A Fresh Look at Stress and Resilience in Communities Affected by Environmental Contamination

From toxic waste in Love Canal, New York, to lead in Flint, Michigan, environmental contamination can cause chronically elevated psychosocial stress (see sidebar) in individuals and across families and communities (Cuthbertson, Newkirk, Loveridge, & Skidmore, 2016; Edelstein, 2004; Levine, 1983). Stress is a normal reaction to environmental contamination, not a mental health disorder. Still, stress can affect people’s health and quality of life.

Environmental contamination can cause psychosocial stress among affected community members for many reasons, including:

• Uncertainty: At the individual level, people might not know whether, at what level or for how long, they were exposed. Moreover, scientists and physicians might be uncertain about the possible health effects of exposure.

• Health and safety concerns: At a family level, parents might worry about their children’s health. They might feel their home is not a safe place anymore.

• Social conflict: At the community level, there can be discord between community members who have differing beliefs about the seriousness of the threat.

In addition, lengthy environmental and health investigations, loss of trust in institutions, financial strains, and other concerns associated with environmental contamination are sources of stress.

For affected community members, the stress of living with environmental contamination can pose physiological health risks on top of risks associated with direct exposure to the contamination. Chronic stress has been linked with cardiovascular effects, increasing the risk for development of hypertension and plaque formation in atherosclerosis (Kaplan, Pettersson, Manuck, & Olsson, 1991; Melin, Lundberg, Söderlund, & Granqvist, 1999; Seeman et al., 2010). Stress can also trigger complex headaches (e.g., migraines) and flares in autoimmune (Stojanovich & Marisavljevich, 2008) and dermatological conditions (Arndt, Smith, & Tausk, 2008). Disadvantaged and vulnerable populations might also disproportionately suffer from other psychosocial and environmental stressors (e.g., institutionalized discrimination, adverse childhood events) (Collaborative on Health and the Environment, 2016; Morello-Frosch & Shenassa, 2006). Further, stress and chemical exposures can interact, producing worse health outcomes than either independently (McEwen & Tucker, 2011).

Conversely, individual and community resilience can promote physical and psychological health and enhance well-being. Community resilience is the ability of a community to adapt to changing conditions and prepare for, withstand, and rapidly recover from disruption (The White House, 2015). Communities able to develop an actionable plan to cope with and recover from a disaster tend to have better outcomes (Wulff, Donato, & Lurie, 2015). While acute disasters affect communities differently from chronic environmental contamination incidents (Table 1), resilience theory and principles can be applied to help communities prepare for, survive, and recover from natural and technological disasters (Sandifer & Walker, 2018).

TABLE 1.

Acute Disasters and Chronic Contamination Affect Communities Differently

Acute Disasters (e.g., Hurricane, Terrorist Attack)	Chronic Contamination (e.g., Toxic Chemical in Drinking Water)
Have a before and after	Becomes a context of community life with no clear beginning and end
Immediate visible damage	Relatively invisible
Clear human health and safety impacts	Uncertain human health impacts
Promote action	Promote study of potential remedies
People cycle through stages of warning/threat/impact, response, recovery	Traps some people in warning/threat/impact stages without a clear path to recovery

Adapted from Couch and Coles (2011) and Sandifer and Walker (2018).

The Agency for Toxic Substances and Disease Registry (ATSDR) and other federal, state, and local health professionals with experience in communities affected by environmental contamination recognize stress as a challenge. ATSDR’s efforts to address this issue date back to a 1995 expert panel on the psychological effects of hazardous substances (Agency for Toxic Substances and Disease Registry [ATSDR], 1995). Following the expert panel, ATSDR established a community stress team that worked directly with communities to develop public health strategies to mitigate community stress from 1998–2002. The team also delivered trainings on stress and contamination for public health and environmental professionals, and in some communities, for local psychologists, healthcare providers, and social workers.

More recently, public health agencies, including ATSDR, have developed stress-focused materials for affected community members. These materials acknowledge stress and worry related to environmental contamination, validate these feelings as normal responses, offer ideas for coping, and point to helpful resources (ATSDR, 2017a; County of Los Angeles Public Fiealth, 2018, Multnomah County, 2016). ATSDR also developed tips for health professionals to review before addressing this topic with community members (ATSDR, 2017b) and has provided awareness-level training for public health and environmental professionals (U.S. Environmental Protection Agency, 2018). ATSDR’s fact sheet (in English and Spanish) and tips sheet are available at www.atsdr.cdc.gov/factsheets.html under the Stress and Environmental Contamination section.

Currently, ATSDR is taking a fresh look at psychosocial stress related to environmental contamination, with a focus on per- and polyfluoroalkyl substances (PFAS) in drinking water. This community-engaged project might enhance knowledge and understanding of PFAS contamination-related stressors, informing new tools, resources, and strategies to reduce stress and build resilience in affected communities.

The project includes the following activities:

• Review literature: A systematic literature review on the intersection of chronic environmental contamination, psychosocial health, and community resilience will inform other activities and be presented in a peerreviewed manuscript and an online webinar.

• Understand community experiences: We conducted nine key informant interviews with community leaders and state health officials to learn more about how communities experience and cope with PFAS contamination events. While not a nationally representative picture of community responses to PFAS contamination, the interviews helped put community voices at the center of the project.

• Develop educational materials: We will revise and develop new educational materials on environmental contamination, stress, and community resilience for health professionals and affected community members based on the literature review and community experiences. The materials will be designed for and tested with health professionals and people living in PFASaffected communities.

• Develop a community stress resilience toolkit: We will develop a toolkit for state and local health organizations with practical, evidence-based public health strategies for implementing stress resilience interventions in communities facing environmental contamination.

• Convene stakeholder group: A stakeholder group with community leaders, health professionals, disaster mental health experts, and others will provide input on toolkit content and implementation.

ATSDR looks forward to engaging community members and public health partner organizations in this work. Contact Ben Gerhardstein at bgerhardstein@cdc.gov to learn more.

What Is Psychosocial Stress?

Psychosocial stress is a term that combines “psychological stress” and “social stress.” Psychological stress refers to emotional, behavioral, biochemical, and physiological reactions that people experience when confronted with a situation that strains their ability to cope. Social stress refers to feelings that can arise from a person’s relationship to others, including family, neighborhoods, and the workplace, that can lead to psychological stress. Each type of stress can influence the other. Taken together, the terms are called psychosocial stress.