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.

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.

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.

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.

Assessment of sociodemographic and geographic disparities in cancer risk from air toxics in South Carolina.

Populations of color and low-income communities are often disproportionately burdened by exposures to various environmental contaminants, including air pollution. Some air pollutants have carcinogenic properties that are particularly problematic in South Carolina (SC), a state that consistently has high rates of cancer mortality for all sites. The purpose of this study was to assess cancer risk disparities in SC by linking risk estimates from the U.S. Environmental Protection Agency's 2005 National Air Toxics Assessment (NATA) with sociodemographic data from the 2000 US Census Bureau. Specifically, NATA risk data for varying risk categories were linked by tract ID and analyzed with sociodemographic variables from the 2000 census using R. The average change in cancer risk from all sources by sociodemographic variable was quantified using multiple linear regression models. Spatial methods were further employed using ArcGIS 10 to assess the distribution of all source risk and percent non-white at each census tract level. The relative risk (RR) estimates of the proportion of high cancer risk tracts (defined as the top 10% of cancer risk in SC) and their respective 95% confidence intervals (CIs) were calculated between the first and latter three quartiles defined by sociodemographic factors, while the variance in the percentage of high cancer risk between quartile groups was tested using Pearson's chi-square. The average total cancer risk for SC was 26.8 people/million (ppl/million). The risk from on-road sources was approximately 5.8 ppl/million, higher than the risk from major, area, and non-road sources (1.8, 2.6, and 1.3 ppl/million), respectively. Based on our findings, addressing on-road sources may decrease the disproportionate cancer risk burden among low-income populations and communities of color in SC.

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.

Being overburdened and medically underserved: assessment of this double disparity for populations in the state of Maryland.

BACKGROUND: Environmental justice research has shown that many communities of color and low-income persons are differentially burdened by noxious land uses including Toxic Release Inventory (TRI) facilities. However, limited work has been performed to assess how these populations tend to be both overburdened and medically underserved. We explored this "double disparity" for the first time in Maryland. METHODS: We assessed spatial disparities in the distribution of TRI facilities in Maryland across varying levels of sociodemographic composition using 2010 US Census Health Professional Shortage Area (HPSA) data. Univariate and multivariate regression in addition to geographic information systems (GIS) were used to examine relationships between sociodemographic measures and location of TRI facilities. Buffer analysis was also used to assess spatial disparities. Four buffer categories included: 1) census tracts hosting one or more TRI facilities; 2) tracts located more than 0 and up to 0.5 km from the closest TRI facility; 3) tracts located more than 0.5 km and up to 1 km from a TRI facility; and 4) tracts located more than 1 km and up to 5 km from a TRI facility. RESULTS: We found that tracts with higher proportions of non-white residents and people living in poverty were more likely to be closer to TRI facilities. A significant increase in income was observed with an increase in distance between a census tract and the closest TRI facility. In general, percent non-white was higher in HPSA tracts that host at least one TRI facility than in non-HPSA tracts that host at least one TRI facility. Additionally, percent poverty, unemployment, less than high school education, and homes built pre-1950 were higher in HPSA tracts hosting TRI facilities than in non-HPSA tracts hosting TRI facilities. CONCLUSIONS: We found that people of color and low-income groups are differentially burdened by TRI facilities in Maryland. We also found that both low-income groups and persons without a high school education are both overburdened and medically underserved. The results of this study provide insight into how state agencies can better address the double disparity of disproportionate environmental hazards and limited access to health care resources facing vulnerable communities in Maryland.

Spatial disparity in the distribution of superfund sites in South Carolina: an ecological study.

BACKGROUND: According to the US Environmental Protection Agency (EPA), Superfund is a federal government program implemented to clean up uncontrolled hazardous waste sites. Twenty-six sites in South Carolina (SC) have been included on the National Priorities List (NPL), which has serious human health and environmental implications. The purpose of this study was to assess spatial disparities in the distribution of Superfund sites in SC. METHODS: The 2000 US census tract and block level data were used to generate population characteristics, which included race/ethnicity, socioeconomic status (SES), education, home ownership, and home built before 1950. Geographic Information Systems (GIS) were used to map Superfund facilities and develop choropleth maps based on the aforementioned sociodemographic variables. Spatial methods, including mean and median distance analysis, buffer analysis, and spatial approximation were employed to characterize burden disparities. Regression analysis was performed to assess the relationship between the number of Superfund facilities and population characteristics. RESULTS: Spatial coincidence results showed that of the 29.5% of Blacks living in SC, 55.9% live in Superfund host census tracts. Among all populations in SC living below poverty (14.2%), 57.2% were located in Superfund host census tracts. Buffer analyses results (0.5mi, 1.0mi, 5.0mi, 0.5km, 1.0km, and 5.0km) showed a higher percentage of Whites compared to Blacks hosting a Superfund facility. Conversely, a slightly higher percentage of Blacks hosted (30.2%) a Superfund facility than those not hosting (28.8%) while their White counterparts had more equivalent values (66.7% and 67.8%, respectively). Regression analyses in the reduced model (Adj. R2 = 0.038) only explained a small percentage of the variance. In addition, the mean distance for percent of Blacks in the 90th percentile for Superfund facilities was 0.48mi. CONCLUSION: Burden disparities exist in the distribution of Superfund facilities in SC at the block and census tract levels across varying levels of demographic composition for race/ethnicity and SES.

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.

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.

Use of community-owned and -managed research to assess the vulnerability of water and sewer services in marginalized and underserved environmental justice communities.

In the study described in this article, the authors' objective was to use community-owned and -managed research (COMR) to assess the safety and adequacy of water and sewer services in three low-income African-American communities in Mebane, North Carolina. Community monitor (CM) training workshops, household surveys, and drinking water and surface water tests of fecal pollution were completed at private (target) and regulated public (referent) service households. CMs collected survey data showing a mixture of failing private wells and septic systems and regulated public drinking water and sewer infrastructure. Drinking water and surface water fecal pollution levels exceeded limits protecting health at target and referent households. COMR methods built community capacity to investigate private and regulated public drinking water and sewer service failures. Drinking and surface water fecal contamination levels suggest a need for provision of improved water and sewer services to protect health in these underserved and marginalized communities.

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.

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.

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.

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.

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.