Abstract
Children are highly susceptible to deleterious effects of environmental toxins. Those who live in underserved communities may be particularly at risk because environmental pollution has been found to be disproportionately distributed among communities. Mounting evidence suggests that asthma rates are rising and that this disease can be caused or aggravated by air pollution. Although ambient air quality has generally improved, these improvements have not reached minority communities in equal proportions. This and other data has fueled the concept of environmental justice or environmental equity, which has led to community activism and government actions. One possible example of environmental inequity and its consequences is the Hunt's Point community, in the South Bronx, New York. This community experiences a high pollution burden with the siting of facilities that emit hazardous wastes into the air. Our approach to this problem has been the formation of mechanisms for bidirectional communication between community residents, government entities, and academic institutions such as Mount Sinai Medical Center. As a result of this experience, we believe that the key to achieving environmental health, especially in communities of color where many children are at risk, is to empower residents to take charge of their environment by providing relevant educational opportunities. Strategies for environmental health education include multitiered training approaches that include community residents, parent education, direct children education, and community education through professional counselors and train-the-trainer approaches. We propose that academic researchers must use community residents not just as subjects of our studies, but to increase our mutual understanding of environmental health, resulting in active participation of community members in research design, data collection, analysis, and dissemination of results in order to make intervention strategies more effective.
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Selected References
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- Balint J., Shelton W. Regaining the initiative. Forging a new model of the patient-physician relationship. JAMA. 1996 Mar 20;275(11):887–891. doi: 10.1001/jama.275.11.887. [DOI] [PubMed] [Google Scholar]
- Bates D. V., Sizto R. Air pollution and hospital admissions in Southern Ontario: the acid summer haze effect. Environ Res. 1987 Aug;43(2):317–331. doi: 10.1016/s0013-9351(87)80032-4. [DOI] [PubMed] [Google Scholar]
- Bates D. V., Sizto R. The Ontario Air Pollution Study: identification of the causative agent. Environ Health Perspect. 1989 Feb;79:69–72. doi: 10.1289/ehp.897969. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bellack J. P., Musham C., Hainer A., Graber D. R., Holmes D. Environmental health competencies: a survey of U.S. nurse practitioner programs. J Nurs Educ. 1996 Feb;35(2):74–81. doi: 10.3928/0148-4834-19960201-07. [DOI] [PubMed] [Google Scholar]
- Bone R. C. Goals of asthma management. A step-care approach. Chest. 1996 Apr;109(4):1056–1065. doi: 10.1378/chest.109.4.1056. [DOI] [PubMed] [Google Scholar]
- Brown P. Popular epidemiology and toxic waste contamination: lay and professional ways of knowing. J Health Soc Behav. 1992 Sep;33(3):267–281. [PubMed] [Google Scholar]
- Bullard R. D. Solid waste sites and the black Houston community. Sociol Inq. 1983;53(2-3):273–288. doi: 10.1111/j.1475-682x.1983.tb00037.x. [DOI] [PubMed] [Google Scholar]
- Capek S. M. Environmental justice, regulation, and the local community. Int J Health Serv. 1992;22(4):729–746. doi: 10.2190/VV58-Y1C6-VEYM-KEMK. [DOI] [PubMed] [Google Scholar]
- Carr W., Zeitel L., Weiss K. Variations in asthma hospitalizations and deaths in New York City. Am J Public Health. 1992 Jan;82(1):59–65. doi: 10.2105/ajph.82.1.59. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chaisson C. E., Glotzer D. E. Counseling to prevent childhood lead poisoning. J Natl Med Assoc. 1996 Aug;88(8):489–492. [PMC free article] [PubMed] [Google Scholar]
- Cheney R., Merwin A. Integrating a theoretical framework with street outreach services: issues for successful training. Public Health Rep. 1996;111 (Suppl 1):83–88. [PMC free article] [PubMed] [Google Scholar]
- Choudhury A. H., Gordian M. E., Morris S. S. Associations between respiratory illness and PM10 air pollution. Arch Environ Health. 1997 Mar-Apr;52(2):113–117. doi: 10.1080/00039899709602873. [DOI] [PubMed] [Google Scholar]
- Claudio L. From the laboratory to the community: a commitment to outreach. Environ Health Perspect. 1997 Mar;105(3):278–281. doi: 10.1289/ehp.97105278. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Claudio L. Making more minority scientists. Environ Health Perspect. 1997 Feb;105(2):174–176. doi: 10.1289/ehp.97105174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Claudio L. New asthma efforts in the Bronx. Environ Health Perspect. 1996 Oct;104(10):1028–1029. doi: 10.1289/ehp.961041028. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Corby N. H., Enguídanos S. M., Kay L. S. Development and use of role model stories in a community level HIV risk reduction intervention. Public Health Rep. 1996;111 (Suppl 1):54–58. [PMC free article] [PubMed] [Google Scholar]
- Crain E. F., Weiss K. B., Bijur P. E., Hersh M., Westbrook L., Stein R. E. An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics. 1994 Sep;94(3):356–362. [PubMed] [Google Scholar]
- Dassen W., Brunekreef B., Hoek G., Hofschreuder P., Staatsen B., de Groot H., Schouten E., Biersteker K. Decline in children's pulmonary function during an air pollution episode. J Air Pollut Control Assoc. 1986 Nov;36(11):1223–1227. doi: 10.1080/00022470.1986.10466168. [DOI] [PubMed] [Google Scholar]
- De Palo V. A., Mayo P. H., Friedman P., Rosen M. J. Demographic influences on asthma hospital admission rates in New York City. Chest. 1994 Aug;106(2):447–451. doi: 10.1378/chest.106.2.447. [DOI] [PubMed] [Google Scholar]
- Detels R., Tashkin D. P., Sayre J. W., Rokaw S. N., Coulson A. H., Massey F. J., Jr, Wegman D. H. The UCLA population studies of chronic obstructive respiratory disease. 9. Lung function changes associated with chronic exposure to photochemical oxidants; a cohort study among never-smokers. Chest. 1987 Oct;92(4):594–603. doi: 10.1378/chest.92.4.594. [DOI] [PubMed] [Google Scholar]
- Dockery D. W., Speizer F. E., Stram D. O., Ware J. H., Spengler J. D., Ferris B. G., Jr Effects of inhalable particles on respiratory health of children. Am Rev Respir Dis. 1989 Mar;139(3):587–594. doi: 10.1164/ajrccm/139.3.587. [DOI] [PubMed] [Google Scholar]
- Ehrlich R., Kattan M., Godbold J., Saltzberg D. S., Grimm K. T., Landrigan P. J., Lilienfeld D. E. Childhood asthma and passive smoking. Urinary cotinine as a biomarker of exposure. Am Rev Respir Dis. 1992 Mar;145(3):594–599. doi: 10.1164/ajrccm/145.3.594. [DOI] [PubMed] [Google Scholar]
- Ernst P., Demissie K., Joseph L., Locher U., Becklake M. R. Socioeconomic status and indicators of asthma in children. Am J Respir Crit Care Med. 1995 Aug;152(2):570–575. doi: 10.1164/ajrccm.152.2.7633709. [DOI] [PubMed] [Google Scholar]
- Euler G. L., Abbey D. E., Hodgkin J. E., Magie A. R. Chronic obstructive pulmonary disease symptom effects of long-term cumulative exposure to ambient levels of total oxidants and nitrogen dioxide in California Seventh-Day Adventist residents. Arch Environ Health. 1988 Jul-Aug;43(4):279–285. doi: 10.1080/00039896.1988.10545950. [DOI] [PubMed] [Google Scholar]
- Evans D., Clark N. M., Feldman C. H., Rips J., Kaplan D., Levison M. J., Wasilewski Y., Levin B., Mellins R. B. A school health education program for children with asthma aged 8-11 years. Health Educ Q. 1987 Fall;14(3):267–279. doi: 10.1177/109019818701400302. [DOI] [PubMed] [Google Scholar]
- Evans D., Mellins R., Lobach K., Ramos-Bonoan C., Pinkett-Heller M., Wiesemann S., Klein I., Donahue C., Burke D., Levison M. Improving care for minority children with asthma: professional education in public health clinics. Pediatrics. 1997 Feb;99(2):157–164. doi: 10.1542/peds.99.2.157. [DOI] [PubMed] [Google Scholar]
- Fish L., Wilson S. R., Latini D. M., Starr N. J. An education program for parents of children with asthma: differences in attendance between smoking and nonsmoking parents. Am J Public Health. 1996 Feb;86(2):246–248. doi: 10.2105/ajph.86.2.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Folinsbee L. J., McDonnell W. F., Horstman D. H. Pulmonary function and symptom responses after 6.6-hour exposure to 0.12 ppm ozone with moderate exercise. JAPCA. 1988 Jan;38(1):28–35. doi: 10.1080/08940630.1988.10466349. [DOI] [PubMed] [Google Scholar]
- Gergen P. J., Weiss K. B. Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA. 1990 Oct 3;264(13):1688–1692. [PubMed] [Google Scholar]
- Gorman K. S., Pollitt E. Does schooling buffer the effects of early risk? Child Dev. 1996 Apr;67(2):314–326. [PubMed] [Google Scholar]
- Griffiths S. D. A discussion of the environmental influences on asthma and the role of Environmental Health Officers in combating it. J R Soc Health. 1996 Aug;116(4):223–229. doi: 10.1177/146642409611600405. [DOI] [PubMed] [Google Scholar]
- Higgins D. L., O'Reilly K., Tashima N., Crain C., Beeker C., Goldbaum G., Elifson C. S., Galavotti C., Guenther-Grey C. Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects. Public Health Rep. 1996;111 (Suppl 1):28–35. [PMC free article] [PubMed] [Google Scholar]
- Hill M. N., Bone L. R., Butz A. M. Enhancing the role of community-health workers in research. Image J Nurs Sch. 1996 Fall;28(3):221–226. doi: 10.1111/j.1547-5069.1996.tb00355.x. [DOI] [PubMed] [Google Scholar]
- Horstman D. H., Folinsbee L. J., Ives P. J., Abdul-Salaam S., McDonnell W. F. Ozone concentration and pulmonary response relationships for 6.6-hour exposures with five hours of moderate exercise to 0.08, 0.10, and 0.12 ppm. Am Rev Respir Dis. 1990 Nov;142(5):1158–1163. doi: 10.1164/ajrccm/142.5.1158. [DOI] [PubMed] [Google Scholar]
- Howland J., Bauchner H., Adair R. The impact of pediatric asthma education on morbidity. Assessing the evidence. Chest. 1988 Nov;94(5):964–969. doi: 10.1378/chest.94.5.964. [DOI] [PubMed] [Google Scholar]
- Jensen R. A. Outreach by the Hanford Tribal Service Program to Indian communities around the Hanford Nuclear Reservation. Cancer. 1996 Oct 1;78(7 Suppl):1607–1611. [PubMed] [Google Scholar]
- Kehrl H. R., Vincent L. M., Kowalsky R. J., Horstman D. H., O'Neil J. J., McCartney W. H., Bromberg P. A. Ozone exposure increases respiratory epithelial permeability in humans. Am Rev Respir Dis. 1987 May;135(5):1124–1128. doi: 10.1164/arrd.1987.135.5.1124. [DOI] [PubMed] [Google Scholar]
- Kinney P. L., Ozkaynak H. Associations of daily mortality and air pollution in Los Angeles County. Environ Res. 1991 Apr;54(2):99–120. doi: 10.1016/s0013-9351(05)80094-5. [DOI] [PubMed] [Google Scholar]
- Kinney P. L., Ware J. H., Spengler J. D., Dockery D. W., Speizer F. E., Ferris B. G., Jr Short-term pulmonary function change in association with ozone levels. Am Rev Respir Dis. 1989 Jan;139(1):56–61. doi: 10.1164/ajrccm/139.1.56. [DOI] [PubMed] [Google Scholar]
- Klingelhofer E. L., Gershwin M. E. Asthma self-management programs: premises, not promises. J Asthma. 1988;25(2):89–101. doi: 10.3109/02770908809071359. [DOI] [PubMed] [Google Scholar]
- Koren H. S., Devlin R. B., Graham D. E., Mann R., McGee M. P., Horstman D. H., Kozumbo W. J., Becker S., House D. E., McDonnell W. F. Ozone-induced inflammation in the lower airways of human subjects. Am Rev Respir Dis. 1989 Feb;139(2):407–415. doi: 10.1164/ajrccm/139.2.407. [DOI] [PubMed] [Google Scholar]
- Lanphear B. P., Weitzman M., Eberly S. Racial differences in Urban children's environmental exposures to lead. Am J Public Health. 1996 Oct;86(10):1460–1463. doi: 10.2105/ajph.86.10.1460. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lewis C. E., Rachelefsky G., Lewis M. A., de la Sota A., Kaplan M. A randomized trial of A.C.T. (asthma care training) for kids. Pediatrics. 1984 Oct;74(4):478–486. [PubMed] [Google Scholar]
- Lewis M. A., Lewis C. E., Leake B., Monahan G., Rachelefsky G. Organizing the community to target poor Latino children with asthma. J Asthma. 1996;33(5):289–297. doi: 10.3109/02770909609055370. [DOI] [PubMed] [Google Scholar]
- Lucey C. T. What role does occupational and environmental health law have in graduate and continuing medical education? J Occup Environ Med. 1996 Feb;38(2):169–177. doi: 10.1097/00043764-199602000-00014. [DOI] [PubMed] [Google Scholar]
- Martinez F. D., Antognoni G., Macri F., Bonci E., Midulla F., De Castro G., Ronchetti R. Parental smoking enhances bronchial responsiveness in nine-year-old children. Am Rev Respir Dis. 1988 Sep;138(3):518–523. doi: 10.1164/ajrccm/138.3.518. [DOI] [PubMed] [Google Scholar]
- Masterson-Allen S., Brown P. Public reaction to toxic waste contamination: analysis of a social movement. Int J Health Serv. 1990;20(3):485–500. doi: 10.2190/ATLC-AX39-M5EX-BYHF. [DOI] [PubMed] [Google Scholar]
- Metzger R., Delgado J. L., Herrell R. Environmental health and Hispanic children. Environ Health Perspect. 1995 Sep;103 (Suppl 6):25–32. doi: 10.1289/ehp.95103s625. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Montgomery L. E., Carter-Pokras O. Health status by social class and/or minority status: implications for environmental equity research. Toxicol Ind Health. 1993 Sep-Oct;9(5):729–773. doi: 10.1177/074823379300900505. [DOI] [PubMed] [Google Scholar]
- Mott L. The disproportionate impact of environmental health threats on children of color. Environ Health Perspect. 1995 Sep;103 (Suppl 6):33–35. doi: 10.1289/ehp.95103s633. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Muller C., Fahs M. C., Mulak G., Walther V., Blumenfield S., Fulop G. Pediatric AIDS at Mount Sinai Medical Center 1988-89: a study of costs and social severity. Soc Work Health Care. 1996;22(4):1–20. doi: 10.1300/J010v22n04_01. [DOI] [PubMed] [Google Scholar]
- Murray A. B., Ferguson A. C. Dust-free bedrooms in the treatment of asthmatic children with house dust or house dust mite allergy: a controlled trial. Pediatrics. 1983 Mar;71(3):418–422. [PubMed] [Google Scholar]
- Murray A. B., Morrison B. J. The effect of cigarette smoke from the mother on bronchial responsiveness and severity of symptoms in children with asthma. J Allergy Clin Immunol. 1986 Apr;77(4):575–581. doi: 10.1016/0091-6749(86)90348-9. [DOI] [PubMed] [Google Scholar]
- Musham C., Bellack J. P., Graber D. R., Holmes D. Environmental health training: a survey of family practice residency program directors. Fam Med. 1996 Jan;28(1):29–32. [PubMed] [Google Scholar]
- O'Connor G. T., Weiss S. T., Tager I. B., Speizer F. E. The effect of passive smoking on pulmonary function and nonspecific bronchial responsiveness in a population-based sample of children and young adults. Am Rev Respir Dis. 1987 Apr;135(4):800–804. doi: 10.1164/arrd.1987.135.4.800. [DOI] [PubMed] [Google Scholar]
- O'Neill M. S. Helping schoolchildren with asthma breathe easier: partnerships in community-based environmental health education. Environ Health Perspect. 1996 May;104(5):464–466. doi: 10.1289/ehp.96104464. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olden K. A bad start for socioeconomically disadvantaged children. Environ Health Perspect. 1996 May;104(5):462–463. doi: 10.1289/ehp.96104462. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pope C. A., 3rd, Dockery D. W., Spengler J. D., Raizenne M. E. Respiratory health and PM10 pollution. A daily time series analysis. Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):668–674. doi: 10.1164/ajrccm/144.3_Pt_1.668. [DOI] [PubMed] [Google Scholar]
- Pope C. A., 3rd Respiratory disease associated with community air pollution and a steel mill, Utah Valley. Am J Public Health. 1989 May;79(5):623–628. doi: 10.2105/ajph.79.5.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Quackenboss J. J., Krzyzanowski M., Lebowitz M. D. Exposure assessment approaches to evaluate respiratory health effects of particulate matter and nitrogen dioxide. J Expo Anal Environ Epidemiol. 1991 Jan;1(1):83–107. [PubMed] [Google Scholar]
- Rowan F. The high stakes of risk communication. Prev Med. 1996 Jan-Feb;25(1):26–29. doi: 10.1006/pmed.1996.0010. [DOI] [PubMed] [Google Scholar]
- SCHOETTLIN C. E., LANDAU E. Air pollution and asthmatic attacks in the Los Angeles area. Public Health Rep. 1961 Jun;76:545–548. [PMC free article] [PubMed] [Google Scholar]
- Seltzer J., Bigby B. G., Stulbarg M., Holtzman M. J., Nadel J. A., Ueki I. F., Leikauf G. D., Goetzl E. J., Boushey H. A. O3-induced change in bronchial reactivity to methacholine and airway inflammation in humans. J Appl Physiol (1985) 1986 Apr;60(4):1321–1326. doi: 10.1152/jappl.1986.60.4.1321. [DOI] [PubMed] [Google Scholar]
- Sexton K., Gong H., Jr, Bailar J. C., 3rd, Ford J. G., Gold D. R., Lambert W. E., Utell M. J. Air pollution health risks: do class and race matter? Toxicol Ind Health. 1993 Sep-Oct;9(5):843–878. doi: 10.1177/074823379300900509. [DOI] [PubMed] [Google Scholar]
- Sporik R., Holgate S. T., Platts-Mills T. A., Cogswell J. J. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med. 1990 Aug 23;323(8):502–507. doi: 10.1056/NEJM199008233230802. [DOI] [PubMed] [Google Scholar]
- Ware J. H., Ferris B. G., Jr, Dockery D. W., Spengler J. D., Stram D. O., Speizer F. E. Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children. Am Rev Respir Dis. 1986 May;133(5):834–842. [PubMed] [Google Scholar]
- Weiss K. B., Gergen P. J., Hodgson T. A. An economic evaluation of asthma in the United States. N Engl J Med. 1992 Mar 26;326(13):862–866. doi: 10.1056/NEJM199203263261304. [DOI] [PubMed] [Google Scholar]
- Whittemore A. S., Korn E. L. Asthma and air pollution in the Los Angeles area. Am J Public Health. 1980 Jul;70(7):687–696. doi: 10.2105/ajph.70.7.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zill N. Parental schooling & children's health. Public Health Rep. 1996 Jan-Feb;111(1):34–43. [PMC free article] [PubMed] [Google Scholar]
