Association between private drinking water wells and the incidence of Campylobacteriosis in Maryland: An ecological analysis using Foodborne Diseases Active Surveillance Network (FoodNet) data (2007-2016).

Campylobacter is a leading cause of bacterial foodborne illness in the United States. Campylobacter infections have most often been associated with food-related risk factors, such as the consumption of poultry and raw milk. Socioeconomic, agricultural and environmental factors, including drinking water source, can also influence the risk of campylobacteriosis. Approximately 19% of Maryland residents rely on private wells as their sole source of water. Given that the federal Safe Drinking Water Act does not regulate the water quality of private wells, these could be important non-foodborne transmission pathways for Campylobacter. To address this issue, data on the number of culture-confirmed cases of Campylobacter infection in Maryland between 2007 and 2016 were obtained from the Foodborne Diseases Active Surveillance Network. Cases were linked by zip code with data from the Maryland well permits registry, the 2010 U.S. Census, the 2016 American Community Survey, and the USDA Agricultural Census. Campylobacteriosis incidence rates and well prevalence were calculated by zip code. Negative binomial regression models were then constructed to evaluate the association between the prevalence of private wells, presence/absence of animal feeding operations and the incidence of campylobacteriosis across the physiographic provinces in Maryland. From 2007 to 2016, a total of 5746 cases of campylobacteriosis were reported in Maryland, and annual incidence rates ranged from 6.65 to 11.59 per 100,000 people. In our statewide analysis, a significant positive association was observed between well prevalence and increased campylobacteriosis incidence at the zip code level (Incidence Rate Ratio (IRR) = 1.35, 95% Confidence Interval (CI) = 1.11, 1.63). A significant positive association was also observed between well prevalence and increased campylobacteriosis incidence in the Appalachian and Coastal provinces of Maryland (IRR = 2.94, 95% CI = 1.11, 7.76 and IRR = 1.70, 95% CI = 1.25, 2.31, respectively). The presence of broiler chicken operations, increasing median age and percentage of residents living in poverty were also significantly associated with campylobacteriosis incidence at the zip code level in some physiographic provinces in Maryland. To our knowledge, these are the first US data to demonstrate an association between prevalence of private wells and campylobacteriosis incidence at the zip code level.

Exploring perceptions of cancer risk, neighborhood environmental risks, and health behaviors of blacks.

Cancer risk perceptions and cancer worry are shaped by race/ethnicity, and social, economic, and environmental factors, which in turn shape health decision-making. A paucity of studies has explored risk perceptions and worry in metropolitan areas with disparate environmental conditions and cancer outcomes. This study examined perceptions of cancer risk, neighborhood environmental health risks, and risk-reducing health behaviors among Blacks. A 59-item survey was administered to respondents in Metropolitan Charleston, South Carolina from March to September 2013. A convenience sample of males and females was recruited at local venues and community events. Descriptive statistics, bivariate analyses (Chi square tests), and logistic regression models were estimated using SAS 9.3 software. Respondents (N = 405) were 100% Black, 81% female (n = 323), and ranged from 18 to 87 years of age (M = 49.55, SD = 15.27). Most respondents reported lower perceptions of cancer risk (37%) and equated their cancer beliefs to direct or indirect (i.e. personal or family) experiences. Low perceived cancer risk (absolute risk) was significantly associated (p < .05) with non-alcohol consumption, having a colon cancer screening test, being female, and being age 25-44 or 45-64. Cancer worry was significantly associated (p < .05) with being a current smoker, having a "fair" diet, non-alcohol consumption, and having any colon cancer screening test. Perceived cancer risk is an important indicator of health behaviors among Blacks. Direct or indirect experiences with cancer and/or the environment and awareness of family history of cancer may explain cancer risk perceptions.

Public infrastructure disparities and the microbiological and chemical safety of drinking and surface water supplies in a community bordering a landfill.

The historically African-American Rogers-Eubanks community straddles unincorporated boundaries of two municipalities in Orange County, North Carolina, and predates a regional landfill sited along its border in 1972. Community members from the Rogers-Eubanks Neighborhood Association (RENA), concerned about deterioration of private wells and septic systems and a lack of public drinking water and sewer services, implemented a community-driven research partnership with university scientists and community-based organizations to investigate water and sewer infrastructure disparities and the safety of drinking and surface water supplies. RENA drafted memoranda of agreement with partners and trained community monitors to collect data (inventory households, map water and sewer infrastructure, administer household water and sewer infrastructure surveys, and collect drinking and surface water samples). Respondents to the surveys reported pervasive signs of well vulnerability (100%) and septic system failure (68%). Each 100-m increase in distance from the landfill was associated with a 600 most probable number/100 mL decrease in enterococci concentrations in surface water (95% confidence interval = -1106, -93). Pervasive private household water and sewer infrastructure failures and poor water quality were identified in this community bordering a regional landfill, providing evidence of a need for improved water and sanitation services.

Assessment of the distribution of toxic release inventory facilities in metropolitan Charleston: an environmental justice case study.

OBJECTIVES: We assessed spatial disparities in the distribution of Toxic Release Inventory (TRI) facilities in Charleston, SC. METHODS: We used spatial methods and regression to assess burden disparities in the study area at the block and census-tract levels by race/ethnicity and socioeconomic status (SES). RESULTS: Results revealed an inverse relationship between distance to TRI facilities and race/ethnicity and SES at the block and census-tract levels. Results of regression analyses showed a positive association between presence of TRI facilities and high percentage non-White and a negative association between number of TRI facilities and high SES. CONCLUSIONS: There are burden disparities in the distribution of TRI facilities in Charleston at the block and census-tract level by race/ethnicity and SES. Additional research is needed to understand cumulative risk in the region.

Hybrid Resiliency-Stressor Conceptual Framework for Informing Decision Support Tools and Addressing Environmental Injustice and Health Inequities.

While structural factors may drive health inequities, certain health-promoting attributes of one's "place" known as salutogens may further moderate the cumulative impacts of exposures to socio-environmental stressors that behave as pathogens. Understanding the synergistic relationship between socio-environmental stressors and resilience factors is a critical component in reducing health inequities; however, the catalyst for this concept relies on community-engaged research approaches to ultimately strengthen resiliency and promote health. Furthermore, this concept has not been fully integrated into environmental justice and cumulative risk assessment screening tools designed to identify geospatial variability in environmental factors that may be associated with health inequities. As a result, we propose a hybrid resiliency-stressor conceptual framework to inform the development of environmental justice and cumulative risk assessment screening tools that can detect environmental inequities and opportunities for resilience in vulnerable populations. We explore the relationship between actual exposures to socio-environmental stressors, perceptions of stressors, and one's physiological and psychological stress response to environmental stimuli, which collectively may perpetuate health inequities by increasing allostatic load and initiating disease onset. This comprehensive framework expands the scope of existing screening tools to inform action-based solutions that rely on community-engaged research efforts to increase resiliency and promote positive health outcomes.

Correction to: Effects-based spatial assessment of contaminated estuarine sediments from Bear Creek, Baltimore Harbor, MD, USA.

The authors of the article have informed the Journal that an author, Dr. Sacoby Wilson of the University of Maryland School of Public Health, was inadvertently omitted from the published version of their manuscript due to a miscommunication regarding authorship criteria.

Prevalence of Microbiological and Chemical Contaminants in Private Drinking Water Wells in Maryland, USA.

Although many U.S. homes rely on private wells, few studies have investigated the quality of these water sources. This cross-sectional study evaluated private well water quality in Maryland, and explored possible environmental sources that could impact water quality. Well water samples (n = 118) were collected in four Maryland counties and were analyzed for microbiological and chemical contaminants. Data from the U.S. Census of Agriculture were used to evaluate associations between the presence of animal feeding operations and well water quality at the zip code level using logistic regression. Overall, 43.2% of tested wells did not meet at least one federal health-based drinking water standard. Total coliforms, fecal coliforms, enterococci, and Escherichia coli were detected in 25.4%, 15.3%, 5.1%, and 3.4% of tested wells, respectively. Approximately 26%, 3.4%, and <1% of wells did not meet standards for pH, nitrate-N, and total dissolved solids, respectively. There were no statistically significant associations between the presence of cattle, dairy, broiler, turkey, or aquaculture operations and the detection of fecal indicator bacteria in tested wells. In conclusion, nearly half of tested wells did not meet federal health-based drinking water standards, and additional research is needed to evaluate factors that impact well water quality. However, homeowner education on well water testing and well maintenance could be important for public health.

Effects-based spatial assessment of contaminated estuarine sediments from Bear Creek, Baltimore Harbor, MD, USA.

Estuarine sediments in regions with prolonged histories of industrial activity are often laden to significant depths with complex contaminant mixtures, including trace metals and persistent organic pollutants. Given the complexity of assessing risks from multi-contaminant exposures, the direct measurement of impacts to biological receptors is central to characterizing contaminated sediment sites. Though biological consequences are less commonly assessed at depth, laboratory-based toxicity testing of subsurface sediments can be used to delineate the scope of contamination at impacted sites. The extent and depth of sediment toxicity in Bear Creek, near Baltimore, Maryland, USA, was delineated using 10-day acute toxicity tests with the estuarine amphipod Leptocheirus plumulosus, and chemical analysis of trace metals and persistent organic pollutants. A gradient of toxicity was demonstrated in surface sediments with 21 of 22 tested sites differing significantly from controls. Effects were most pronounced (100% lethality) at sites proximate to a historic industrial complex. Sediments from eight of nine core samples to depths of 80 cm were particularly impacted (i.e., caused significant lethality to L. plumulosus) even in locations overlain with relatively non-toxic surface sediments, supporting a conclusion that toxicity observed at the surface (top 2 cm) does not adequately predict toxicity at depth. In seven of nine sites, toxicity of surface sediments differed from toxicity at levels beneath by 28 to 69%, in five instances underestimating toxicity (28 to 69%), and in two instances overestimating toxicity (44 to 56%). Multiple contaminants exceeded sediment quality guidelines and correlated positively with toxic responses within surface sediments (e.g., chromium, nickel, polycyclic aromatic hydrocarbon (PAH), total petroleum hydrocarbon). Use of an antibody-based PAH biosensor revealed that porewater PAH concentrations also increased with depth at most sites. This study informs future management decisions concerning the extent of impact to Bear Creek sediments, and demonstrates the benefits of a spatial approach, relying primarily on toxicity testing to assess sediment quality in a system with complex contaminant mixtures.

Baseline Air Quality Assessment of Goods Movement Activities before the Port of Charleston Expansion: A Community-University Collaborative.

As the demand for goods continues to increase, a collective network of transportation systems is required to facilitate goods movement activities. This study examines air quality near the Port of Charleston before its expansion and briefly describes the establishment and structure of a community-university partnership used to monitor existing pollution. Particulate matter (PM) concentrations (PM2.5 and PM10) were measured using the Thermo Fisher Scientific Partisol 2000i-D Dichotomous Air Sampler, Thermo Scientific Dichotomous Sequential Air Sampler Partisol-Plus 2025-D, and Rupprecht & Patashnick TEOM Series 1400 Sampler at neighborhood (Union Heights, Rosemont, and Accabee) and reference (FAA2.5 and Jenkins Street) sites. Descriptive statistics were performed and an ANOVA (analysis of variance) was calculated to find the difference in overall mean 24-hour PM average concentrations in communities impacted by environmental injustice. PM2.5 (15.2 µg/m3) and PM10 (27.2 µg/m3) maximum concentrations were highest in neighborhoods such as Union Heights neighborhoods due to more goods movement activities. Nevertheless, there was no statistically significant difference in mean concentrations of PM2.5 and PM10 across neighborhood sites. In contrast, mean PM10 neighborhood concentrations were significantly lower than mean PM10 reference concentrations for Union Heights (p = 0.00), Accabee (p ≤ 0.0001), and Rosemont (p = 0.01). Although PM concentrations were lower than current National Ambient Air Quality Standards, this study demonstrated how community-university partners can work collectively to document baseline PM concentrations that will be used to examine changes in air quality after the port expansion brings additional goods movement activities to the area.

Place-based perceptions of the impacts of fracking along the Marcellus Shale.

We examined community perspectives and experiences with fracking in Doddridge County, West Virginia, USA as part of a larger assessment to investigate the potential health impacts associated with fracking in neighboring Maryland, USA. In November 2013, we held two focus groups with community residents who had been impacted by fracking operations and conducted field observations in the impacted areas. Employing grounded theory, we conducted qualitative analysis to explore emergent themes related to direct and indirect health impacts of fracking. Three components of experience were identified, including (a) meanings of place and identity, (b) transforming relationships, and (c) perceptions of environmental and health impacts. Our findings indicate that fracking contributes to a disruption in residents' sense of place and social identity, generating widespread social stress. Although community residents acknowledged the potential for economic growth brought about by fracking, rapid transformations in meanings of place and social identity influenced residents' perceptions of environmental and health impacts. Our findings suggest that in order to have a more complete understanding of the health impacts of fracking, future work must consider the complex linkages between social disruption, environmental impacts, and health outcomes through critical engagements with communities undergoing energy development.

Environmental Justice Radar: A Tool for Community-Based Mapping to Increase Environmental Awareness and Participatory Decision Making.

BACKGROUND: As part of the Charleston Area Pollution Prevention Partnership (CAPs), studies have been performed to address environmental health issues using various techniques including Geographic Information Systems (GIS) mapping. Most of the mapping has been conducted by academic team members; however, there is a need for more community-based mapping to ensure the sustainability and effectiveness of community-driven efforts to eliminate environmental hazards and health disparities. The emergence of public participatory GIS (PPGIS) has been shown as a way to democratize science, build community capacity, and empower local citizens to address environmental health issues. PURPOSE: This article describes the development of the Environmental Justice (EJ) Radar, a PPGIS tool that provides stakeholders in South Carolina with a way to raise environmental awareness and improve citizen participation in local environmental decision-making. We describe the functionality of EJ Radar and discuss feedback received from stakeholders to improve the utility of the PPGIS tool.

Association between an Internet-Based Measure of Area Racism and Black Mortality.

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.

Environmental injustice and the Mississippi hog industry.

The recent growth and restructuring of the swine industry in the state of Mississippi has raised various environmental and socioeconomic concerns. We spatially examined the location and attributes of 67 industrial hog operations to determine if African American and low-income communities have a high prevalence of industrial hog operations located near their neighborhoods at the census block group level. We used spatial data and cross-classification analysis to compare the prevalence of industrial hog operations in neighborhoods that are primarily African American and low income with the prevalence in neighborhoods that are African American and affluent. We also used logistic regression to evaluate the relationship between the environmental justice variables and the location of the industrial hog operations. The block group characterization showed a high prevalence of hog operations in the four highest quintiles compared with the lowest quintile for percentage African American and percentage poverty. At increasing levels of percentage African Americans and percentage of persons in poverty, there are 2.4-3.6 times more operations compared with the referent group; additionally, scale adjustment to only the hog counties reduces this to 1.8-3.1 more operations compared with the referent group. The inequitable distribution of hog-confined agricultural feeding operations in these communities may have adverse environmental impacts associated with industrial hog production, such as increased health risks and quality of life degradation, as have occurred in other areas having similar facilities.

Use of segregation indices, Townsend Index, and air toxics data to assess lifetime cancer risk disparities in metropolitan Charleston, South Carolina, USA.

BACKGROUND: Studies have demonstrated a relationship between segregation and level of education, occupational opportunities, and risk behaviors, yet a paucity of research has elucidated the association between racial residential segregation, socioeconomic deprivation, and lifetime cancer risk. OBJECTIVES: We examined estimated lifetime cancer risk from air toxics by racial composition, segregation, and deprivation in census tracts in Metropolitan Charleston. METHODS: Segregation indices were used to measure the distribution of groups of people from different races within neighborhoods. The Townsend Index was used to measure economic deprivation in the study area. Poisson multivariate regressions were applied to assess the association of lifetime cancer risk with segregation indices and Townsend Index along with several sociodemographic measures. RESULTS: Lifetime cancer risk from all pollution sources was 28 persons/million for half of the census tracts in Metropolitan Charleston. Isolation Index and Townsend Index both showed significant correlation with lifetime cancer risk from different sources. This significance still holds after adjusting for other sociodemographic measures in a Poisson regression, and these two indices have stronger effect on lifetime cancer risk compared to the effects of sociodemographic measures. CONCLUSIONS: We found that material deprivation, measured by the Townsend Index and segregation measured by the Isolation index, introduced high impact on lifetime cancer risk by air toxics at the census tract level.

Assessment of Particulate Matter Levels in Vulnerable Communities in North Charleston, South Carolina prior to Port Expansion.

INTRODUCTION: The Port of Charleston, one of the busiest US ports, currently operates five terminals. The fifth terminal is being planned for expansion to accommodate container ships from the proposed Panama Canal expansion. Such expansion is expected to increase traffic within local vulnerable North Charleston neck communities by at least 7,000 diesel truck trips per day, more than a 70% increase from the present average rate of 10,000 trucks per day. Our objective was to measure the current particulate matter (PM) concentrations in North Charleston communities as a baseline to contrast against future air pollution after the proposed port expansion. METHODS: Saturation study was performed to determine spatial variability of PM in local Charleston neck communities. In addition, the temporal trends in particulate air pollution within the region were determined across several decades. With the BGI sampler, PM samples were collected for 24 hours comparable to the federal reference method protocol. Gravimetric analysis of the PM filter samples was conducted following EPA protocol. RESULTS: The range of the PM10 annual average across the region from 1982 to 2006 was 17.0-55.0 µg/m3. On only two occasions were the records of PM10 averaged above the 50.0 µg/m3 national standard. In the case of PM2.5, the annual average for 1999-2006 ranged from 11.0 to 13.5 µg/m3 and no annual average exceeded the 15.0 µg/m3 PM2.5 annual standard. CONCLUSIONS: Although ambient PM levels have fallen in the Charleston region since the 1960s due to aggressive monitoring by the stakeholders against air pollution, local air pollution sources within the North Charleston neck communities have consistently contributed to the PM levels in the region for several decades. This baseline assessment of ambient PM will allow for comparisons with future assessments to ascertain the impact of the increased truck and port traffic on PM concentrations.

The West End Revitalization Association's community-owned and -managed research model: development, implementation, and action.

BACKGROUND: Principal investigators (PIs) of community-based projects are predominantly university faculty who partner with community-based organizations (CBOs) to find a place to conduct research in communities that will cooperate with their research objectives. University-managed research models (UMRMs) are not always beneficial for CBOs because the university usually manages the study, collects and owns the data, and leverages control at each stage of research, without priority to resolution of problems impacting the quality of life of participating communities. OBJECTIVES: We present the principles of community-owned and -managed research (COMR), as a new community-driven research model developed by the West End Revitalization Association (WERA), a CBO in Mebane, North Carolina. METHODS: We describe WERA's development of COMR, compare the power hierarchies of COMR with traditional UMRMs, distinguish COMR partnerships from UMRM partnerships, discuss disbursement of funds, and control/ownership of data. As the PI of research activities, WERA drafted Memoranda of Agreement (MOAs) for all partners, including academic researchers, implemented quality assurance and control procedures, submitted community research protocols for institutional review, and retained data ownership for action, activism, and problem solving. COMR methods encouraged corrective action of environmental justice (EJ) problems in affected communities, including provision of public, regulated drinking water and sewer services. CONCLUSIONS: COMR promotes CBOs with demonstrated organizational capacity to PI and project manager. The COMR model goes beyond UMRMs and CBPR because it emphasized the credibility and capacity of CBOs to develop, own, manage, foster, and sustain viable research agendas to address ongoing environmental hazards and related threats to health and quality of life.

Use of EPA collaborative problem-solving model to obtain environmental justice in North Carolina.

BACKGROUND: The West End Revitalization Association (WERA), a community-based organization (CBO) in Mebane, North Carolina, was awarded a Collaborative Problem-Solving (CPS) grant from the U.S. Environmental Protection Agency's Office of Environmental Justice (EPA OEJ). OBJECTIVES: The purpose of this paper is to highlight WERA's efforts to bring stakeholders in three low-income African-American communities where environmental hazards created public health risks together for collaboration rather than litigation. METHODS: WERA's board and staff organized nine working groups with specific areas of expertise that would facilitate research, identify lack of basic amenities, and encourage funding for corrective action and participation in progress reporting workshops. WERA used consensus building, dispute resolution, and resource mobilization as part of the CPS model to address noncompliance with environmental laws, including the Clean Air Act, Clean Water Act, Safe Drinking Water Act, Toxic Substances Control Act, and Solid Waste Disposal Act. RESULTS: WERA's CPS "Right to Basic Amenities" project produced a framework for (1) grassroots management and ownership of a collaborative problem-solving process; (2) bringing stakeholders together with diverse and conflicting viewpoints; (3) implementation of an innovative community-owned and managed (COMR) research model; and (4) leveraging millions of dollars to fund installation of first-time municipal water/sewer services, street paving, and relocation of the 119-bypass to advance environmental health solutions. CONCLUSION: The structure and successes of WERA's Right to Basic Amenities project have been discussed at demonstration and training sessions to help others replicate the model in comparable low-income communities of color in North Carolina and across the United States.