Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution.

OBJECTIVES: To identify strategies and tactics communities use to translate research into environmental health action. METHODS: We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks. RESULTS: In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation. CONCLUSIONS: CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

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.

Health Lens Analysis: A Strategy to Engage Community in Environmental Health Research in Action.

Health Lens Analysis is a tool to facilitate collaboration among diverse community stakeholders. We employed HLA as part of a community based participatory research (CBPR) and action study to mitigate the negative health effects of TRAP and ultrafine particles (UFPs) in Somerville, MA. HLA is a Health in All Policies tool with previously limited implementation in a North American context. As part of the HLA, community and academic partners engaged residents from across near-highway neighborhoods in a series of activities designed to identify health concerns and generate recommendations for policies and projects to improve health over an 18-month planning period. Noise barriers, which may reduce TRAP exposure among residents in addition to reducing traffic noise, were seen as an acceptable solution by community stakeholders. We found HLA to be an effective means to engage stakeholders from across sectors and diverse community residents in critical discourse about the health impacts of near-roadway exposures. The iterative process allowed the project team to fully explore the arguments for noise barriers and preferred health interventions, while building a stakeholder base interested in the mitigation of TRAP, thus, creating a shared language and understanding of the issue.

Effect of Reducing Ambient Traffic-Related Air Pollution on Blood Pressure: A Randomized Crossover Trial.

Exposure to traffic-related air pollution (TRAP) may contribute to increased prevalence of hypertension and elevated blood pressure (BP) for residents of near-highway neighborhoods. Relatively few studies have investigated the effects of reducing TRAP exposure on short-term changes in BP. We assessed whether reducing indoor TRAP concentrations by using stand-alone high-efficiency particulate arrestance (HEPA) filters and limiting infiltration through doors and windows effectively prevented acute (ie, over a span of hours) increases in BP. Using a 3-period crossover design, 77 participants were randomized to attend three 2-hour-long exposure sessions separated by 1-week washout periods. Each participant was exposed to high, medium, and low TRAP concentrations in a room near an interstate highway. Particle number concentrations, black carbon concentrations, and temperature were monitored continuously. Systolic BP (SBP), diastolic BP, and heart rate were measured every 10 minutes. Outcomes were analyzed with a linear mixed model. The primary outcome was the change in SBP from 20 minutes from the start of exposure. SBP increased with exposure duration, and the amount of increase was related to the magnitude of exposure. The mean change in SBP was 0.6 mm Hg for low exposure (mean particle number and black carbon concentrations, 2500 particles/cm3 and 149 ng/m3), 1.3 mm Hg for medium exposure (mean particle number and black carbon concentrations, 11 000 particles/cm3 and 409 ng/m3), and 2.8 mm Hg for high exposure (mean particle number and black carbon concentrations, 30 000 particles/cm3 and 826 ng/m3; linear trend P=0.019). There were no statistically significant differences in the secondary outcomes, diastolic BP, or heart rate. In conclusion, reducing indoor concentrations of TRAP was effective in preventing acute increases in SBP.

Two communities, one highway and the fight for clean air: the role of political history in shaping community engagement and environmental health research translation.

BACKGROUND: This paper explores strategies to engage community stakeholders in efforts to address the effects of traffic-related air pollution (TRAP). Communities of color and low-income communities are disproportionately impacted by environmental threats including emissions generated by major roadways. METHODS: Qualitative instrumental case study design was employed to examine how community-level factors in two Massachusetts communities, the City of Somerville and Boston's Chinatown neighborhood, influence the translation of research into practice to address TRAP exposure. Guided by the Interactive Systems Framework (ISF), we drew on three data sources: key informant interviews, observations and document reviews. Thematic analysis was used. RESULTS: Findings indicate political history plays a significant role in shaping community action. In Somerville, community organizers worked with city and state officials, and embraced community development strategies to engage residents. In contrast, Chinatown community activists focused on immediate resident concerns including housing and resident displacement resulting in more opposition to local municipal leadership. CONCLUSIONS: The ISF was helpful in informing the team's thinking related to systems and structures needed to translate research to practice. However, although municipal stakeholders are increasingly sympathetic to and aware of the health impacts of TRAP, there was not a local legislative or regulatory precedent on how to move some of the proposed TRAP-related policies into practice. As such, we found that pairing the ISF with a community organizing framework may serve as a useful approach for examining the dynamic relationship between science, community engagement and environmental research translation. Social workers and public health professionals can advance TRAP exposure mitigation by exploring the political and social context of communities and working to bridge research and community action.

CBPR Partnerships and Near-Roadway Pollution: A Promising Strategy to Influence the Translation of Research into Practice.

Community-based participatory research (CBPR) aims to engage those traditionally left out of the research process. Partnering with community stakeholders to design, plan, implement and disseminate research can facilitate translation into practice. Using qualitative research methods, we set out to explore the policy and practice implications of a CBPR partnership focused on reducing exposure to near-roadway pollution. Key Informant interviews (n = 13) were conducted with individuals from various entities (municipal, state and private) for whom partners to the Community Assessment of Freeway Exposure and Health (CAFEH) provided technical assistance between 2013 and 2017. The findings indicate community research partnerships may have the power to inform local planning efforts. Developers and planners who the partnership consulted indicated a greater awareness of the implications of near-roadway exposure. They also described making changes in their practice based on study findings. The CAFEH partnership has demonstrated active attention to translating knowledge can influence local planning and practice, albeit with some challenges.

Participatory Democracy, Community Organizing and the Community Assessment of Freeway Exposure and Health (CAFEH) Partnership.

Background: Conflicting interests, power imbalance and relationships characterized by distrust are just a few of the many challenges community-academic research partnerships face. In addition, the time it takes to build relationships is often overlooked, which further complicates matters and can leave well-intentioned individuals re-creating oppressive conditions through inauthentic partnerships. This paper presents a novel approach of using meeting minutes to explore partnership dynamics. The Community Assessment of Freeway Exposure and Health (CAFEH) partnership is used as an illustrative case study to identify how community academic partnerships overcome the challenges associated with community-based participatory research (CBPR). CAFEH is a study of ultrafine particle exposure (UFP) near highways in the Boston, MA area. Methods: Qualitative analysis was applied to meeting minutes and process evaluation reports from the first three years of the CAFEH study (n = 73 files). In addition, a group meeting was held with project partners in order to contextualize the findings from the document analysis. Results: The three most commonly referenced challenges included language barriers, the overall project structure and budgetary constraints. Meanwhile, a heavy emphasis on process and an approach steeped in participatory democracy facilitated CAFEH's ability to overcome these challenges, as well as sustain and augment strong partnership ties. Conclusions: This experience suggests that leadership that incorporates an organizing approach and a transformational style facilitates CBPR processes and helps teams surmount challenges.

Association of modeled long-term personal exposure to ultrafine particles with inflammatory and coagulation biomarkers.

BACKGROUND: Long-term exposure to fine particulate matter has been linked to cardiovascular disease and systemic inflammatory responses; however, evidence is limited regarding the effects of long-term exposure to ultrafine particulate matter (UFP, <100nm). We used a cross-sectional study design to examine the association of long-term exposure to near-highway UFP with measures of systemic inflammation and coagulation. METHODS: We analyzed blood samples from 408 individuals aged 40-91years living in three near-highway and three urban background areas in and near Boston, Massachusetts. We conducted mobile monitoring of particle number concentration (PNC) in each area, and used the data to develop and validate highly resolved spatiotemporal (hourly, 20m) PNC regression models. These models were linked with participant time-activity data to determine individual time-activity adjusted (TAA) annual average PNC exposures. Multivariable regression modeling and stratification were used to assess the association between TAA-PNC and single peripheral blood measures of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor-necrosis factor alpha receptor II (TNFRII) and fibrinogen. RESULTS: After adjusting for age, sex, education, body mass index, smoking and race/ethnicity, an interquartile-range (10,000particles/cm(3)) increase in TAA-PNC had a positive non-significant association with a 14.0% (95% CI: -4.6%, 36.2%) positive difference in hsCRP, an 8.9% (95% CI: -0.4%, 10.9%) positive difference in IL-6, and a 5.1% (95% CI: -0.4%, 10.9%) positive difference in TNFRII. Stratification by race/ethnicity revealed that TAA-PNC had larger effect estimates for all three inflammatory markers and was significantly associated with hsCRP and TNFRII in white non-Hispanic, but not East Asian participants. Fibrinogen had a negative non-significant association with TAA-PNC. CONCLUSIONS: Our findings suggest an association between annual average near-highway TAA-PNC and subclinical inflammatory markers of CVD risk.

Gender, Ethnicity and Environmental Risk Perception Revisited: The Importance of Residential Location.

Studies in the U.S. have found that white men are less concerned about pollution than are women or people of other ethnicity. These studies have not assessed respondents' proximity to localized sources of pollution. Our objective was to assess lay perceptions of risk from air pollution in an ethnically diverse sample in which proximity to a major perceptible source of pollution is known. Cross sectional interview study of combined area probability and convenience sample of individuals 40 and older in the Boston area, selected according to proximity to high traffic controlled access highways. Of 697 respondents 46% were white, 37% Asian (mostly Chinese), 6.3% African-American, 6.3% Latino, and 7.6% other ethnicity. While white respondents, and particularly white men, were less concerned about air pollution than others, this effect disappeared when controlling for distance from the highway. White men were slightly less supportive than others of government policy to control pollution. The "white male" effect may in part be accounted for by the greater likelihood of minority respondents to live near perceptible localized sources of pollution.

Developing Community-Level Policy and Practice to Reduce Traffic-Related Air Pollution Exposure.

The literature consistently shows associations of adverse cardiovascular and pulmonary outcomes with residential proximity to highways and major roadways. Air monitoring shows that traffic-related pollutants (TRAP) are elevated within 200-400 m of these roads. Community-level tactics for reducing exposure include the following: 1) HEPA filtration; 2) Appropriate air-intake locations; 3) Sound proofing, insulation and other features; 4) Land-use buffers; 5) Vegetation or wall barriers; 6) Street-side trees, hedges and vegetation; 7) Decking over highways; 8) Urban design including placement of buildings; 9) Garden and park locations; and 10) Active travel locations, including bicycling and walking paths. A multidisciplinary design charrette was held to test the feasibility of incorporating these tactics into near-highway housing and school developments that were in the planning stages. The resulting designs successfully utilized many of the protective tactics and also led to engagement with the designers and developers of the sites. There is a need to increase awareness of TRAP in terms of building design and urban planning.

In-home air filtration for improving cardiovascular health: lessons from a CBPR study in public housing.

BACKGROUND: Particulate air pollution, including from motor vehicles, is associated with cardiovascular disease. OBJECTIVES: To describe lessons learned from installing air filtration units in public housing apartments next to a major highway. METHODS: We reviewed experience with recruitment, retention, and acceptance of the air filtration units. RESULTS: Recruitment and retention have been challenging, but similar to other studies in public housing. Equipment noise and overheated apartments during hot weather have been notable complaints from participants. In addition, we found that families with members with Alzheimer's or mental disability were less able to tolerate the equipment. CONCLUSIONS: For this research, the primary lesson is that working closely with each participant is important. A future public health program would need to address issues of noise and heat to make the intervention more acceptable to residents.