baron et al. partnerships for environmental and occupational justice - ajph 2009

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HEALTH POLICY AND ETHICS

Partnerships for Environmental andOccupational Justice

Partnerships for Environmental and Occupational Justice:Contributions to Research, Capacity and Public Health

Sherry Baron, MD, MPH, Raymond Sinclair, PhD, Devon Payne-Sturges, PhD, Jerry Phelps, BS, Harold Zenick, PhD,Gwen W. Collman, PhD, and Liam R. O’Fallon, MA

In 1994, the National Insti-tute of Environmental HealthSciences (NIEHS) initiated aprogram to address commu-nication gaps between com-munity residents, researchersand health care providers inthe context of disproportion-ate environmental exposures.

Over 13 years, together withthe Environmental ProtectionAgency and National Institutefor Occupational Health andSafety, NIEHS funded 54 envi-ronmental justiceprojects.Herewe examine the methods usedand outcomes produced basedon data gathered from sum-maries submitted for annualgrantees’ meetings. Data high-light how projects fullled pro-gram objectives of improvingcommunity awareness and ca-pacity and the positive publichealth and public policy out-comes achieved. Our ndingsunderscore the importanceof community participation indeveloping effective, culturallysensitive interventions and em-phasize the importance of sys-tematic program planning andevaluation. ( AmJ Public Health.

2009;99:S517–S525. doi:10.2105/AJPH.2009.174557)

IN THE LATE 1980S, THE ENVI-

ronmental justice movement emerged to address the disproportionate burden of environ-mental exposures on low-incomeand minority communities.1,2

Concerned communities raisedawareness of the myriad environ-

mental and health issues they facedand called for the federal govern-ment to respond.3 In 1993, theNational Institute of EnvironmentalHealth Sciences (NIEHS), theAgency for Toxic Substances andDisease Registry (ATSDR) and theEnvironmental Protection Agency(EPA) held a 2-day workshop onresearch needs to address environ-mental justice and equity that gen-erated recommendations including the need to engage communitygroups in the research discussion.4,5

In 1994, 6 government agencieswith the support of community andacademic leaders convened the rst federal environmental justice sym- posium, Health Research andNeeds to Ensure Environmental Justice, to seek recommendations by community leaders, workers, business and academic representa-tives, diverse government

personnel, and the broader scien-tic community. One key recom-mendation was improving commu-nication and trust among partners.3,6

In response, NIEHS issued therst of many funding announce-ments, Environmental Justice:

Partnerships for Communication.Subsequently joined by the EPA and the National Institute for Oc-cupational Safety and Health(NIOSH), Partnerships for Com-munication became a 13-year in-teragency program, funding 54 projects addressing a wide spec-trum of environmental and occupational exposures across com-munities both urban and rural(Table 1).7 Projects were fundedfor 4 years (with reapplication pos-sible) at $150000 to $200000annually (direct costs) and requiredthe collaboration of 3 partners:a research organization, a commu-nity-based organization, and a health care–provider organization.The 54 projects were funded sepa-rately by the agencies, but the pro-gram was coordinated as an inter-agency initiative through the use of a common project summary form

and an annual grantees’ meeting during which scientic progress wasshared.

The structure of the programchanged little over time, but adjustments were made tostrengthen it. Initially the pro-gram’s objective was to build

bridges among the 3 required partners (community groups, health care professionals, and re-searchers), to build trust, to pro-vide community residents withaccess to information, and to improve researchers’ capacity towork in partnership with commu-nities. In 1998, a second objectivewas added that encouraged part-nerships to develop researchstrategies to identify, assess, andreduce environmental and occupational exposures and improve public health.7 In 2002, appli-cants were required to include anevaluation plan to measure public health impact and were encour-aged to involve a social scientist in evaluation planning.

Demonstrating the success of large federal programs using mea-surable outcome-based metrics isessential to securing continued

Supplement 3, 2009, Vol 99, No. S3 | American Journal of Public Health Baron et al. | Peer Reviewed | Health Policy and Ethics | S517



TABLE 1—Projects Funded by the NIEHS, NIOSH, and EPA Under the Partnerships for Communication Program: 1994–2007

Project Title Issue Population Lead Organization Dates

Akwesasne First Environment Communications Program Environmental contamination Native Americans CBO

Southeast Los Angeles Environmental Health Project Environmental contamination Latinos CBO 19

Risk Management In Native American Communities Radiation Native Americans University 19

Environment Justice Partnership For Communication Air and water pollution African Americans University

Richmond Laotian Environmental Justice Collaboration Lead, toxic emissions, sh contamination Laotians CBO 1

Community Responsive Partners For Environmental Health Hazardous waste and pesticides African Americans and farmworkers CBO

Southeast Asian Environmental Health–Lowell Partnership Hazardous waste Southeast Asians University 19

Lower Price Hill Environmental Leadership Coalition Industrial chemicals contamination Indigent Whites CBO

Environmental Justice Outreach In Northern Manhattan Lead, air pollution African Americans and Latinos CBO Community Health And Environmental Reawakening Livestock, toxic waste, industrial pollution African Americans University

Health, Opportunities, Problem-Solving, and Empowerment Reproductive health Southeast Asian women CBO 1

Silicon Valley Environmental Health and Justice Project Hazardous waste Latinos and Asians CBO 19

Network For Responsible Stewardship Hazardous wastes (military sites) Alaska Natives CBO 19

Uranium Education In The Navajo Nation Uranium Native Americans University 199

Communi ty Outreach For CTD Screening In High Risk Groups Systemic lupus erythematosis African Americans University

Environmental Justice For St Lawrence Island, Alaska Hazardous wastes Alaska Natives University 20

Environmental Impacts On Arab Americans In Metro Detroit Inner-city environmental pollution Indigent Arab Americans CBO

Casa De Salud: A Model For Engaging Community Asthma, lead Latinos CBO 200

Land Use, Environmental Justice, And Children’s HealthCLEAN Air pollution Latinos CBO

Casa A Campo: Pesticide Safety For Farmworkers’ Families Pesticides Latinos University 20

Community Assist Of Southern Arizona Heavy metals Latinos CBO 2001–Community Partnership For Asthma Prevention Indoor and outdoor allergens Inner-city children University 2

Asthma And Lead Prevention In Chicago Public Housing Indoor allergens, lead African Americans and

Puerto Ricans

CBO 2001–2005

Fish Consumption Risk Communication In Ethnic Milwaukee Chemical contamination Latinos and Hmong University

Dietary Risks And Benets In Alaskan Villages Chemical contamination Native Americans CBO 2

South Valley Partners In Environmental Justice Industrial and agricultural chemicals Latinos and Native Americans Health department

Contaminated Subsistence Fish: A Yakama Nation Response Water contamination Native Americans CBO 2

Williamsburg Brooklyn Asthma and Environmental Consortium Envi ronmental and occupational asthma Latinos CBO

Bioaccumulative Toxics In Native American Shellsh Chemical contaminants Native Americans CBO 2

South Bronx Environmental Justice Partnership Air qual ity, toxic exposures Indigent inner-city populations University

Communi ty Heal th Intervention With Yakima Agricultural Workers Occupational hazards Latino farmworkers University

Community Collaborations For Farmworker Health And Safety Occupational hazards Farmworkers University

Day Laborers United With The Community Occupational hazards Hispanic day laborers Health department 20

Communities Organized Against Asthma And Lead (COAL) Asthma triggers, lead Latinos University

Communi ty Exposure To Peruorooctanate Peruorooctanates contamination The Appalachian community University

Harlem Children’s Zone Asthma Initiative Asthma African Americans CBO 200

Dorchester Occupational Health Initiative Occupational hazards Vietnamese and Cape Verdeans CBO 200

Work Environment Justice Partnership for Brazilian Immigrants Solvents and other occupational hazards Brazilian workers University

Healthy Homes & Community for High Point Families Multiple environmental exposures Public-housing residents Health department

Healthy Food, Healthy Schools and Healthy Communities Obesity, diabetes Urban, low-income Latinos University

JUSTA: Justice and Health for Poultry Workers Occupational hazards Rural Latino poultry workers University

Continued


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support.8,9

Here we examine the program’s accomplishments inachieving its 2 broad objectives: (1)establish methods for linking members of a community who are di-rectly affected by adverse environ-mental and occupational conditionswith researchers and health care providers, and (2) enable partner-ships to develop appropriate re-search strategies to address envi-ronmental and occupational health problems of concern in order toimpact public health and health policy.7

METHODS

A team of researchers from the3 funding agencies reviewed andsynthesized data from grantees’ project summaries developed for their annual meetings. We as-sumed that project teams would

highlight key accomplishments inthese reports. From 1994 to 2001summaries were unstructuredand usually 1 to 2 pages. Therewas no meeting report in 2002.From 2003 to 2007, when theagencies placed greater emphasison evaluation and outcomesmeasurement,10 a more structuredreporting format was used with sec-tions for project aims, summary, health impacts, and policy impacts.

Because the program had no preexisting formal evaluationmodel, we developed one to guidethis review process based on the program’s 2 objectives (Figure 1).To review methods used toachieve these objectives, 4 teammembers (S.B., D.P., J.P., andL.O.) collected data from project summaries. After reviewing manyactivities across the 54 projects,we used an iterative process to

classify the methods. Initially, all 4reviewers exchanged and dis-cussed examples from a smallsubset of projects to ensure a con-sistent approach to the extractionand coding process. Based on thisinitial review, we developed a list of output measures consistent withthe project activities listed in Fig-ure 1. Each member thenreviewed and coded project sum-maries funded by or related totheir agency’s research portfolio.

To examine the program’s suc-cess in impacting public healthand health policy, a trained eval-uator (R.S.) with no prior con-nection to the environmental jus-tice program reviewed all of thesummaries to identify project outcomes. We considered anoutcome to have public health or policy impact when it involvedactions by outside organizations

and individuals to improve public health and health policy, that is,what others did as a result of the project, not what the project or its staff did. For example, if project staff spoke to a government oversight board, we did not count that as an outcome unless it appeared that they were invited by that board, rather than testi-fying without invitation in a pub-lic session.

RESULTS

We present the ndings fromour analysis of the project sum-maries according to the approachoutlined in our evaluation model(Figure 1). First we summarize themajor project activities that con-tributed to raising communityawareness or building communitycapacity, then we describe the

TABLE 1—Continued

Promoting Occupational Health Among

Indigenous Farmworkers in Oregon

Occupational hazards Indigenous farmworkers CBO 2004–200

Asian Girls for Environmental Health Chemicals in beauty products Asian women CBO

Linking Breast Cancer Advocacy and Environmental Justice Endocrine-disrupting compounds

and other chemicals

African American and

Latino women

CBO 2004–2008

Environmental Justice on Cheyenne River Mercury, arsenic, other heavy metals Native Americans Health care provider

Strengthening Vulnerable Communi ties in Worcester Toxic chemicals, violence Low-income populations University

Dine´ Network For Environmental Health (DiNEH) Project Uranium, heavy metals Native Americans University

Partnership to Reduce Asthma and Obesity in Latino Schools Indoor air quality, pests Latino children CBO 20

Environmental Health and Justice in Norton Sound, Alaska Formerly used defense sites Alaska Natives CBO 2

Alton Park/Piney Woods Environmental Health and Justice Chemical contamination African Americans University

Building Food Justice in East New York Inequitable access to heal thy food African Americans and Latinos University

South Valley Partners for Environmental Justice Land-use decisions and urban sprawl Latinos and low-income

populations

CBO 2005–2009

Assessing and Controlling Occupational

Health Risks in Somerville, MA

Occupational hazards Immigrant workers University 2005–200

New York Restaurant Worker Health and Safety Project Occupational hazards Immigrant workers CBO 2

Note. NIEHS=National Institute of Environmental Health Sciences; NIOSH=National Institute for Occupation Safety and Health; EPA=Environmental Protection Agency; Corganization; CTD= connective tissue disorder.





major outcomes or impacts on public health and health policy.

Raising CommunityAwareness

Given the program’s central fo-cus on communication, all of the projects reported various methodsused to link communities and re-searchers by raising communityawareness about environmentaland occupational hazards and promoting preventive actions toimprovehealth, suchas using safer chemicals in the workplace or making home improvements todecrease asthma symptoms, suchas improving the control of pestsand dust. Reecting the projects’commitment to community empowerment, projects also increasedknowledge about how communi-ties could take collective action todecrease exposures. For example,in at least 40 projects the com-munity met with public ofcials,

31 projects organized public meetings or protests, and at least

20 conducted research to improveenvironmental regulations.

Almost all projects (53) con-ducted community meetings. Most (51) organized some form of classor workshop, ranging from brief educational presentations in com-munity centers and religious in-stitutions and technical informa-tion meetings in response tospecic community complaints, tomore-substantial community col-lege courses and student intern-ships. One project even createda 40-hour community course theycalled the Neighborhood Envi-ronmental College. Almost half (25) also targeted some training toward health care providers.

Nearly three fourths (35) of the projects organized train-the-trainer programs for communityoutreach workers. These ‘‘neighbor-to-neighbor’’ outreach

programs were usually conducted by trained community members

using a variety of innovative approaches, such as portable illus-trated ip charts, photographs for digital storytelling, and interactiveexercises.

Projects used a wide range of traditional and innovative massmedia outlets, including radio,television, and newspapers; educa-tional fact sheets and pamphlets; posters; videos and DVDs; audiocassettes; photo exhibits; commu-nity theater performances; and‘‘treasures and toxics tours.’’ At least 41 projects developed printedmaterials; 34, electronic materialsincluding videos, DVDs and Inter-net products; and 34 used radio,television, or newspapers.

Most commonly, the projectsdemonstrated the methods’ effec-tiveness by quantifying outputs,such as the number of communitymembers trained, the number of

classes or radio shows created, or the number of educational pam-

phlets distributed. A few projectsattempted to quantify evidence of increased community awareness by measuring changes in knowl-edge through pre-and posttraining tests. Summaries also includedevidence of the projects’ effective-ness by describing positivechanges in individual behaviorsand in community interest andactivism. For example:

An evaluation of the Safe and

Dignied Cleaning training pro-gram indicated that domestic workers participating in this Unidos project have gainedleadership skills and self con-dence, and have improved their health and well-being after im- plementing ergonomic changesand using less-toxic cleaning products. (From the DayLaborers United With theCommunity project; Table 1)

Over 200 girls and young women have successfully com- pleted the leadership

FIGURE 1—Program evaluation model for Partnerships for Communication.





development and training pro-gram. Their efforts have resultedin two successful campaignswhich shut down a MedicalWaste Incinerator in Oaklandand achieved 6 new policychanges that protects girls safetyin public schools in Long Beach,California. (From the Health,Opportunities, Problem-Solving,and Empowerment project;Table1)

Building Community CapacityCommunity–researcher part-

nerships developed appropriateresearch strategies by building existing and newly emerging community leaders’ capacity to become active partners in the projects’ diverse research, out-reach, and intervention activities.

Project summaries described sev-eral methods for building leader-ship capacity, including engaging community leaders as decisionmakers, as members of the re-search team staff, and as key con-tributors to the design of effectiveintervention and dissemination products (Table 2).

Community leadership’s pri-marily role was as decision makerswho prioritized health concerns,identied information gaps, anddetermined future research direc-tions. Almost all (50) projectsestablished some type of formal or informal community advisory board. In some, longstanding

TABLE 2—Community Roles in the Partnerships for Communication Projects: 1994–2007

Community Role Examples in Project Summaries (Project Name)

Decision makers

Create networks of existing community

organizations

Advisory boards in both project cities provided ongoing feedback and input from environmental justice

organizations, breast cancer advocacy organizations, community residents, environmental health scientists, and

health care and public health professionals. (Linking Breast Cancer Advocacy and Environmental Justice)

Create new community leadership

and decision makers

The primary goal of the Bienestar Project was to develop strategies that will enable the community of Hispanic agricultural

workers to effectively identify, characterize, and respond to the many occupational and environmental health risks.

(Community Health Intervention With Yakima Agricultural Workers)

Research team members

Provide culturally sensitive facilitators We have conducted 8 focus groups in Spanish and indigenous languages. Project partners, especially the

indigenous-language-speaking community educators, led this effort. (Promoting Occupational Health Among Indigenous FarmworkeImprove survey design Swinomish developed the methodology for the seafood diet interviews because data collection and analysis methods used in the

previous studies may have led to inaccurate results based on inappropriate questions and survey methods not congruent

with tribal knowledge transfer pathways. (Bioaccumulative Toxics In Native American Shellsh)

Improve sampling by better targeting

hazards

As the Casa de Salud trainers taught Casa Leaders about the health effects of exposure to mercury through consumption of

freshwater sh, the Casa Leaders told the trainers about the extensive and health-threatening ritualistic use of mercury

in the community. (Casa De Salud: A Model For Engaging Community)

Improve cross-cultural outreach One of the original justications for working with our adolescent educators (uently bilingual non-native English speakers) was

role as a source of information for and social connection between the English-speaking-only community and their non- or

limited-English-speaking families. (Assessing and Controlling Occupational Health Risks in Somerville, MA)

Design appropriate interventions A team of farmworkers and farm owners in a vegetable-producing region of New York addressed the problem of eye irritation

caused by the very ne black soil in the region. Several different types of protective eyewear were selected by the workers

and subsequently systematically tested in eld trials. (Community Collaborations For Farmworker Health And Safety)

Design appropriate community

training programs

Course facilitators and community members together prepared pilot course materials, incorporating ideas of the newly

formed neighbors planning committee. Neighborhood staff and community members have been identied to facilitate other

courses modeled on this pilot. (Alton Park/Piney Woods Environmental Health and Justice)

Developers of communication products

Developing culturally appropriate

communication messages

Tribal leaders believe that the health risk message is best delivered through an appeal for stewardship and protection of the salmon,

and have expressed concern that focusing on personal behavior change would be viewed as forcing change on the victims of invo

exposure. (Contaminated Subsistence Fish: A Yakama Nation Response)

Designing appropriate communication

products

A group of 50 Asian girls were trained in the health and safety issues of personal cosmetic products. They decided that using a digit

telling format and some interactive exercises were the best way to educate their peers and they developed these intervention tools.

(Asian Girls for Environmental Health)





community-based environmental justice organizations with well-established capacity were the project leaders. In half (27), a com-munity organization was the principal investigator and the re-searchers provided the organizationwith scientic and technical support (Table1). In many others, re-searchers supported communityleaders in catalyzing the creation of sustainable community organiza-tions. In 2 projects this successwas demonstrated when the com-munity assumed primary responsi- bility, becoming the principal in-vestigator.

The second major approach toincreasing community leadershipcapacity was to incorporate com-munity members into the projects’day-to-day data collection and in-formation dissemination activities.Whether the community partner

was a well-established organiza-tion or not, this development of skilled community research teammembers was a consistently posi-tive accomplishment reportedacross the projects. Almost all (49) projects included communitymembers as active (and frequently paid) members of the researchteam.

One popular approach was todevelop youth leadership pro-grams through summer and after-school programs and the creationof curriculum for schools andcommunity colleges. Community youths were available, enthusias-tic, and talented, and the commu-nity welcomed these programs as building sustainable communitycapacity. Over half (30) of the projects established youth leader-ship training programs, and 18included components that allowed

youths to reach out to other youths. Another common approach (35 projects) was to implement promotora , or lay healthworker programs, providing train-ing to a small group of paid com-munity members who then col-lected data and sometimesimplemented community out-reach and training programs.These approaches were found toenhance many different compo-nents of the research (Table 2).

With communication a centralobjective of the program, an important method for improving re-searcher and community capacity

was through their joint creation of innovative interventions andcommunication products. Projectsemphasized the key role of com-munity leaders in creating cultur-ally appropriate communicationmessages and in choosing appropriate and effective information-dissemination formats (Table 2).For example, in a project targeting Latino indigenous farmworkers,community members suggestedusing dramatizations delivered by audiocassette, because manyindigenous speakers are not familiar with their writtenlanguage.

Impacts on Public Health andHealth Policy

From project summaries weextracted 159 descriptions of out-comes that covered a broad rangeof actions by a variety of organi-zations and individuals. Prior toimplementing the structured report format in 2003, which hadsections on health and policy impacts, only 18 outcomes (11%)were reported. We subdivided theoutcomes into long-term andshort-term, based loosely on2 criteria: long-term outcomeswere more independent from project activities (perhaps

TABLE 3—Long- and Short-Term Project Outcomes From 54 Partnerships for Communication Projects:1994–2007

No. of Outcomesa

Long-term Total

Reduction in community exposure to toxins 6

Government regulatory or legislative actions

Actions to control current exposure 18

Actions to prevent new exposures 9 (1)

Administrative activities by the government

New and improved services 10 (5)

Changes in practices 24 (4)

Changes in government planning (land use, building public works) 6

Actions by nongovernmental organizations to decrease exposures 2

Short-term

Total

Measurable improvements in community health outcomes 4

Input to external bodies not clearly associated with a measurable health or exposure outcome 48 (2

External agents sought funding to improve the environment as a result of project activities 8 (

Increased awareness of environmental issues without measurable outcomes by:

Media 10 (1)

Colleges and universities 5 (2)

Community members 9 (1)

Note. Outcomes were dened as actions taken by those external to the project to decrease exposures or improve health.a Numbers in parentheses indicate outcome numbers from reports prior to 2003, when a structured report format that included hepolicy impacts was introduced.





indicating a stronger reaction by project stakeholders to the project)and more likely to have a moresustained positive impact on improving environmental justice(Table 3).

We classied approximately half the outcomes as long-term.The rst group (6 outcomes) in-cluded those outcomes that resulted in a direct reduction inexposure to a hazardous environ-mental toxin in a community. Ex-amples included reductions in theuse of toxic cleaning compoundsin a large commercial cleaning worksite, reductions to airbornecontaminants in auto body shops,and reductions in the use of toxins by computer manufacturers. Al-though not technically toxins, wealso included the reduction instudent access to unhealthy foods by school boards in Chicago, Illi-

nois, and Los Angeles, California.The second group was govern-

ment regulatory or legislative ac-tions (27 outcomes). Eighteenregulations or laws were supported in some way by projects.For example, with the help of children’s health organizations,the South Bronx Environmental Justice Project saw their effortswith the New York City Councilresult in legislation to control die-sel emissions from school busidling. Similarly, another project supported the passage of a rule bythe California Air ResourcesBoard prohibiting plating opera-tions that used hexavalent chro-mium from locating in residentialor mixed-use neighborhoods. Theother 9 outcomes concerned in-stances in which projects contrib-uted to efforts to stop legislation,deny or change a government

permit (e.g., landll), or close downan organization classied asa public health threat (e.g., medicalwaste incinerator).

The third group of long-termoutcomes involved administrativeactivities by government bodies(35 outcomes). Ten of these out-comes involved the provision of tangible infrastructure to a com-munity (e.g., trash cans, pedestrianstreet safety enhancements,a sewer line). Some contributionswere large, like an environmental justice center and a 24-hour complaint line. Others were small,such as the production of a pam- phlet or warning signs. Nineteenoutcomes in the third group in-volved government changes in practices such as enforcement of environmental regulations, public interface practices, stafng andtraining for government workers,

and permits for organizations like pest control companies. In onecase, partly because of efforts of the Communities OrganizedAgainst Asthma and Lead project,the Houston Mayor’s Task Forceon Air Quality worked with pet-rochemical facilities to reduceemissions of key pollutants. Six more outcomes involved changesin various types of government plans such as land use, abatement,clean-up priorities, environmental justice, and public works con-struction. Nine outof 10 of the pre-2003 outcomes were in this group.

The fourth group of long-termoutcomes included cases in whichnongovernmental organizationstook actions to improve the well- being of citizens. Attorneys pur-sued compensation for injuredworkers. A manufacturer of blue- berry harvesting rakes began

marketing rakes that were lessstressful on workers. An insurancecompany encouraged farm com- pany clients to use employeetraining materials developed bythe Together for AgricultureSafety project in Florida. Our analysis showed no clear differ-ences in types of outcomesreported before and after thestandardized reporting require-ments, although most long-termoutcomes prior to 2003 were inthe category of government ad-ministrative changes (Table 3).

We organized the 84 short-term outcomes into 4 subgroups.The 8 pre-2003 outcomes weredistributed across 3 of the 4 sub-groups (Table 3). The rst sub-group (3 outcomes) involved projects that achieved measurable positive health results. We con-sidered these few cases of direct

project action (rather than actionsof others) to qualify as outcomes because they achieved the endoutcome of health. For example,the Harlem Children’s ZoneAsthma Initiative achieved signi-cant changes in asthma morbidityamong enrolled children by pro-viding education, social, environ-mental, medical, and legalsupports.

Over half of the short-term out-comes (48; subgroup 2) involvedcollaborative actions taken by or-ganizations working with environ-mental justice projects. In many projects, government or quasi-government agencies and legisla-tive bodies requesteddata or askedfor expert advice on issues. Wedifferentiated such outcomes frommajor outcomes because it was not evident that the outcome resultedin a nal action (e.g., a law) byoutside bodies. Examples include:

1. The Dorchester OccupationalHealth Initiative, which advisedthe Alliance for a HealthyTomorrow on ‘‘safer alterna-tives’’ legislation.

2. The Los Angeles Planning De- partment, which asked theHealthy Food, Healthy Schools,and Healthy Communities project for advice on food accessissues.

3. The Environmental Justice onCheyenne River project, whichwas asked for help in drafting legislation to create a TribalEnvironmental Health Advi-sory Board.

Many project personnel wereinvited to serve on local or state-wide advisory and regulatory boards such as the Boston HealthCommission, the North Carolina Governor’s Advisory Council on

Hispanic/Latino Affairs, and theHouston Mayor’s Taskforce on Air Quality. Staff advised government executives such as New York CityMayor Michael Bloomberg andNew York State Governor GeorgePataki on environmental issues.Almost every project describedcollaborations with other organi-zations for specic purposes. TheSilicon Valley Health and Envi-ronmental Justice project workedwith other organizations to de-velop policies on environmentallyresponsible electronics productionand disposal. Most of the environ-mental justice projects in New York City were connected witha number of city and state activist organizations.

The next group of short-termoutcomes involved action by or-ganizations that were not project partners but were motivated by





a project to secure funding for environmental work. For example,after the Community Health andEnvironmental Reawakening project identied the acute need for sewer work in a North Carolina community, the town government secured a $690000 hardshiploan from the EPA to build a new sewer line. As the result of work-ing with another project, the Cityof Houston, Texas, secureda $750000 grant for lead-expo-sure survey work. Other grantswere not as large, and sometimesthe amount of support was not reported, but these outcomes in-dicate the inuence of projects ontheir collaborators.

The last group of short-termoutcomes included reports of me-dia coverage of project activities(at least 10 outcomes) and collegesand universities that added envi-

ronmental justice courses or ac-tivities (at least 5 outcomes). It alsoincluded reports of groups of citi-zens who, as a result of a project,changed their awareness, interest,knowledge, and behaviors relatedto environmental issues. Althoughthese individual changes may have had a substantial impact onwell-being, we classied them inthe nal group of short-term out-comes because, for the most part,there was no discussed measure-ment of reported changes.

DISCUSSION

To our knowledge, this is therst evaluation of a major 13-year federal extramural funding pro-gram targeting environmental andoccupational justice concerns andfocusing on building communica-tion and trust between

communities and researchers. Our ndings demonstrate the successof the program in achieving bothof its objectives. Contributions of the funding program include de-veloping successful methods for increasing community awarenessand improving community capac-ity to create sustainable programsand to effectively advocate for health-promoting public policyandother actions to reduce exposures.

Our evaluation is consistent with ndings by other researchersdemonstrating the success of community-based participatoryenvironmental justice research.Minkler et al.11 conducted in-depthcase studies of 4 of the 54 projectsand documented their success in building community capacity andchanging public policy to controlexposures. Cook’s12 recent litera-ture review of 33 Medline-indexed

articles from 20 studies addressing disparities in environmental andoccupational health demonstrated positive community-level action toimprove health and also only in-cluded 4 of our 54 projects. Sys-tematic literature reviews do not necessarily capture the full range of Partnerships for Communication projects, which prioritize science- based, education-outreach productstargeting the local, rather than sci-entic, community. Our ndingscomplement and expand theseother ndings by providing a re-view of the complete set of 54 projects funded within this pro-gram.

Although basing this evaluationon data drawn from project sum-mary reports provided an oppor-tunity to include all projects, thisapproach has limitations. All evi-dence reported was anecdotal and

not part of a formal programevaluation; thus, a number of outcomes were likely not reportedor detected and grantees may have been more motivated to report positive rather than negativeoutcomes. This is especially true prior to 2003, when no standard-ized report format was providedand fewer outcomes werereported. Additionally, all but 5 of the projects included at least 1 year of funding after the intro-duction of the structured reporting form (Table 1), so our evaluationmay have underestimated thenumber of outcomes from theinitial years. After 2002, funded projects required an evaluation plan, but there were no ongoing reports of evaluation results be- yond the brief summaries. Finally, because only 1 evaluator com- pleted the content analysis of out-

comes, we could not examine thereliability of that coding process.

These limitations underscorethe importance of federal agenciesestablishing systematic, ongoing evaluations, especially for largeand innovative funding initia-tives.8,9,13 Although it would in-crease program costs for federalfunding agencies, rigorouslydesigned prospective evaluationsshould engage stakeholders anduselogic modeling or similar methodsto map the intent of the programand to select output and outcomeobjectives. When possible, evalua-tions should include comparisongroups of individuals, organizations,and even municipalities for whicha similar program has not beenimplemented. Evaluation evidenceshould be collected both at baselineand follow-up from persons, docu-ments, or observations. Careful

analysis, clear statement of ndings,and dissemination of ndings to participants, funders, policymakers,and the public are all parts of appropriate program evaluation practice.14 Evaluations should alsoinclude methods and protocols tocollect information appropriate for identifying and summarizing les-sons learned, not just for collecting and documenting outcome data.Findings from systematic evalua-tions will also likely contribute tocommunities’ and researchers’success in securing sustainablesources of funding for ongoing programs.

Much has been accomplishedsince theearly1990s, but minorityand economically disadvantaged populations continue to bear a disproportionate share of envi-ronmental exposures and relatedillnesses.15,16 Concern for inequity

among these groups is based not only on potentially higher levels of exposure to environmental hazards but also on synergistic effects of exposure to multiple contaminantsand other stressors like poverty. Inresponse, some environmental health researchers are blending so-cial science with traditional envi-ronmental science methods.17 In-terdisciplinary approaches andcollaboration with sociologists, psy-chologists, and social epidemiolo-gists are needed to examine the joint effects of social and environ-mental stressors. New develop-ments in methods of analysis andmultilevel approaches that can becombined with the successfulcommunity-based participatoryresearch approaches developedthrough the Partnerships for Communication projects present opportunities to make advances





in designing and evaluating in-terventions.18,19 These projectsdemonstrate the important rolethe community can play in appro- priately designing and implement-ing these methods.20,21

When the Partnerships for Communication program was ini-tiated in1994, the expectation wasthat novel approaches for building trust and communication for community involvement in re-search would be developed. Thisapproach is grounded in the pre-sumption that in democratic soci-eties health risks are best under-stood through the participation of all stakeholders, not just experts.Each stakeholder group bringsa separate set of experiences, andthe best and most efcient coursefor dealing with a health risk isdetermined through vigorous ex-changes of information about risk

among the stakeholders.22 Resultsof this evaluation support the importance of establishing good com-munication and set a baseline for future programs that bring together communities and universities toaddress environmental health is-sues. Looking to the future to meet the emerging and re-emerging is-sues, capacity building must con-tinue to be supported to promotefurther mutual trust, understanding,

and respect among all partners.Skillsgainedthrough such equitable partnerships may also contribute tocommunities’ success in obtaining ongoing political and nancial support to continue their work. j

About the AuthorsSherry Baron and Raymond Sinclair are with the National Institute for Occupational Safety and Health, Centers for Disease

Control and Prevention, Cincinnati, OH. Jerry Phelps, Gwen W. Collman, and Liam R. O’Fallon are with the National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC. Devon Payne-Sturges is with the US Environmental Protection Agency,Washington, DC. Jerry Phelps, Gwen W.Collman, and Liam R. O’Fallon are with the National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC. Harold Zenick is with the US Environmental Pro- tection Agency, Research Triangle Park.

Correspondence should be sent to Sherry Baron, MD, MPH, National Institute for Occupational Safety and Health, 4676 Co- lumbia Parkway, R-17, Cincinnati, OH 45226 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the ‘‘Reprints/Eprints’’ link.

This article was accepted June 15,2009.

Note. The ndings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health, National Institute of Environ- mental Health Sciences, or the US Envi- ronmental Protection Agency.

ContributorsS. Baron, L.R. O’Fallon, and H. Zenickoriginated and conceptualized the project. S. Baron contributed to the data collection and article formulation andwrote and revised the article. R. Sinclair,D. Payne-Sturges, J. Phelps, and L.R.O’Fallon contributed to data collectionand formulating, writing, and revising thearticle. H. Zenick and G.W. Collmancontributed to the formulation of thearticle and reviewed the drafts.

AcknowledgmentThe authors would like to thank thecommunity activists and leaders, the health care providers, and the researcherswho created and implemented the 54Environmental Justice Partnerships for Communication projects. We would alsolike to thank the federal leaders whosupported the foundational work for this program as well as the staff who providedongoing support during its implementa-tion.

Human Participant ProtectionNo protocol approval was needed for thisstudy because it involved secondarysources.

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