Environmental Injustice and Industrial Chicken Farming in Delaware.

Potential disparities in the distribution of poultry CAFOs (confined animal feeding operations) and meat-processing facilities across Delaware were explored with regards to sociodemographic factors including race, ethnicity, and socioeconomic status. We conducted buffer analyses of CAFO host census tracts alongside sociodemographic data in order to explore populations in proximity to the Delaware chicken industry. We conducted a hotspot analysis of CAFOs to find areas with large concentrations of poultry operations and applied zero-inflation regression models to determine if there's a relationship between sociodemographic composition and number of CAFOs/meat- processing facilities in Delaware. Median household income was lower in CAFO host census tracts than all others, and also lower than the state median. A larger percentage of people living in poverty are in poultry CAFO hotspots (15.4 percent) compared to the state average (13.7 percent). Delaware's chicken industry disproportionately burdens low-wealth communities. Delaware policy-makers should employ environmental justice-oriented solutions to best serve impacted populations.

Environmental Injustice and Industrial Chicken Farming in Maryland.

Maryland's growing chicken industry, including concentrated animal feeding operations (CAFOs) and meat processing plants, raises a number of concerns regarding public health and environmental justice. Using hot spot analysis, we analyzed the totality of Maryland's CAFOs and meat processing plants and those restricted to the Eastern Shore to assess whether communities of color and/or low socioeconomic status communities disproportionately hosted these types of facilities at the census tract level. We used zero-inflated regression modeling to determine the strength of the associations between environmental justice variables and the location of CAFOs and meatpacking facilities at the State level and on the Eastern Shore. Hot spot analyses demonstrated that CAFO hot spots on the Eastern Shore were located in counties with some of the lowest wealth in the State, including the lowest ranking county-Somerset. Zero-inflated regression models demonstrated that increases in median household income across the state were associated with a 0.04-unit reduction in CAFOs. For every unit increase in the percentage of people of color (POC), there was a 0.02-unit increase in meat processing facilities across the state. The distribution of CAFOs and meat processing plants across Maryland may contribute to poor health outcomes in areas affected by such production, and contribute to health disparities and health inequity.

Real-time air monitoring of occupational exposures to particulate matter among hairdressers in Maryland: A pilot study.

Hairdressers are exposed to particulate matter (PM), a known air pollutant linked to adverse health effects. Still, studies on occupational PM exposures in hair salons are sparse. We characterized indoor air PM concentrations in three salons primarily serving an African/African American (AA) clientele, and three Dominican salons primarily serving a Latino clientele. We also assessed the performance of low-cost sensors (uRAD, Flow, AirVisual) by comparing them to high-end sensors (DustTrak) to conduct air monitoring in each salon over 3 days to quantify work shift concentrations of PM2.5 , respirable PM (RPM), and PM10 . We observed high spatial and temporal variability in 30-min time-weighted average (TWA) RPM concentrations (0.18-5518 µg/m3 ). Readings for the uRAD and AirVisual sensors were highly correlated with the DustTrak (R2  = 0.90-0.99). RPM 8-hour TWAs ranged from 18 to 383 µg/m3 for AA salons, and 9-2115 µg/m3 for Dominican salons. Upper 95th percentiles of daily RPM exposures ranged from 439 to 2669 µg/m3 . The overall range of 30-min TWA PM2.5 and PM10 concentrations was 0.13-5497 and 0.36-,541 µg/m3 , respectively. Findings suggest that hairdressers could be overexposed to RPM during an 8-hour shift. Additional comprehensive monitoring studies are warranted to further characterize temporal and spatial variability of PM exposures in this understudied occupational population.

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.

Rapid Health Impact Assessment of a Proposed Poultry Processing Plant in Millsboro, Delaware.

In 2013, Allen Harim Foods purchased the former site of a Vlasic Pickle plant in Millsboro, Delaware, and proposed to convert the site into a poultry processing plant that would process approximately two million birds weekly. This generated concerns about the proposed plant's potential to impact health and quality of life among residents. We conducted a rapid health impact assessment (HIA) of the proposed plant to assess baseline environmental health issues in the host community and projected impacts. The scoping and baseline assessment revealed social, economic, and health disparities in the region. We also determined that residents in the area were already underserved and overburdened with pollution from multiple environmental hazards near the proposed plant including two sites contaminated with hazardous wastes, a power plant, and another poultry processing plant. The projected size and amount of poultry to be processed at the plant would likely cause increased levels of air, soil and water pollution, additional odor issues, and increased traffic and related pollution and safety issues. The information generated from the HIA formed the basis of a campaign to raise awareness about potential problems associated with the new facility and to foster more engagement of impacted residents in local decision-making about the proposed plant. In the end, the HIA helped concerned residents oppose the new poultry processing plant. This case study provides an example of how HIAs can be used as a tool to educate residents, raise awareness about environmental justice issues, and enhance meaningful engagement in local environmental decision-making processes.

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.

Utilization of the Maryland Environmental Justice Screening Tool: A Bladensburg, Maryland Case Study.

Maryland residents' knowledge of environmental hazards and their health effects is limited, partly due to the absence of tools to map and visualize distribution of risk factors across sociodemographic groups. This study discusses the development of the Maryland EJSCREEN (MD EJSCREEN) tool by the National Center for Smart Growth in partnership with faculty at the University of Maryland School of Public Health. The tool assesses environmental justice risks similarly to the U.S. Environmental Protection Agency's (USEPA) EJSCREEN tool and California's tool, CalEnviroScreen 3.0. We discuss the architecture and functionality of the tool, indicators of importance, and how it compares to USEPA's EJSCREEN and CalEnviroScreen. We demonstrate the use of MD EJSCREEN through a case study on Bladensburg, Maryland, a town in Prince George's County (PG) with several environmental justice concerns including air pollution from traffic and a concrete plant. Comparison reveals that environmental and demographic indicators in MD EJSCREEN most closely resemble those in EPA EJSCREEN, while the scoring is most similar to CalEnviroScreen. Case study results show that Bladensburg has a Prince George's environmental justice score of 0.99, and that National Air Toxics Assessment (NATA) air toxics cancer risk is concentrated in communities of color.

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.

Linking stormwater Best Management Practices to social factors in two suburban watersheds.

To reduce nutrient pollution in urban watersheds, residents need to voluntarily practice a range of stormwater Best Management Practices (BMPs). However, little is known about the underlying social factors that may act as barriers to BMP implementation. The overall goal of this study was to better understand barriers to BMP implementation by exploring the links among resident demographics, knowledge, and behaviors so that appropriate education can be more effectively developed and targeted. In 2014-2015, a detailed questionnaire was administered door-to-door to 299 randomly selected households in two sub-watersheds of the Chesapeake Bay basin to test relationships among resident demographics, knowledge and attitudes towards water resources and BMPs, and BMP implementation. Multifactor regression models showed that respondents who had greater knowledge of water resources and BMPs lived in households that implemented greater numbers of BMPs. In turn, resident BMP knowledge, or familiarity with BMPs, strongly varied with race and ownership status, with respondents who identified as Caucasian or within a collection of 'Other' races, and who were home owners, having greater BMP knowledge than respondents who identified as African American and who were home renters, respectively. Renters and members of homeowner's associations were also less likely to implement BMPs independent of knowledge, possibly reflecting perceived or real bureaucratic or procedural barriers to good stormwater management. Overall, respondents preferred to receive educational materials on stormwater via pamphlets and YouTube videos. These results suggest that resident ownership status knowledge is important to determining the number of household BMPs, and that education outreach should probably target African American and renting households that have lower BMP knowledge and landlords and administrators of homeowner's associations using well-planned print and video educational media.

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.

Examining Long-Term Mental Health in a Rural Community Post-Disaster: A Mixed Methods Approach.

Psychological stressors have been observed immediately following disasters, yet less is known about the long-term effects on the mental health of vulnerable communities. In 2005, Graniteville, S.C. was ravaged by a train derailment that leaked approximately 60 tons of chlorine gas and left several people dead in the small community. The purpose of this study was to examine the mental health of Graniteville-area residents in the nine years following the train disaster using a mixed methods approach. Using the photovoice method, participants reported compromised mental health with symptoms consistent with depression, post-traumatic stress disorder, fear, and anxiety. Medical records analysis indicated that mental health-related hospital encounters generally increased post-disaster. Mental health concerns should be anticipated in the long-term aftermath of disasters. Addressing these concerns is particularly vital in resource-poor communities. Our findings can be useful in developing mental health disaster management protocols and policies for communities in the long-term post-disaster period.

Community-based participatory research for the study of air pollution: a review of motivations, approaches, and outcomes.

Neighborhood level air pollution represents a long-standing issue for many communities that, until recently, has been difficult to address due to the cost of equipment and lack of related expertise. Changes in available technology and subsequent increases in community-based participatory research (CBPR) have drastically improved the ability to address this issue. However, much still needs to be learned as these types of studies are expected to increase in the future. To assist, we review the literature in an effort to improve understanding of the motivations, approaches, and outcomes of air monitoring studies that incorporate CBPR and citizen science (CS) principles. We found that the primary motivations for conducting community-based air monitoring were concerns for air pollution health risks, residing near potential pollution sources, urban sprawl, living in "unmonitored" areas, and a general quest for improved air quality knowledge. Studies were mainly conducted using community led partnerships. Fixed site monitoring was primarily used, while mobile, personal, school-based, and occupational sampling approaches were less frequent. Low-cost sensors can enable thorough neighborhood level characterization; however, keeping the community involved at every step, understanding the limitations and benefits of this type of monitoring, recognizing potential areas of debate, and addressing study challenges are vital for achieving harmony between expected and observed study outcomes. Future directions include assessing currently unregulated pollutants, establishing long-term neighborhood monitoring sites, performing saturation studies, evaluating interventions, and creating CS databases.

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.

A pilot study to assess residential noise exposure near natural gas compressor stations.

BACKGROUND: U.S. natural gas production increased 40% from 2000 to 2015. This growth is largely related to technological advances in horizontal drilling and high-volume hydraulic fracturing. Environmental exposures upon impacted communities are a significant public health concern. Noise associated with natural gas compressor stations has been identified as a major concern for nearby residents, though limited studies exist. OBJECTIVES: We conducted a pilot study to characterize noise levels in 11 homes located in Doddridge County, West Virginia, and determined whether these levels differed based on time of day, indoors vs. outdoors, and proximity of homes to natural gas compressor stations. We also compared noise levels at increasing distances from compressor stations to available noise guidelines, and evaluated low frequency noise presence. METHODS: We collected indoor and outdoor 24-hour measurements (Leq, 24hr) in eight homes located within 750 meters (m) of the nearest compressor station and three control homes located >1000m. We then evaluated how A-weighted decibel (dBA) exposure levels differed based on factors outlined above. RESULTS: The geometric mean (GM) for 24-hour outdoor noise levels at homes located <300m (Leq,24hr: 60.3 dBA; geometric standard deviation (GSD): 1.0) from the nearest compressor station was nearly 9 dBA higher than control homes (Leq,24hr: 51.6 dBA; GSD: 1.1). GM for 24 hour indoor noise for homes <300m (Leq,24hr: 53.4 dBA; GSD: 1.2) from the nearest compressor station was 11.2 dBA higher than control homes (Leq,24hr: 42.2 dBA; GSD: 1.1). Indoor average daytime noise for homes <300m of the nearest compressor stations were 13.1 dBA higher than control homes, while indoor nighttime readings were 9.4 dBA higher. CONCLUSIONS: Findings indicate that living near a natural gas compressor station could potentially result in high environmental noise exposures. Larger studies are needed to confirm these findings and evaluate potential health impacts and protection measures.

Using photovoice as a tool for community engagement to assess the environment and explore environmental health disparities.

Photovoice was used as a participatory research method to document perceived local environmental hazards, pollution sources, and potential impact on health among community members to address environmental health disparities. A convenience sample of 16 adults in Orangeburg, South Carolina participated in Photovoice. Photos depicted positive and negative implications of the environment across seven themes: recreation and leisure; food access; hazards and pollution; health, human, and social services; economic issues; beautification; and accommodation and accessibility. Positive and negative photos demonstrated a high level of interest among community members in considering how the environment influences health and health disparities.

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.

Off the rails in rural South Carolina: a qualitative study of healthcare provider perspectives on the long-term health impact of the Graniteville train disaster.

INTRODUCTION: In 2005, a train derailment and subsequent chlorine spill ravaged the rural town of Graniteville in South Carolina, resulting in one of the worst chlorine gas exposures in US. HISTORY: Significant health and economic challenges persist in the community more than a decade later. Healthcare providers offered healthcare services to community members in the immediate aftermath of the disaster, and many still live in the community and continue to provide healthcare services. As such, healthcare professionals provide a unique and important perspective to help understand the impact of the disaster on the community's health. The purpose of this study was to explore healthcare providers' perspectives about the long-term effects of the disaster on community health, healthcare access, and wellbeing. METHODS: Semi-structured interviews were conducted with 30 healthcare providers who treated survivors of the Graniteville train disaster. A qualitative, essentialist, inductive thematic analytic approach was used to analyze study data. RESULTS: Four themes emerged regarding the disaster's long-term impact: effects of chlorine exposure on physical health, issues with healthcare access, residual effects of the disaster on personal and community wellbeing, and improving health and community wellbeing. CONCLUSIONS: Disaster recovery should not be considered solely an acute event; agencies must be prepared for long-term, potentially chronic ailments, particularly in underserved, rural communities. Efforts to address the long-term health needs of communities post-disaster should consider the perspectives of healthcare providers to offer a well-rounded assessment of community needs. Study findings can help inform future disaster response strategies in communities locally and globally.

Hazard Ranking Methodology for Assessing Health Impacts of Unconventional Natural Gas Development and Production: The Maryland Case Study.

The recent growth of unconventional natural gas development and production (UNGDP) has outpaced research on the potential health impacts associated with the process. The Maryland Marcellus Shale Public Health Study was conducted to inform the Maryland Marcellus Shale Safe Drilling Initiative Advisory Commission, State legislators and the Governor about potential public health impacts associated with UNGDP so they could make an informed decision that considers the health and well-being of Marylanders. In this paper, we describe an impact assessment and hazard ranking methodology we used to assess the potential public health impacts for eight hazards associated with the UNGDP process. The hazard ranking included seven metrics: 1) presence of vulnerable populations (e.g. children under the age of 5, individuals over the age of 65, surface owners), 2) duration of exposure, 3) frequency of exposure, 4) likelihood of health effects, 5) magnitude/severity of health effects, 6) geographic extent, and 7) effectiveness of setbacks. Overall public health concern was determined by a color-coded ranking system (low, moderately high, and high) that was generated based on the overall sum of the scores for each hazard. We provide three illustrative examples of applying our methodology for air quality and health care infrastructure which were ranked as high concern and for water quality which was ranked moderately high concern. The hazard ranking was a valuable tool that allowed us to systematically evaluate each of the hazards and provide recommendations to minimize the hazards.

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.

Photovoice: Assessing the Long-Term Impact of a Disaster on a Community's Quality of Life.

Photovoice is a qualitative method of inquiry whereby individuals can document their lived experiences, particularly individuals whose voices are not typically heard in regard to promoting social change and policy development. We used photovoice to elicit major themes regarding community members' perceptions of the long-term impact on their quality of life as a deadly technological disaster hit a small, rural town in South Carolina. Overall, participants photographed more negative images than positive. Overarching themes included residential and business vacancies, economic decline, the need for clean-up and modernization, attention to wellness or rehabilitation, and concerns for safety. Emergency response agencies should consider the themes elicited from these community residents to help identify where to focus disaster response efforts both in the immediate aftermath and during the long-term recovery period of technological disasters, particularly in underserved, rural communities.