention. Analysis of the interview data revealed participants’ initial understanding of health literacy was limited, and this impeded organisational responsiveness to health literacy needs. Participants reported the workshop and tool content were relevant to their organisation; they valued involving members from all parts of the organisation and having an external facilitator to ensure the impartiality of the process. External barriers to improving their internal organisational health literacy responsiveness were identified, with participants acknowledging the management style and culture of open communication within the organisation as enablers of change. Participants identified actionable changes to improve their organisational health literacy responsiveness using the process of organisational assessment and change.

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

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

Appalachian Environmental Health Literacy: Building Knowledge and Skills to Protect Health

Environmental health literacy (EHL) is an emerging, multidisciplinary field that promotes understanding of how environmental exposures can affect human health. After discussing the regional relevance of environmental health knowledge and skills, this article describes three ongoing Appalachian projects that are focused on measuring and building EHL.

Advancing Environmental Health Literacy: Validated Scales of General Environmental Health and Environmental Media-Specific Knowledge, Attitudes and Behaviors

Environmental health literacy (EHL) involves understanding and using environmental information to make decisions about health. This study developed a validated survey instrument with four scales for assessing media-specific (i.e., air, food, water) and general EHL. The four scales were created as follows: 1) item generation: environmental health scientists and statisticians developed an initial set of items in three domains: knowledge, attitudes, and behaviors; 2) item review: items were reviewed for face validity; 3) validation: 174 public health students, the exploratory sample, and 98 community members, the test sample, validated the scales. The scales’ factor structure was based on exploratory factor analysis (EFA) and model fit was assessed through confirmatory factor analysis (CFA). For each scale, the final EFA resulted in an independent three-factor solution for knowledge, attitudes, and behaviors. Good fit for the three-factor structure was observed. Model fit for CFA was generally confirmed with fit indices. The scales showed internal consistency with Cronbach’s alpha from 0.63 to 0.70. The 42-item instrument represents an important contribution towards assessing EHL and is designed to enable meaningful engagement between researchers and community members about environmental health. The intended outcome is sustained community–academic partnerships benefiting research design, implementation, translation, dissemination, and community action.

Engaged Environmental Science for Underserved Youth

The National Institute for Environmental Health Sciences has called for targeted efforts to engage underserved youth in environmental education programs that support environmental literacy and contribute to the development of a diverse workforce pipeline for environmental science-related occupations. Evidence suggests that career knowledge among low income and minority youth is more likely to be incompatible with post-secondary educational opportunities than other racial and ethnic groups. One approach to attenuating discordant college and career expectations among underserved youth is building networks for information sharing between secondary and post-secondary students. The purpose of this commentary is to describe the development and implementation of a high school curriculum on environmental science and environmental justice by Texas A&M University in collaboration with community engagement partners, students, and teachers at Furr High School, an innovative XQ Super School in Houston, Texas.

Communicating the environmental health risk assessment process: formative evaluation and increasing comprehension through visual design

The environmental health risk assessment process informs clean-up activities at hazardous waste sites. Ensuring this process is accessible and transparent to communities is crucial for environmental health literacy initiatives. The goals of this project were to develop plain language and effective visuals that can be used when communicating the risk assessment process and methods used to predict excess cancer risk(s) due to environmental exposures. In this study, a community factsheet entitled, "Understanding Environmental Health Risk Assessment" was developed and a participatory design and formative evaluation approach was implemented with a set of representative users (n = 11). Community members living in the vicinity of two Arizona hazardous waste sites as well as three public health professionals/researchers were asked to evaluate the functionality and accessibility of the factsheet, particularly the graphics and whether the text was written in plain language. Participant responses revealed the following major findings: 1) form follows function, 2) graphic elements should outweigh text, 3) line of sight and layout is critical to information accessibility, 4) color coding dramatically aids the reader, 5) content should be strategically grouped, 6) concepts per figure should be minimized to ensure comprehension, 7) interactive content is preferred over static content, and 8) communication efforts need to interweave new information with the targeted audience's past and current environmental health understandings to aid in their ability to retain new concepts. Based on participant feedback, new and improved layout decisions, infographics and accompanying text were designed and prepared. This research demonstrates the need and importance of participatory design, information design prototyping, formative evaluation, and a cultural model of risk communication.

Visualizing Air Pollution: Communication of Environmental Health Information in a Chinese Immigrant Community

This study developed and evaluated a visual approach to promoting environmental health literacy about highway pollution. The Interactive Map of Chinatown Traffic Pollution was the centerpiece of a communication approach designed to make complex scientific information about traffic-related air pollution comprehensible to Chinese immigrants with limited English proficiency. The map enabled visualization of the spatial distribution of ultrafine particles (less than 100 nanometers in diameter), a toxic and invisible form of air pollution, in Boston Chinatown. A university-community partnership enabled design of intergenerational training sessions aimed toward empowering community members to take health-promoting actions that reduce exposure to ultrafine particulate pollution. A mixed methods approach was taken to evaluation. Nine high school youth learned to use the map and then tutored adults recruited from English as a Second Language (ESL) classes and from a community workshop. Seventy-three of these adults completed a pre-post survey measuring change in three domains: pollution knowledge, attitudes toward environmental issues, and self-efficacy in using maps. Adult participants demonstrated statistically significant improvements in all three domains (Wilcoxon signed-rank test, all p < 0.01). Seventeen adults and nine youth participated in interviews. Interview participants reported adjusting daily routines to reduce exposure to pollution.

Public Awareness of Air Pollution and Health Threats: Challenges and Opportunities for Communication Strategies To Improve Environmental Health Literacy

Accurate, timely information can be a powerful tool to mitigate harmful effects of air pollution. While national guidelines for environmental risk communication - based on risk and crisis communication principles - exist, little is known how these are operationalized, nor about the effectiveness of existing communication efforts. Moreover, a growing literature on environmental health literacy suggests that communication about environmental risks must move beyond individual behavior education to empower communities to mobilize to reduce environmental threats. This study aimed to identify and critically evaluate public sources of information about the causes and controllability of air pollution and its health effects, and potential disparities in information reach and utility. The case study triangulated data from three sources: Systematic analysis of the public information environment, interviews with regional expert stakeholders, and interviews with community residents. Three themes emerged: 1) Lack of clarity about responsibility for communicating about air quality (information sources), 2) Existing air quality communication strategies lack critical information including risk mitigation behaviors and long-term health impacts (information quality), and 3) Existing air quality communications fail to reach vulnerable populations (information reach). This study demonstrates that air quality communication is lacking yet crucially needed. Information about air pollution and health risks focuses on individual risk behaviors but is disseminated using channels that are unlikely to reach the most vulnerable populations. We discuss opportunities to improve the reach and impact of communication of air quality health risks, an increasingly important global priority, situating our argument within a critical environmental health literacy perspective.

Increasing Environmental Health Literacy through Contextual Learning in Communities at Risk

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

Building and Maintaining a Citizen Science Network With Fishermen and Fishing Communities Post Deepwater Horizon Oil Disaster Using a CBPR Approach

When the Deepwater Horizon oil rig blew out in 2010, the immediate threats to productive deep water and estuarial fisheries and the region's fishing and energy economies were obvious. Less immediately obvious, but equally unsettling, were risks to human health posed by potential damage to the regional food web. This paper describes grassroots and regional efforts by the Gulf Coast Health Alliance: health risks related to the Macondo Spill Fishermen's Citizen Science Network project. Using a community-based participatory research approach and a citizen science structure, the multiyear project measured exposure to petrogenic polycyclic aromatic hydrocarbons, researched the toxicity of these polycyclic aromatic hydrocarbon compounds, and communicated project findings and seafood consumption guidelines throughout the region (coastal Louisiana, Mississippi, and Alabama). Description/analysis focuses primarily on the process of building a network of working fishermen and developing group environmental health literacy competencies.

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

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

The Role of Environmental Health Literacy When Developing Traffic Pollution Fact Sheets for Puerto Rican Adults

Environmental health literacy is particularly relevant to racial/ethnic and linguistic minority populations who are likely to live near major roadways and highways. We conducted exploratory research to develop ways to communicate the risks of traffic-related air pollution to Puerto Rican adults living in and near Boston, Massachusetts. We held two initial focus groups with Spanish-speaking Puerto Rican adults (N = 16) enrolled in the Boston Puerto Rican Health Study (BPRHS). Most had only a high school education or less and earned a low income. We used thematic analysis of transcripts to suggest ways to improve three fact sheets designed to communicate BPRHS findings to the community. Based on these results, we made substantial revisions. We then conducted a second set of two focus groups with the same participants to assess revisions. Participants viewed the revised fact sheets more favorably and indicated that they found them easier to read. Lessons learned about improving readability and relevance included increasing text size, adding more graphics, chunking text, and providing more technical details. Designing successful environmental health communication tools that retain scientific accuracy is not a simple task. There is need for systematic attempts to evaluate and report on health literacy and community engagement processes for developing materials that are easy to read, culturally relevant, and that communicate complex environmental health information and concepts in ways people can understand and act on.

Making Air Pollution Visible: A Tool for Promoting Environmental Health Literacy

BACKGROUND

Digital maps are instrumental in conveying information about environmental hazards geographically. For laypersons, computer-based maps can serve as tools to promote environmental health literacy about invisible traffic-related air pollution and ultrafine particles. Concentrations of these pollutants are higher near major roadways and increasingly linked to adverse health effects. Interactive computer maps provide visualizations that can allow users to build mental models of the spatial distribution of ultrafine particles in a community and learn about the risk of exposure in a geographic context.

OBJECTIVE

The objective of this work was to develop a new software tool appropriate for educating members of the Boston Chinatown community (Boston, MA, USA) about the nature and potential health risks of traffic-related air pollution. The tool, the Interactive Map of Chinatown Traffic Pollution ("Air Pollution Map" hereafter), is a prototype that can be adapted for the purpose of educating community members across a range of socioeconomic contexts.

METHODS

We built the educational visualization tool on the open source Weave software platform. We designed the tool as the centerpiece of a multimodal and intergenerational educational intervention about the health risk of traffic-related air pollution. We used a previously published fine resolution (20 m) hourly land-use regression model of ultrafine particles as the algorithm for predicting pollution levels and applied it to one neighborhood, Boston Chinatown. In designing the map, we consulted community experts to help customize the user interface to communication styles prevalent in the target community.

RESULTS

The product is a map that displays ultrafine particulate concentrations averaged across census blocks using a color gradation from white to dark red. The interactive features allow users to explore and learn how changing meteorological conditions and traffic volume influence ultrafine particle concentrations. Users can also select from multiple map layers, such as a street map or satellite view. The map legends and labels are available in both Chinese and English, and are thus accessible to immigrants and residents with proficiency in either language. The map can be either Web or desktop based.

CONCLUSIONS

The Air Pollution Map incorporates relevant language and landmarks to make complex scientific information about ultrafine particles accessible to members of the Boston Chinatown community. In future work, we will test the map in an educational intervention that features intergenerational colearning and the use of supplementary multimedia presentations.

Analyzing Patterns of Community Interest at a Legacy Mining Waste Site to Assess and Inform Environmental Health Literacy Efforts

Understanding a community's concerns and informational needs is crucial to conducting and improving environmental health research and literacy initiatives. We hypothesized that analysis of community inquiries over time at a legacy mining site would be an effective method for assessing environmental health literacy efforts and determining whether community concerns were thoroughly addressed. Through a qualitative analysis, we determined community concerns at the time of being listed as a Superfund site. We analyzed how community concerns changed from this starting point over the subsequent years, and whether: 1) communication materials produced by the USEPA and other media were aligned with community concerns; and 2) these changes demonstrated a progression of the community's understanding resulting from community involvement and engaged research efforts. We observed that when the Superfund site was first listed, community members were most concerned with USEPA management, remediation, site-specific issues, health effects, and environmental monitoring efforts related to air/dust and water. Over the next five years, community inquiries shifted significantly to include exposure assessment and reduction methods and issues unrelated to the site, particularly the local public water supply and home water treatment systems. Such documentation of community inquiries over time at contaminated sites is a novel method to assess environmental health literacy efforts and determine whether community concerns were thoroughly addressed.

Improving Environmental Health Literacy and Justice through Environmental Exposure Results Communication

Understanding the short- and long-term impacts of a biomonitoring and exposure project and reporting personal results back to study participants is critical for guiding future efforts, especially in the context of environmental justice. The purpose of this study was to evaluate learning outcomes from environmental communication efforts and whether environmental health literacy goals were met in an environmental justice community. We conducted 14 interviews with parents who had participated in the University of Arizona's Metals Exposure Study in Homes and analyzed their responses using NVivo, a qualitative data management and analysis program. Key findings were that participants used the data to cope with their challenging circumstances, the majority of participants described changing their families' household behaviors, and participants reported specific interventions to reduce family exposures. The strength of this study is that it provides insight into what people learn and gain from such results communication efforts, what participants want to know, and what type of additional information participants need to advance their environmental health literacy. This information can help improve future report back efforts and advance environmental health and justice.

Reporting back environmental exposure data and free choice learning

Reporting data back to study participants is increasingly being integrated into exposure and biomonitoring studies. Informal science learning opportunities are valuable in environmental health literacy efforts and report back efforts are filling an important gap in these efforts. Using the University of Arizona's Metals Exposure Study in Homes, this commentary reflects on how community-engaged exposure assessment studies, partnered with data report back efforts are providing a new informal education setting and stimulating free-choice learning. Participants are capitalizing on participating in research and leveraging their research experience to meet personal and community environmental health literacy goals. Observations from report back activities conducted in a mining community support the idea that reporting back biomonitoring data reinforces free-choice learning and this activity can lead to improvements in environmental health literacy. By linking the field of informal science education to the environmental health literacy concepts, this commentary demonstrates how reporting data back to participants is tapping into what an individual is intrinsically motivated to learn and how these efforts are successfully responding to community-identified education and research needs.