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. 2021 Jun 23;16(6):e0252127. doi: 10.1371/journal.pone.0252127

Crosscutting environmental risk with design: A multi-site, multi-city socioecological approach for Iowa’s diversifying small towns

Benjamin Shirtcliff 1,*, Rosie Manzo 1, Rachel Scudder 2
Editor: Tzai-Hung Wen3
PMCID: PMC8221475  PMID: 34161328

Abstract

Globally, the influx of refugee, migrant, and immigrant populations into small centers of industrialized agriculture has called attention to a looming public health crisis. As small towns shift from remote villages into rural, agri-industrial centers, they offer limited access to amenities needed to support human well-being. Our study focused on three Iowa towns that continue to experience an increase in under-represented minority populations and decline of majority populations as a proxy for studying shifting populations in an era of industrialized agriculture and global capital. We aimed to understand the socioecological impact of built environments—outdoor locations where people live and work—and likelihood of environmental exposures to impact vulnerable populations. Urban socioecological measures tend to present contradictory results in small towns due to their reliance on density and proximity. To compensate, we used post-occupancy evaluations (POE) to examine built environments for evidence of access to environmental design criteria to support healthy behaviors. The study systematically identified 44 locations on transects across three small towns to employ a 62 item POE and assess multiple environmental criteria to crosscut design with environmental health disparities. Principal-components factor analysis identified two distinct significant components for environmental risk and population vulnerability, supporting similar studies on parallel communities. Multilevel modeling found a divergence between supportive environmental design coupled with an increase environmental risk due to location. The combined effect likely contributes to environmental health disparities. The study provides a strategy for auditing small town built environments as well as insight into achieving equity.

1. Introduction: Small U.S. towns & rural built environments

Countries around the world are facing an increase in industrialized agriculture, growing urbanization, shifting populations, and a mounting public health dichotomy between urban/rural built environments [1, 2]. The current state of research on local life in small agrarian towns reveals a critical knowledge-gap linking built environments with health-promoting behaviors. Recently, the National Institutes of Health (NIH) modified health disparity populations to include people from underserved rural areas. NIH’s change responds to the limited research in rural settings, including measuring the impact of small-town environments on healthy behaviors [3, 4]. The intersection of environmental risk and design on vulnerable populations has received extensive study in urban settings but, as new U.S. policies suggest, rural areas and small towns pose a substantial gap in the literature. The study’s objective is to correlate environmental risk with environmental design for evidence of factors potentially exacerbating health disparities faced by vulnerable populations; and, identify strategic opportunities for designers and planners.

1.1. Literature review

1.1.1. Environmental justice and small town built environments

Globally, population shifts have led to an emergence of multiple health and well-being concerns, such as the mental health and physical health impacts of racism [5], an increase in cardiovascular disease among workers exposed to pesticides and fertilizers [6], an increase in asthma amongst young people [710], and physical and social isolation that prevents access to health-related services [1113]. For example, as industrialized agriculture continues to develop, small towns have become gateways and job centers for a new, vulnerable workforce [1, 14, 15]. The situation is like what environmental justice advocates describe as a “double jeopardy” of injustice where people with the fewest resources reside in low-income communities with high level of environmental risk and unable defend against social threats like racism [9, 10, 1618]. The recent change has left many decision makers wondering how to use limited community resources to address new and existing population needs [1924]. In contrast to theories describing urban-rural change as evidence of environmental racism [2], our research paper seeks to understand how environmental risk and design in small towns may unintentionally impact vulnerable populations. Since social factors are unique for minority communities in rural environments, the paper will briefly discuss the environmental justice related to parallel communities.

1.1.2. Parallel communities in rural Midwest

Small towns throughout the Midwest have experienced steady population loss, however towns that process farm products, provide farm labor, or employment in ag-related manufacturing replace decreasing numbers with a growing minority base—predominately first and/or second generation foreign-born, under-represented minority groups [25]. This attraction to small Midwestern started in the 1980’s, following expanding meat processing and declining post-union salaries [26]. Despite population stabilization, Sandoval found vulnerabilities related to poor living conditions and parallel communities.

Parallel communities, populations that seldom interact due to work and shopping schedules, geography, and language barriers, can effectively destabilized local economies due to hidden “flows through employment recruitment networks, lending networks, remittance transfers, and smuggling networks” [27]. At one extreme, Sandoval, Nelson, and others found that individuals with questionable status due to the color of their skin, even residents with citizenship or green cards, felt compelled to isolate themselves because of their inferred ‘illegal’ identity [28]. Nelson et al., noted that the population shift has changed the ethnic composition of small towns, decreased tax-base, and created a form of residential segregation where people live in parallel universes, rarely interacting with one another [28]. In Postville, Iowa, for example, the local economy became dependent upon a workforce that was committed to investing somewhere else. The reliance on a parallel distribution of social, economic, and ecosystem resources eventually led to the collapse of Postville’s economic and social systems, as will be discussed in the implications.

1.2. Justification of methods: Crosscutting environmental risk with design in three small towns in Iowa

To understand the physical reality of these parallel universes, the present study used a crosscutting approach which began with the use of transects (see below) to strategically cut across small towns to relate environmental risk with design. Environmental risk coupled with poor environmental design has the capacity to impact everyone but likely to exacerbate vulnerability for under-represented and invisible populations. As suggested by Talen [29], due to historic patterns of uneven development and segregation, the present study included natural and infrastructural barriers, like rivers and highways, known to isolate neighborhoods. Following others, our study implemented multiple means to assess outdoor, built environments [30]. In the following sections, we operationalize built environments, review measurement approaches, and suggest transects to overcome the limitations of density-based models to study how environmental risks may impact daily stressors.

1.2.1. The built environment and POE

The built environment is a commonly used term in the realm of public health, human sciences, and design. The Center for Disease Control (CDC) classifies the built environment as “all the physical parts of where we live and work.” The broad reaching definition is focused in the current study to outdoor environments such as streetscapes, open spaces, social gathering spaces, and infrastructure [31]. Recent environmental health research has led to a myriad of urban studies that use population density as a proxy for built environments with lower levels of population density often showing equitable levels of access to green infrastructure [32]. Similarly, studies examining neighborhood characteristics have measured the built environment using features such as street tree density, residential density, intersection density, land-use mix, greenspace distribution, greenspace quality, and the walkability index that combines these features [30, 33, 34]. Small towns, with low population densities and lacking other forms of geographic density represent a paradox: the built environment is not comparable with common urban measures.

The rural-health paradox suggests that vulnerable and isolated populations in low-density areas appear to be less at-risk. Rural populations are less-likely to report symptoms because there are fewer individuals but also because of lack of access and awareness [35]. Similarly, in reference to commonly reported urban green and supportive benefits of nature [36], small, agrarian towns appear to be surrounded by green and nature (e.g., corn fields). However, industrialized agriculture has made these green landscapes volatile [9]. One similarity between urban and rural built environments is the threat of “natural” green spaces. Vacant lots in cities and rural, industrialized, green areas contain contaminated soils and plants [37]. In response, our study used a 62-item Likert scale to survey the perceivable quality of built environments through post-occupancy evaluation (POE) to measure the quality of environmental design to meet residential needs.

POE refers to auditing the quality and use of built environments after implementation and is predominately used for buildings by architects and interior designers. Typically, trained observers score locations looking for issues like access, facilities, amenities, features, incivilities, safety, and usage. Scales such as the Natural Environment Scoring Tool or the Community Park Audit Tool provide a standardized means of assessing conditions of types of places for human populations [30, 38]. Our study employed a holistic model developed for outdoor residential environments using the validated instrument Cross and Küller developed in Sweden [39]. To validate this checklist, Cross and Küller “compared the experts’ scores (r = .71) for each area to the satisfaction residents had regarding outdoor environment” (ibid., p. 79). The 62-item checklist (Table 1) has been used by others to study both objective measures of the built environment—explicitly measurable features like visibility of trash or water—and subjective measures—implicitly understood by trained professionals like legibility [40].

Table 1. POE items from cross’s checklist.
Criteria Measures Number of Items
Physical Criteria general layout, complexity & coherence, identity and affection, construction materials, greenery, climate, pollution 37
Social Criteria meeting areas, privacy, security, traffic, and maintenance 25

1.2.2. Environmental risk, daily stressors, and environmental design

The impact of environmental risk is increasingly measured through daily stressors. Epidemiological research by Theall et al., has identified serious impacts of the built environment on stress-related inflammation and other health outcomes at an urban scale [see 4143]. Such public health research provides precedents for the importance of measuring and classifying environmental risk in built environments [44]. Our study builds upon this area by incorporating environmental risk from pollution [9] and exposure to heat and wind, for example, that potentially exacerbate health-related problems [45]. While this study does not propose to measure individual-level stress, it does build upon a growing public health literature and key legislative documents such as the Clean Air Act and the Clean Water Act identifying the impact of unhealthy conditions on human well-being. Daily stressors found at the intersection of vulnerability and environmental risk include: weathering [46, 47], individual risk [8, 44, 48], morbidity [7, 9, 35, 49], and human mortality [6, 18, 50]. In response to environmental risk, vulnerable populations may benefit from environmental design that buffers stressors and provides a protective mechanism in neighborhood environments [51]. The following study looks at the intersection of environmental risk with design to formalize criteria planners and designers could assess in addressing public health disparities.

1.3. Research questions and hypothesis

The present study aims to understand how small towns could overcome parallel lives and provide environmental resources. The null hypothesis, built upon the environmental justice literature, is that vulnerable residents at the intersection of low-SES and minority status are just as likely as wealthier, educated, English-speaking residents to live and work in outdoor locations with supportive environmental design and that no difference would be found between small towns and average, urban populations. The study used a crosscutting, systematic sampling method through transects to identify whether vulnerable populations were at an increased risk for health disparities due to environmental risk and design.

2. Methods

The medium-sized, descriptive study of transect points across three small towns (n = 44) used a qualitative and quantitative comparative analysis approach to identify probabilistic relationships related to environmental risk and design [52]. The post-occupancy evaluation of study sites selected locations using a systematic sampling interval based upon variations in socio-ecological criteria, e.g. low-income housing in floodplains, through transects [53, 54]. Internal validity was achieved by evaluating each point twice in the field and once online by different pairs of trained graduate students. The modal score of each trice evaluated point was used to achieve reliability. Secondary data was obtained from publicly available reputable sources, Environmental Protection Agency, Center for Disease Control, and Census data. The study did not involve human subjects.

2.1. Study sites

Our study focuses on the built environments in three Iowan small towns deeply affected by the transnational shift in population and economic resources. Of Iowa’s roughly three million people, one-third, or one million live in small towns with a population below 10,000 [55]. The state average, accordingly, is considered mostly urban. The three towns, Perry, Ottumwa, and Marshalltown were selected based upon size, over 70 miles apart, exempt from a municipal statistical area, and documented population change.

2.2. Transects

In this study, each transect line had to cross environmental criteria potentially exacerbating risk, such as agricultural fields next to a public middle school, or support quality of life, like access to a park (see criteria and maps in Fig 1). Overall, four trained graduate student researchers from environmental design disciplines and the primary investigator identified multiple transects that cut across each small town. Transect lines were divided into equally spaced points with ½ mi. buffers and each point was field verified using the POE and secondary data for each point was downloaded from the EPA (Fig 1). Each transect conducted a post-occupancy evaluation (POE) of built environments using Cross’s validated residential survey. The use of secondary environmental and vulnerability data provides insight into public health concerns and risks to human well-being. Finally, mapping and locating transect points, POE data, and secondary data, permitted spatial relationships to be analyzed.

Fig 1. Transects across Perry, Marshalltown, and Ottumwa follow the criteria: Includes at least one urban boundary, a natural edge, an agricultural edge, and an urban center; cross high and low elevation points, i.e. water’s edge to hilltop or ridge and floodplain; pass across or close to at least one elementary, middle, or high school; includes a potentially harmful and a potentially beneficial infrastructure, like a canal, interstate, railroad, bike path, park, factory, or other major transportation infrastructure; includes multiple land use types: Residential, commercial, multifamily, industrial; be accessible at intervals by car, bike, or walking.

Fig 1

Transect buffers overlap in heterogeneous areas to capture increased complexity of built environments. Reprinted from Iowa DOT under Create Commons license of public domain data with a waiver of all rights including attribution CCZero license [2018].

2.3. Primary data collection and measures

Graduate research assistants—four across two years working in pairs—with extensive training in landscape architecture, architecture, and planning conducted the POE using the freely available, educational license of the mobile data collection platform Fulcrum (www.fulcrumapp.com). The mobile app geolocates survey points and functions through computers, smart phones, and through offline tablets if maps are downloaded prior to going into the field. For this study, an app was built using Cross’s survey (see section 1.2.1), with the permission of the authors, that included the pictures and occasionally videos of each location. Research assistants assessed transect points using Cross’s 4-point scale of agreement, for example “I very much agree that this area has no trash present” or “I mostly agree that this area contains a landmark that makes it easy to locate.” The scale is written using negative in the question, so that “very much agree” scores will always overall rank in positive environmental characteristics. For example, a score of “Very Much Agree” that there are no traces of vandalism would be a positive measure even though the question is about vandalism. This permits a sum of all points and sums of point for each criterion to easily compare across locations. Final scores were numerically modified (1–4) to support statistical analysis. (Table 2).

Table 2. Variables Collected through Fulcrum show the number of transect points, the average group criteria score for each transect point across the three cities, and the average scores across all cities.

Average Transect Point Scores and Average Sum of Scores for Each Category per City        
Category Perry   Ottumwa   Marshalltown Overall  
n AVG (SD) AVG (SD) n AVG (SD) Avg Sum (SD) n AVG (SD) Avg Sum (SD) AVG (SD) Avg Sum (SD)
Physical Criteria (# of items)                
General Layout (6) 20 1.95 (.57) 11.70 (3.40) 14 2.42 (.47) 14.50 (2.82) 10 1.60 (.44) 9.60 (2.63) 2.02 (.59) 12.11 (3.52)
Complexity and Coherence (5) 20 2.71 (.70) 11.65 (3.60) 14 2.34 (.70) 9.36 (2.80) 10 2.58 (.63) 8.90 (3.38) 2.56 (.69) 10.30 (3.47)
Identification and Affection (8) 20 2.55 (.54) 19.50 (4.57) 14 2.50 (.70) 14.78 (3.53) 10 2.64 (.71) 14.20 (7.70) 2.55 (.54) 16.77 (5.62)
Construction Materials (5) 20 1.98 (.48) 9.75 (2.61) 14 1.59 (.29) 7.93 (1.44) 8 1.93 (.92) 6.63 (2.89) 1.84 (.56) 8.55 (2.61)
Greenery (4) 20 2.01 (.80) 6.50 (3.82) 14 2.24 (.61) 7.86 (2.96) 7 2.11 (.71) 5.86 (4.88) 2.11 (.71) 6.85 (3.73)
Climate (2) 20 2.38 (.86) 4.75 (1.71) 14 1.68 (.61) 3.36 (1.22) 10 2.20 (.75) 4.40 (1.51) 2.11 (.81) 4.23 (1.61)
Pollution and Noise (2) 20 2.18 (1.04) 4.35 (2.08) 14 1.2 (.38) 2.43 (.76) 10 1.75 (.54) 3.50 (1.08) 1.77 (.87) 3.55 (1.74)
Ecological Sustainability (5) 20 3.51 (.40) 13.83 (3.73) 13 2.33 (.55) 4.46 (1.8) 6 3.15 (.80) 8.83 (7.52) 3.04 (.75) 9.73 (5.84)
Social Criteria                
Place (8) 20 2.65 (.55) 20.40 (5.21) 14 3.14 (.48) 23.71 (4.25) 10 2.52 (.82) 15.7 (7.01) 2.77 (.64) 20.39 (6.04)
Privacy 5) 20 2.76 (.77) 12.35 (3.42) 14 2.40 (.63) 10.36 (3.25) 9 2.68 (.51) 9.56 (2.70) 2.63 (.68) 11.12 (3.38)
Security and Traffic Control (8) 20 2.41 (.40) 17.5 (2.97) 14 2.60 (.48) 18.07 (3.75) 10 2.36 (.38) 15.6 (3.66) 2.46 (.42) 17.25 (3.44)
Maintenance (5) 20 1.38 (.67) 5.15 (2.89) 14 1.58 (.65) 5.14 (2.14) 10 1.43 (.94) 3.70 (.83) 1.43 (.72) 4.82 (2.37)

Each group has multiple measures of evaluation, 2–8, as indicated in the parentheses, so the mode of each item was averaged into its group criteria. Average sums illustrate the highest negative value, i.e. I strongly disagree that this area is well organized (4), so the 6-item general layout could have a range from 6 of meets environmental design criteria to 24 of severely lacking.

2.4. Secondary data sources and measures

Transect points were triangulated with secondary data from the Environmental Justice Screening and Mapping tool (EJSCREEN) developed by the EPA (Table 3, S1 File). EJSCREEN is a publicly available data source that allows users to explore recent demographic and environmental indicators of environmental justice issues for specific geographic areas. Environmental indicators display potential sources of environmental pollutants and include eleven data points, that illustrate toxicity and proximity measures for air, waste, water, and soil. Demographic indicators focus on vulnerability and include six data points, including low-income, minority, less than high school education, linguistic isolation, and individuals under age five and over the age of 64. The use of multiple population vulnerability measures has been advocated by others as means of moving beyond poverty and/or SES as the primary predictor of environmental disparities [30, 56].

Table 3. Variables downloaded using EPA’s EJscreen for each 1/2 mi. transect point.

Category Selected Variables n Range, Average (SD) State Avg. Sig.
Environmental Particulate Matter (PM 2.5 in ug/m3) 44 8.67–9.47, 9.04 (.32) 9.23 ~
Environmental Ozone (ppb) 44 39.8–40.3, 39.9 (.2) 40.5 ~
Environmental NATA Diesel PM (ug/m3) 44 .28–2.22, .71 (.34) 0.586 t = 2.5, p < .05
Environmental NATA Air Toxics Cancer Risk (risk per MM) 39 23–41, 31.87 (3.78) 30 t = 3.09, p < .01
Environmental NATA Respiratory Hazard Index 39 .66–2.0, 1.14 (.23) 1.1 ~
Environmental Traffic Proximity and Volume 39 2.4–3500, 743 (954) 1500 ~
Environmental Lead Paint Indicator 39 .19-.94, .62 (.18) 0.42 t = 7.2, p < .01
Environmental Superfund Proximity 39 .02-.03, .021 (.005) 0.098 ~
Environmental RMP Proximity 39 .26–3.6, 1.53 (.84) 1.2 t = 2.4, p < .05
Environmental Hazardous Waste Proximity 39 .01–1.2, .24 (.36) 0.53 ~
Environmental Wastewater Discharge Indicators 39 .00-.16, .023 (.035) 0.018 ~
Demographic Demographic Index 39 10%-62%, 39% (12%) 21% t = 20.5, p < .01
Demographic Minority Population 39 3%-62%, 33% (16%) 13% t = 12.7, p < .01
Demographic Low Income Population 39 15%-73%, 46% (13%) 30% t = 21.5, P < .01
Demographic Linguistically Isolated Population 39 0%-19%, 7% (5.4%) 2% t = 8.2,p < .01
Demographic Population with Less Than High School Education 39 4%-34%, 19% (6.5%) 8% t = 18.2, p<01
Demographic Population under Age 5 39 1%-16%, 7.75% (3.9%) 6% t = 12.4, p < .01
Demographic Population over Age 64 39 6%-25%, 14% (5.3%) 16% t = 16.3, p < .01
Demographic Population 39 10–1348, 442 (392)    

Variables also show significant deviation from state averages. As forementioned, the state average population is urban permitting state averages to be used as proxy. All data has been deidentified and uploaded as part of this manuscript.

2.5. Analyses

Data was cleaned and screened prior to analysis in SPSS 27. Analysis began by examining significant differences between transect points and an urban proxy, state averages, using t-tests, then constructed two principal component axes (PCA) to measure outcomes related to environmental risk and criteria related to vulnerability, and finally nested environmental exposures, vulnerability, and POE surveyed environmental design variables were entered in multilevel models to interpret what environmental design features were most likely to explain intersections of risk and design among vulnerable populations. The study was designed to use multilevel modeling to cluster variables by location (nesting dependent and independent variables into transect points) to look for within and between location effects. Overall, 206 variables were collected across 44 transect points (five points were eliminated at an early stage in the data collection process due to miscommunication). We used t-tests (Table 3) to see if environmental risk and vulnerability differed in small towns when compared to state population averages—state averages were used as a proxy for urban environments as EPA averages reflect population, which in Iowa is 70% urban. This approach is in concert with the rural-health paradox by Kim et. al. noted above. Similar to Rigolon et al. [57], we entered environmental risk as an outcome variable using a principal-component analysis (PCA). We entered vulnerability as a criterion variable using the same process. PCA converts potentially correlated variables from observations into linearly uncorrelated composite values. PCA is used for exploratory data analysis and for predictive modeling. Finally, to assess criteria from the physical environment, we compared both environmental risk and vulnerability scales to the 62-items checklist through a series of multilevel models.

Multilevel modeling (MLM) was used to examine environmental design criteria across sites as they relate to the PCA environmental risk outcome and vulnerability criteria. This strategy permits a more reliable means of calculating the similarities of differences (i.e., residuals) within and between sites. Following Hoffman [58], restricted maximum likelihood (REML) was used to make estimates and inferences about covariance parameters. First, an initial unconditional model free of any predictors was used to measure the amount of variation in environmental risk, differentiating between-site variance from within-site variance. MLM does not violate the assumption of independent observations when modeling nested data, thereby permitting a more accurate, real-world assessment. Upon setting up the model, we measured the intraclass correlation coefficient (ICC)—a key statistic that is commonly used to evaluate similarities for several “classes” in a school. The ICC measures how well residuals are correlated and can be used to indicate the degree to which observations taken at different locations are stable within each site. Of primary conceptual interest, a high ICC indicates that observations are reliable indicators of differences between locations.

3. Results

3.1. Urban/rural dichotomy, vulnerability and environmental risk

In response to the question whether people in small towns were at higher risk of exposure when compared to their urban counterparts, environmental risk from pollutants was not found to be equal across the three small towns in our study and, in some cases, these towns evidence significantly higher risks of exposure than state averages (Table 3). Small town exposure to diesel ranges from .28 to 2.22 with a state average of .59, air toxics recognized to increase risk of cancer range from 23–41 with a state average of 30, lead paint from older homes .19 to .94 (.42 average), and proximity to potential chemical accidents range .26–3.6 with a state average of 1.2.

Above average environmental risk can remain unnoticed in healthy adults but can pose a serious threat to vulnerable populations. The demographic index, the EPA’s scale of poverty and minority status, ranges in the three study towns from 10% - 62% with a state average of 21%, minority 3% - 62%, low-income 15%-73%, linguistic isolation 0% - 19%, less than high school 4% - 34%, under age 5 ranges 1% - 16%, and over age 64 ranges 6% - 25%. All the social vulnerability indexes were significantly higher than state averages across the three small towns.

3.2. Outcome variable: Environmental risk

Environmental Risk criteria from the EPA’s EJscreen (Appendix 1 in S1 File) were extracted to reveal two components: the first had an eigenvalue of 2.2 and accounted for 43.8% of variance across 44 transect locations. The second component is orthogonal to the first factor and had an eigenvalue of 1.3 and accounted for 26% of the variance of the 5 variables: PM 2.5, NATA Diesel PM, NATA Air Toxics Cancer Risk, Lead Paint, and RMP Proximity. The risk factors positively loaded onto the first factor, with especially high factor loadings for Air Toxics, Particulate Matter and Lead Paint indicators (Fig 2); this first factor is thus collectively termed Environmental Risk. The Environmental Risk variable was normally distributed (Appendix 2 in S1 File) with lower scores representing decreased risk and higher scores increased risk of exposure. The second component suggests some environmental risk is driven by high RMP proximity and low NATA diesel PM values, suggesting this second factor is influenced by small town proximity to RMP facilities and rural isolation. The study used the first component, Environmental Risk, as the outcome variable for further analysis.

Fig 2. Environmental Risk Factors indicates the environmental factors across the transects likely to represent the greatest combined risk.

Fig 2

Higher scores indicate higher risk of environmental exposure.

3.3. Criterion variable: Social vulnerability

Social vulnerability was measured through a (PCA) to create a factor score that merged demographic variables (Minority Population, Low Income Population, Linguistically Isolated Population, Population with Less Than High School, Population under Age 5, and Population over Age 64) into a single construct for vulnerability. The PCA revealed two components. The high vulnerability variable was extracted from the first component with an eigenvalue of 3.52 that explained 58.7% of the total variance in six of seven variables: minority population, low-income, linguistic isolation, less than high school educated, and presence of children under 5 (Fig 3). The second component had a low an eigenvalue of 1.008 that explained 16.8% of the variance, predominately low-income and over 64 (see Appendix 3 in S1 File). This vulnerability variable was normally distributed.

Fig 3. Population vulnerability factors identify the two components from PCA and statistically represent the parallel populations within each small town.

Fig 3

Higher scores indicate more vulnerability.

3.4. Environmental design: Measures of physical and social conditions

The eight physical and four social criteria measures from post-occupancy evaluations were transformed from categorical variables indicating level of agreement (very much agree (1) to very much disagree (4)); and, then the multiple indicators for each transect point were averaged per group and summed to represent each group total score. Overall physical (.32) and social (.65) criteria showed a significant correlation (p < .05, see Appendix 4 in S1 File) with demographic index; areas with minorities showed a positive correlation (.40) with place; low income inversely with ecological sustainability (-.51) and pollution (-.46); population under 5 inversely with identification (-.35), place (-.38), and physical overall (-.39)—vulnerable populations tend to be associated with unsupportive, residential environments. Like vulnerability and environmental risk, a PCA was used to explore how environments rated with poor supportive qualities related to vulnerability and environmental risk. The outcome Environmental Risk variable had a significant correlation with the residential environments PCA (.49), p < .001, suggesting that environments with high levels of environmental risk were likely to also score poorly in terms of environmental design.

3.5. POE and MLM

Next, the analyses examined whether the transect location explained variance and therefore served as an important indicator of exposure to environmental risk. Using multilevel modeling, we used the intraclass correlation, (ICC = .55 (.22), p < .05), to demonstrate that 55% of environmental risk in small towns is related to specific locations. The significant ICC indicates that the relative exposure of populations to environmental burdens is not randomly distributed in small towns. Demonstrating a significant ICC is important for justifying further analysis into what environmental design factors may account for further increase in environmental inequity.

Similar to other neighborhood effect studies, a series of multilinear models were run to see what physical environmental factors were most likely to load variance onto the outcome variable environmental risk [51, 59]. Following Gerring’s [52] suggestion for studies with medium-sized samples, variables from the post-occupancy evaluation survey were dichotomized—scores 1 and 2 were transformed to 0 and scores 3 and 4 were transformed to 1—and dummy coded as 0, agree that the built environment positively supports the variable, and 1, disagree. Data was grouped by subjects using the 44 location points with the outcome variable of environmental risk. The environmental design variables (62) from Cross and Kuller [39, 60] were individually entered—this is due to the inherent limitations in degrees of freedom of 44 transect points—as factors according to their group, like general layout, complexity and character, identity, etc. (see Table 4). Coefficients overall suggest an increase associated with environmental risk in environments without mystery, complexity, history, water, materiality, big trees, shield, biodiversity, and enclosure (Fig 4). Access indicated a significant inverse effect, suggesting that places with more traffic have increased environmental risk. Each of these variables maintained significance when controlling for increases in population vulnerability.

Table 4. Fixed effects from 62 item POE across 44 transect points.

 POE Var. Effect Coefficients (β)  Standard Error  Approx. df  t Ratio  P (2-sided) 95% Confidence Interval
Lower Upper
Access
High Access* 0.69 0.31 37 2.21 0.03 0.06 1.32
Low Access* -0.21 0.36 37 -2.52 0.02 -1.62 -0.18
Mystery
High Mystery -0.30 0.21 37 -1.42 0.16 -0.74 0.13
Low Mystery* 0.63 0.31 37 2.03 0.05 0.00 1.25
Complexity
High Complexity* -1.06 0.47 37 -2.25 0.03 -2.02 -0.11
Low Complexity* 0.12 0.50 37 2.38 0.02 0.18 2.19
History
High History* 0.18 0.33 37 -2.13 0.04 -1.38 -0.03
Low History* 0.89 0.37 37 2.38 0.02 0.13 1.65
Water
High Water* 0.73 0.17 37 -2.38 0.02 -0.75 -0.06
Low Water** 1.13 0.28 37 3.98 0.00 0.55 1.70
Materiality
High Materiality* 0.13 0.42 37 -2.14 0.04 -1.77 -0.05
Low Material* 1.04 0.45 37 2.29 0.03 0.12 1.96
Big Trees
High Trees 0.20 0.32 37 -1.95 0.06 -1.26 0.02
Low Trees* 0.70 0.36 37 2.22 0.03 0.07 1.54
Shield
High Shield 0.19 0.30 37 -1.82 0.08 -1.16 0.06
Low Shield* 0.74 0.35 37 2.11 0.04 0.03 1.45
Biodiversity
High Biodiversity** 0.27 0.29 37 -3.16 0.00 -1.51 -0.33
Low Biodiversity** 1.19 0.33 37 3.61 0.00 0.52 1.87
Enclosure
High Enclosure 0.27 0.25 37 -1.71 0.10 -0.92 0.08
Low Enclosure * 0.69 0.31 37 2.18 0.04 0.05 1.32

* Dependent Variable Environmental Risk. Intercept is positively rated environment and named effect is negatively rated environment, so higher coefficients indicate increase risk associated with lack of main effect, like shield. Aside from Access—the environmental criteria is deemed as a positive in Cross’s survey but access includes proximity to traffic and vehicles—, all variables show an increase in environmental risk associated with poor environmental criteria with significant effects (p < .05) italicized. Significance noted at the * = p < .05; ** = p < .01, and *** = p < .001 level.

Fig 4. Coefficients from a series of multilevel models identify built environment criteria differentiated as lacking environmental design criteria also being associated with our PCA scale of increase in levels of environmental risk—standardized so that a score of 1 us one standard deviation above the mean—and higher quality environments with lower levels of environmental risk.

Fig 4

See Appendix 6 in S1 File for a matrix of exploratory Global Moran I’s post-hoc clusters analyzed in GeoDA 1.18.0. Locations consistently cluster from high quality and low risk to low quality and higher environmental risk. Note that environmental design measures should not be compared in terms of lacking or possessing environmental design criteria—one location may or may not possess multiple criteria—, instead this indicates how specific criteria, like biodiversity, related to environmental risk nested within each location. The number inside each dark green circle indicates the frequency of meeting environmental design criteria.

4. Discussion

This study sought out to address how small towns, struggling with a decline in economic resources and the emergence of parallel lives, might prioritize meaningful investments into the built environment for vulnerable populations. The study replicates findings supporting the urban/rural dichotomy with multiple environmental exposures higher in small towns than state population averages. Moreso, the study also found that within small towns, vulnerable populations were more likely to be in locations with higher levels of environmental risk, potentially increasing daily stressors. Daily stressors relate to the distribution of environmental exposures and may affect chronic inflammation that directly impacts human well-being (Fig 5). A closer examination of the built environment revealed that environmental design correlates with parallel lives and identifies multiple opportunities that could be changed to improve equity in environmental design. Study findings suggest pathways for small towns struggling with the socio-economic resources needed to respond to an emerging crisis.

Fig 5. A non-causal model prioritizing improvement to built environments to counter deteriorating conditions and buffer vulnerable populations.

Fig 5

Our study followed a socioecological approach using transects to permit a cross-sectional, multi-site approach to analyze a holistic socio-ecological picture of small town, built- environments. The approach aimed to overcome limitations of density or political boundaries that often reveal contradictory results, like identifying the benefits of living close to a park [36] or the harms of going to school where farmers spray pesticides [9]. The use of transects enables higher specificity of environmental exposures, vulnerabilities, and access to environmental benefits, to demonstrate inequalities in existing built environments and prioritize planning and urban design efforts.

Our post-occupancy evaluation provided a means of understanding environmental aspects that could support a design-response. The physical criteria of general layout, complexity and coherence, identity, greenery, habitat, and the social characteristic of privacy were significantly lacking in transect points with increased vulnerability and environmental risk. Privacy, for example, is a substantial threat for populations that have been identified as needing to be invisible to protect their livelihoods. Landscape architects, planners, and designers have the tools to improve environmental design by selecting the correct tree species, screening, and vegetation and by working with vulnerable communities to establish gardens with visual interest that enhance privacy. Space, individual experience, and group identity are difficult or impossible to change, however the built environment provides multiple alternatives that may diminish the impact of daily stressors on human weathering, risk, morbidity, and mortality (Fig 5).

The study is in common ground with similar studies pushing for landscape science, planning, and design to go beyond finding causal impacts on human health. The complex relationship of population vulnerability and environmental risk are potentially exacerbated by environmental stressors that lead to weathering, risk, morbidity, and mortality (See Fig 5). Instead, researchers, policymakers, and practitioners hoping to address current and burgeoning public health crises could rely on the availability of reliable data and present capabilities to respond within improved environmental design. The approach builds upon the precautionary principle [61] by asking how do we in the face of uncertainty address increasing risk by linking science, ethics, and practice?

4.1. Implications

Earlier the paper introduced the trouble with parallel rural lives and their demise about Postville, Iowa. In 2008, Postville experienced one of the largest Immigration and Customs Enforcement (ICE) worksite raids in the US [14]. “These small Midwestern towns, no longer tranquil, are now nodes within the global industrial network of food production, a network teeming with immigration-related issues such as the unauthorized status of many workers, exploitation of workers, and new and often “invisible” human, gender, and racial dynamics” (Sandoval, 2013, p. 181). The raid had immediate impacts on increased criminal behavior, long-term impacts on human health, and solidified the insecurity for underrepresented minorities working and living in small towns [47, 62]. Although the influx of foreign-born workers and their families to small towns has enabled economic growth in the hands of a local few, the stability of small towns is fragile. A decline in local investment coupled with aging infrastructure is likely to impact the built environments in small towns, potentially compounding deleterious effects as vulnerable populations bring families and become established.

4.2. Limitations

Landscape architects and professional planners are trained to observe environmental characteristics to improve human well-being. The use of Cross’s Professional Residential Survey provided a validated instrument helping to assess what small towns could do to help improve built environments for vulnerable populations living within environments of risk of exposure. The survey captured criteria relevant to the elements of the built environment that professional designers and planners can address. A limitation of the approach is that the survey tool was created for designed residential settings and does not capture the heterogenous nature of development found within small towns. Small towns, for example, typically lack a planning office or a set of design guidelines, and, instead, address land use issues on an as needed basis. A future study could benefit from this paper by adjusting Cross’s survey to account for the somewhat haphazard nature of small-town development. The survey instrument provided relevant information needed to assess how well residential settings supported human well-being. However, due to study limitations related to time and funding, healthy behaviors were not measured. Although each location was surveyed three times, the study is limited through the use of implicit or subjective, design-related measures to study place effects. Other limitations include the use of secondary data for measuring environmental risk and population vulnerability; potential sampling bias since study sites were selected using a systematic sampling interval based upon variations in socio-ecological criteria; and, focusing on three small towns that all underwent diversification. The use of passive samplers to measure air quality, including communities that remain homogenous, and community surveys to ask residents about perceived environmental risks would contribute to further grounding research in this area.

4.3. Significance

The study makes a significant contribution to a growing area of research on disproportionate burdens vulnerable populations face regarding environmental benefits and burdens. Lack of access to green space has been identified as an environmental injustice by several researchers [30, 32, 38, 57, 63], however spatial models continue to rely on density and political boundaries to infer environmental justice. Such models are known to report misleading and contradictory findings in small towns.

As Breslow indicates, justice (along with security, resilience, and sustainability) is a cross-cutting category that pulls from multiple aspects of the built environment, specifically: capabilities, conditions, and connections [64]. An environmental justice model that stops at comparing SES and access to green oversimplifies complex built environments and socioecological conditions on human health outcomes. Our non-causal model (Fig 5) proposes a means of contextualizing environmental justice within a built environment framework for human well-being. Our study goes beyond spatial autocorrelations to demonstrate paths to improve equity by crosscutting environmental risk from spatial data with field-measured environmental design.

5. Conclusion

Small towns throughout the Midwest began diversifying in the 1980’s and simultaneously witnessed a decline in their economic tax-based as higher income earners relocated to major urban areas. Small towns evidence multiple characteristics described by urban design and planning researchers as the key ingredient to successful, walkable, urban environments, e.g., New Urbanism. The structure is clearly in place; however, history differentiates in how new populations are directly impacted by supportive built environments. Shifting, vulnerable populations—as characterized by underrepresented minority status in once all-Caucasian communities, linguistic isolation, below high-school education, age under 5 and over 64—are more likely to live in conditions that currently may not adequately support human well-being and are more likely to experience environmental risk.

Design activists can achieve environmental justice goals by impacting health effects (chronic and acute) that directly relate to the mortality, morbidity, risk, and weathering of vulnerable populations (Fig 5). Our study suggests that the professional practices like landscape architecture who are responsible for the management, planning, and design of the land should play a ubiquitous role in how daily stressors are translated into individual outcomes. First, we must accept that individual experience, group identity, and space play a fundamental role in daily stressors. Chronic stressors related to environmental exposures and acute stressors related to visibility and access to supportive space can be mediated through supportive environmental design. Landscape architecture prides itself on major parks, i.e., the High-line, and environmental remediation, i.e., Fresh Kills, but seems to continue to neglect the necessity of the banal, everyday “human environment” where a sidewalk, street tree, and crosswalk make a fundamental difference. While this research is in an early phase, findings suggest that small towns could counter a mounting global public health crisis with low-cost interventions.

Supporting information

S1 File. Appendices.

(DOCX)

S1 Data

(XLSX)

Acknowledgments

The project benefited greatly from interdisciplinary collaborators in Iowa State’s Department of Kinesiology, Dr. Meyer, and Dr. Ellingson, and Extension, Dr. Wolseth and Dr. Seeger. The project was completed through the efforts of multiple undergraduate Honor’s students, and the following graduate researchers: Kwadwo Gyan, Eric Lawrence, and Mahsa Adib. The paper benefited from multiple reviewers who added clarity and substantial quality to the organization of text, legibility of figures, and interpretation of the results.

Data Availability

All data used in this study has been made available as part of this submission.

Funding Statement

Funding for this research was provided through grants from the National Institutes of Health LRP 2674-6 NIEHS; Center for Excellence in Arts and Humanities at Iowa State; Fieldstead & Co. Grant for Community Engagement; Honor’s College funding from the Iowa State Foundation; and, a Project U-TuRN Mini-Grant through Iowa State’s Presidential Interdisciplinary Research Initiative. All sources of funding were awarded to BS.

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Decision Letter 0

Tzai-Hung Wen

8 Jul 2020

PONE-D-20-06092

“Ground Truthing” Environmental Barriers to Human Well-Being: Translational Research using a Multi-Site, Multi-City Approach for Iowa’s Diversifying Small Towns

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study involves an interesting analysis of the built environment and correlates with well-being, specifically in rural areas with changing demographics. Analysis of the data appears sound overall, and the paper is generally well written. I have only a few comments and suggestions to improve the clarity of the presentation.

The term “ground-truthing” may be a bit misleading. The study uses both data derived from existing geospatial data sets and on-the-ground observations, but there is no verification of the geospatial data using the observations, as ground-truthing would imply.

I am somewhat familiar with POE for buildings, not for outdoor spaces. If this is an adaptation, or novel aspect of this work, please explain.

By line 295 (and Table 3), it became apparent that the comparison is mainly between small towns and state averages, and not between rural areas and diversifying rural areas. Some of the introduction and background (and the title of the paper) led me to expect an analysis of the effects of diversification, but I suppose that would require a longitudinal (long-term) study, or a broader study of small towns including some that have diversified and others that have not.

Specific Comments:

Line 50: Spell out SES the first time used.

Line 64: Briefly define “parallel lives.”

Line 130: It’s not clear if the study is considering actual physical barriers (highways, railways, waterways) that can promote segregation of populations.

Lines 370-374: A figure (bar chart) or table might be helpful for presenting these results.

Lines 398-400: It may be helpful to define some of these variables, unless they are well known in the field of landscape architecture.

Reviewer #2: This manuscript intended to study the equity of environmental exposure and its built environment factors of the exposure in three small towns in Iowa. Specifically, the authors aimed to compare the exposure between small towns and general urban populations. To evaluate environmental exposure, the secondary EPA data were collected and compared with a state average. Then a post-occupancy evaluation was conducted to explore built environment characteristics. This is an interesting topic and it’s good to see this counterbalance aside from a myriad of urban studies on this topic. However, this manuscript is not ready to be published due to the fact that the analysis and rigorous in writing are not of sufficient quality. So I recommend major revision for this manuscript. My main concerns are listed below.

1. The comparison between small towns and the state average is biased (Table 3), because the transect points are selective and supposed to have higher exposure to pollutants compared to the average in town – “each transect line had to cross environmental criteria potentially exacerbating risk, such as agricultural fields next to a public middle school” (line 229)

2. The aim of this research currently stands is blurry given to the chosen terminology “environmental barrier”. In the literature in environmental health this term is often referred to the barrier for disabled people, or barriers to outdoor activities. However, this study is focusing on “exposure to environmental pollutants”. Plus the point about environmental exposure is also not clear in the introduction. It is highly recommended to make the research goal clearer and coherent throughout the title, abstract, as well as the introduction.

(1) in the abstract, the aim of study is described in a very general way: “We aimed to understand the impact of built environments—all the physical parts of where people live and work—to contribute to healthy behaviors for vulnerable populations.” Please be specific on which part of the built-environment. I am also wondering that did the authors include any variables of “healthy behaviors” in this work? Why is environmental exposure missing in this objective?

(2) In section 1.3 research question, the single hypothesis is that the environmental exposure in the small towns is not different from the exposure that general urban populations hold. Here, the role of built environment is missing in the hypothesis, which is conflicting to point (1).

(3) following the previous point, if the equality of environmental exposure is the only research question, table 3 will be the only relevant result. Why POE analysis, PCA and MLM analysis are needed?

3. It is not justified the design of multilevel model. If the class here is the towns, there would be only three groups. The suggested group size for multilevel model is 50 (Moineddin 2007). Otherwise, for a sample size of 39, a simple map could be clear enough to see the variation between transect locations if that is the only purpose to use multilevel model.

Here are some minor comments.

1. Replace the comma by a full stop in the end of the abstract.

2. Line 59 it’s unclear that if Ozkan is a kind of evaluation or an author name of the cited work until checking the reference.

3. Line 115 what does the combination “[emphasis added] (2008)” mean?

4. Please revisit some sentences and paragraphs. For instance,

(1) can you put the concrete meaning of environmental barriers in line 129 to the first glance around line 52?

(2) Lines 144-146 the authors argue that traditional built-environment metrics such as density are not applicable to rural environments. Right after, can you state what BE components you use for this study instead?

(3) Line 202 “The built environment in small towns may serve parallel populations in a dichotomous manner with underrepresented minorities encountering a disproportionate access to environmental harms and benefits” and following with the hypothesis “The hypothesis, …, is that vulnerable residents at the intersection of low-SES and minority status are just as likely as wealthier, educated, English-speaking residents to live in environments lacking supportive socio- and natural ecosystem services and that no difference would be found…”. What is the connection between these two sentences? Why the provided context in the first sentence drives such an opposite hypothesis? Would you consider rephrase?

(4) Line 212 methods, it is not clear that what the (n=39) sample size means without reading the text afterward. Does it mean towns? Residents? Transects?

(5) Line 267 how those secondary station data fits into transect points? What's the interpolation approach? How many points of observations were calculated around the study sites?

5. At the paragraph lines 136-151, the authors did not mention components of the social environment, making the social criteria in Table 1 come at a surprise.

6. Please check if the POE variables in Table 6 and Table 2 are consistent. Can you put the definition of each variable in method (e.g. unique and history sound very fuzzy)?

7. The authors need to describe the population characteristics of those who conducted POE and discuss the limitation when generalize their perceptions.

8. The data sources of lead pain index and RMP facilities are missing.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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PLoS One. 2021 Jun 23;16(6):e0252127. doi: 10.1371/journal.pone.0252127.r002

Author response to Decision Letter 0


5 Oct 2020

Response to Reviewers: this includes reviewer comments. The word version uploaded might be easier to read since it includes track changes and all of my responses are in blue.

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RESPONSE:

The base map roads are from the Iowa Department of Transportation and fall within the Creative Commons CCZero license of public domain data with a waiver of all rights including attribution. All other map material was created by the author.

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RESPONSE: Added note to figure caption of CCZero license.

3.2. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only.

The following resources for replacing copyrighted map figures may be helpful:

USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/

The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/

Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html

NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/

Landsat: http://landsat.visibleearth.nasa.gov/

USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/#

Natural Earth (public domain): http://www.naturalearthdata.com/

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

________________________________________

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

________________________________________

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

________________________________________

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

________________________________________

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study involves an interesting analysis of the built environment and correlates with well-being, specifically in rural areas with changing demographics. Analysis of the data appears sound overall, and the paper is generally well written. I have only a few comments and suggestions to improve the clarity of the presentation.

The term “ground-truthing” may be a bit misleading. The study uses both data derived from existing geospatial data sets and on-the-ground observations, but there is no verification of the geospatial data using the observations, as ground-truthing would imply.

Good suggestion. It would be inappropriate to suggest that geospatial environmental risk data could be “ground truthed” to predict poor POE. The objective was to see if there was a double-threat of environmental risk and poor, built environmental design. Title changed to reflect the intent of the paper: “Ground-truthing environmental risk with design”. Also added clarification of ground truthing in the methods section to due with visible verification of existing conditions.

I am somewhat familiar with POE for buildings, not for outdoor spaces. If this is an adaptation, or novel aspect of this work, please explain.

Revised the methods section to clarify that the POE used an outdoor, residential tool developed by researchers in Sweden.

By line 295 (and Table 3), it became apparent that the comparison is mainly between small towns and state averages, and not between rural areas and diversifying rural areas. Some of the introduction and background (and the title of the paper) led me to expect an analysis of the effects of diversification, but I suppose that would require a longitudinal (long-term) study, or a broader study of small towns including some that have diversified and others that have not.

This is an excellent point. State averages in the EPA data reflect urban environments because the majority of the population is urban, whereas rural areas remain outliers because they don’t have the density. I revised this section to note that state averages were used as a proxy for urban populations, noting that rural communities deviate substantially. Also, a comparison study of small towns that have diversified and those that have not is an excellent idea! I’ve added that to the limitations. I hope the inclusion of these revisions meets the reviewer’s expectations.

Specific Comments:

Line 50: Spell out SES the first time used. Addressed.

Line 64: Briefly define “parallel lives.” Addressed in lines 49 – 52.

Line 130: It’s not clear if the study is considering actual physical barriers (highways, railways, waterways) that can promote segregation of populations. Added the sentence: As suggested by Talen [36], the present study included natural and infrastructural barriers, like rivers and highways, known to isolate and segregate communities (see transects).

Lines 370-374: A figure (bar chart) or table might be helpful for presenting these results. Environmental risk and population vulnerability are now figures as bar charts. The visual comparison of the divergence between the two factors helps to tell the story, thanks for the suggestion.

Lines 398-400: It may be helpful to define some of these variables, unless they are well known in the field of landscape architecture. Good suggestion but it might be a challenge to respond within word limits. The concepts are well known in the landscape architecture community. To help I included a reference here to the manuscripts by Cross and Kuller that go into detail on what each of these concepts mean.

Reviewer #2: This manuscript intended to study the equity of environmental exposure and its built environment factors of the exposure in three small towns in Iowa. Specifically, the authors aimed to compare the exposure between small towns and general urban populations. To evaluate environmental exposure, the secondary EPA data were collected and compared with a state average. Then a post-occupancy evaluation was conducted to explore built environment characteristics. This is an interesting topic and it’s good to see this counterbalance aside from a myriad of urban studies on this topic. However, this manuscript is not ready to be published due to the fact that the analysis and rigorous in writing are not of sufficient quality. So I recommend major revision for this manuscript. My main concerns are listed below. RESPONSE: noted the myriad of urban studies papers on this topic. The original contribution from this research is its focus on small towns, which remain relatively understudied in this area.

1. The comparison between small towns and the state average is biased (Table 3), because the transect points are selective and supposed to have higher exposure to pollutants compared to the average in town – “each transect line had to cross environmental criteria potentially exacerbating risk, such as agricultural fields next to a public middle school” (line 229) RESPONSE: The first paragraph of the methods section acknowledges this approach, “The post-occupancy evaluation of study sites selected locations using a systematic sampling interval based upon variations in socio-ecological criteria, e.g. low-income housing in floodplains, through transects.” The approach overcomes known political ecology constraints, like red-lining or census tracts, that have either negatively impacted communities through segregation or don’t represent communities due to low-density. In response to the reviewer comment, I have added sampling bias to the limitations section to further acknowledge the approach.

2. The aim of this research currently stands is blurry given to the chosen terminology “environmental barrier”. In the literature in environmental health this term is often referred to the barrier for disabled people, or barriers to outdoor activities. However, this study is focusing on “exposure to environmental pollutants”. Plus the point about environmental exposure is also not clear in the introduction. It is highly recommended to make the research goal clearer and coherent throughout the title, abstract, as well as the introduction. RESPONSE: This is a really important comment and we appreciate the feedback. Please see paper for full extent of revisions, as the comment demanded a major revision. A summary of the changes follows: the title has been changed to emphasize the relationship between environmental risk and design with similar changes throughout the paper; environmental barrier removed and changed to environmental exposure and environmental design to be more specific. The abstract was revised substantially based upon this feedback. Hopefully, the objective is clearer and the use of POE to measure environmental support for behaviors is clearer.

(1) in the abstract, the aim of study is described in a very general way: “We aimed to understand the impact of built environments—all the physical parts of where people live and work—to contribute to healthy behaviors for vulnerable populations.” Please be specific on which part of the built-environment. RESPONSE: changed physical parts to outdoor environments. This eliminates vagueness related to housing, workplaces, and other indoor or otherwise inaccessible locations for survey research.

I am also wondering that did the authors include any variables of “healthy behaviors” in this work? RESPONSE: Added a sentence that healthy behaviors were not measured during the course of the study and emphasized environmental design to support healthy behaviors. Due to funding limitations, the survey portion of the research was eliminated, so no human subjects research was conducted. The POE and MLM strategy serves as a proxy to examine the extent to which the built environment supports activities related to healthy behaviors, which is a common approach in ground truthing research methods.

Why is environmental exposure missing in this objective? RESPONSE: revised the abstract to clearly indicate the study is looking at the correlation of environmental risk and design.

(2) In section 1.3 research question, the single hypothesis is that the environmental exposure in the small towns is not different from the exposure that general urban populations hold. Here, the role of built environment is missing in the hypothesis, which is conflicting to point (1). RESPONSE: removed “socio- and natural ecosystem services” and replaced it with supportive environmental design.

(3) following the previous point, if the equality of environmental exposure is the only research question, table 3 will be the only relevant result. Why POE analysis, PCA and MLM analysis are needed? RESPONSE: see notes throughout. This point has helped bring clarity throughout the paper.

3. It is not justified the design of multilevel model. If the class here is the towns, there would be only three groups. The suggested group size for multilevel model is 50 (Moineddin 2007). Otherwise, for a sample size of 39, a simple map could be clear enough to see the variation between transect locations if that is the only purpose to use multilevel model. RESPONSE: Excellent point although it might be difficult to map 206 variables across 39 locations or to statistically demonstrate significant differences. As noted, MLM has traditionally been used for students in classrooms in schools, but needing to achieve a threshold of 50 is a new constraint and one that I am not familiar. Neither Tabachnick (2007) or Hoffman (2007) suggest a group size of 50 as a threshold. Theall et al., referenced in this paper, found MLM produces reliable statistical analyses with group sizes <5. In justification of the method for the paper, the ICC and Betas from the MLM (Figure 5) demonstrate the environmental design specific to locations with supportive and non-supportive environments exist in the nested transect points across small towns. Parallel environments exist and they correlate with environmental risk. I added a better description of the MLM process and why this particular statistic was used because the study was designed to work with this statistical approach.

Here are some minor comments.

1. Replace the comma by a full stop in the end of the abstract. Revised.

2. Line 59 it’s unclear that if Ozkan is a kind of evaluation or an author name of the cited work until checking the reference. Added date.

3. Line 115 what does the combination “[emphasis added] (2008)” mean? Changed emphasis to italics.

4. Please revisit some sentences and paragraphs. For instance,

(1) can you put the concrete meaning of environmental barriers in line 129 to the first glance around line 52? Revised.

(2) Lines 144-146 the authors argue that traditional built-environment metrics such as density are not applicable to rural environments. Right after, can you state what BE components you use for this study instead? Revised.

(3) Line 202 “The built environment in small towns may serve parallel populations in a dichotomous manner with underrepresented minorities encountering a disproportionate access to environmental harms and benefits” and following with the hypothesis “The hypothesis, …, is that vulnerable residents at the intersection of low-SES and minority status are just as likely as wealthier, educated, English-speaking residents to live in environments lacking supportive socio- and natural ecosystem services and that no difference would be found…”. What is the connection between these two sentences? Why the provided context in the first sentence drives such an opposite hypothesis? Would you consider rephrase? Entire paragraph revised to make this clearer. Thank you for the suggestion.

(4) Line 212 methods, it is not clear that what the (n=39) sample size means without reading the text afterward. Does it mean towns? Residents? Transects? Revised.

(5) Line 267 how those secondary station data fits into transect points? What's the interpolation approach? How many points of observations were calculated around the study sites? This section was confusing and has been revised to be clearer.

5. At the paragraph lines 136-151, the authors did not mention components of the social environment, making the social criteria in Table 1 come at a surprise. Revised.

6. Please check if the POE variables in Table 6 and Table 2 are consistent. Can you put the definition of each variable in method (e.g. unique and history sound very fuzzy)? Table 6 uses some of the variables from table 2 but only the ones that were significant. The other reviewer also requested these terms to be defined but it would greatly expand the length of this already lengthy paper to explain. The reference to Cross and Kuller who created the scale and have published twice on the items has been emphasized.

7. The authors need to describe the population characteristics of those who conducted POE and discuss the limitation when generalize their perceptions. Added description of the graduate students with extensive training in design disciplines to be fitting of a POE.

8. The data sources of lead pain index and RMP facilities are missing. Removed text from document and redirected to appendices which provide a thorough list of sources.

________________________________________

General response to reviewer two. Thank you for your thorough feedback. The paper clearly suffered from too much jargon and we’ve thoroughly vetted the paper seeking to add clarity. Probably the most important point was that socio- ecosystem resources didn’t appear in the hypothesis as what was measured. The revised paper eliminates this over-complicated phrasing and focusing on environmental design to make it clear that POE makes sense.

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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Attachment

Submitted filename: Response to Reviewers.docx

Decision Letter 1

Tzai-Hung Wen

16 Dec 2020

PONE-D-20-06092R1

Ground Truthing” Environmental Risk with Design: Translational Research using a Multi-Site, Multi-City Approach for Iowa’s Diversifying Small Towns

PLOS ONE

Dear Dr. Shirtcliff,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Tzai-Hung Wen, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Partly

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: I Don't Know

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: No

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: This manuscript presented a quantitative analysis for the understanding of equity of environment conditions and well being in small towns or rural areas in Iowa, USA. The topic is important and interesting. But, the manuscript is not ready for publication. The current status of the manuscript was poorly written, with too much of missing information, e.g. the data collection was not clear, how the data was analyzed from one step to another was not clearly described, and the most critical issue---the result figures were missing. These issues would generate too much of confusion for the readers. Especially because of the missing of result figures made me can't judge the quality of the manuscript. Therefore, I can't recommend acceptance for this manuscript. My main concerns were on the rigorousness of the study.

1. First, no figures were attached with the recent manuscript. I can only find three figures in previous submission, which might not be the latest version.

2. Second, I only see three Insert Figure positions (two Figure 2 insert) with figure captions. But the author mentioned Fig 4 (at least once in line 422), and Fig 5 multiple times (e.g. line 448, 468). This is unacceptable.

3. The tables were also needed to be confirmed before submitting the manuscript. The footnote of table 2 indicated Table 1. In Table 3, the value format was different in the "Range, Average (Standard Deviation)" column, e.g. first three rows were different. And, what is "m"; is it necessary to write "m"?

4. The term "ground-truthing" is misleading. The process of ground-truthing is merely one step of their data collection process. As mentioned by the authors: "ground truthing involves driving to locations to visibly verify existing conditions of the built environment [36]". This is a common practice is many social and geographical studies. Based on the aims (as written in section 1.3) and results, the authors did not make any contribution to "ground-truthing".

5. Using previous submission figures. The figure quality (for Fig 1 and 2) is unacceptable to be published. Especially Fig 1, no word in the maps can be recognized except the three location names. Therefore, all things written in lines 254-261 can't be observed from the maps. In addition, the organization of the maps are also not suitable for publications.

6. In section 2.3, the authors described a survey way of data collection, which produced the primary data in this study. The authors should also explicitly mention how many "graduate research assistants" were participated in the data collection process. Moreover, because this is the main data in the study, the authors should also provide a full list of questions in appendix or in the article to tell the readers what data were collected. The only question mentioned by the author was the example of vandalism.

7. Figure 2 in the previous submission is problematic. It presented as a line plots with two lines flow across the horizontal axis, with horizontal axis showing different factors and vertical axis showing the risk of exposures. Line plots can only be used to show trends that have a numerical and continuous horizontal and vertical axes. In this figure, the horizontal axis presented factors, which orders do not have any specific meanings.

Reviewer #4: This study aims to analyse the correlation between environmental risk and built environmental design and conducts precise analyses to demonstrate how the environment risks correlated with the built environment and vulnerability. The paper is well-organised, but the main worries are about the representation of environment design.

First, since the authors clarify that the aim is to see if there was a double threat of environmental risk and poor built environmental design, but the current presentation about environment design is still weak. The authors talked more about environment design and society (health, justices), how to measure environment design, how to evaluate environmental risks in the literature review, but the relationship between design and environmental risks is less mentioned. For example, in existing findings, what kinds of characteristics of the built environment can exacerbate the environmental risks, and can POE evaluate these characteristics effectively, is it validate to apply POE to study risk-related environment design? Or else, how to explain the usage of variables in table 6?

Second, although the analyses from 3.2, 3.3 and 3.4 are helpful, the necessary explanations of variables in MLM are in a lack, and the results are less convincing, which need more evidence. For example, ¨suggesting that places without easy access by car, bus, walking, or biking have reduced environmental risk¨, which is biased. If people cannot walk and cycle to these places, what is a need to study these places? The demonstrations about the analysis and results of MLM need improvement.

Additionally, more discussions about the results of MLM are in need. For example, why and how the variables are related to environmental risk from the findings of this paper. In all, the presentation about the correlation between environmental risk and design should be investigated more.

Minor comments:

1) In the section of 2.5, the structure of analysis should be clarified more, such as the connections of PCA and MLM analyses.

2) Please pay attention to the length of the introduction and literature. The first two paragraphs in literature are repeatable with the introduction, it is better to make them concise.

3) Line 169-170, is this paper the first one to apply the instrument Cross and Küller? If not, it is in a need to mention how others use it in urban and environmental studies.

4) Line 339-340, to be clear about the vulnerability, is it about healthy vulnerability or social vulnerability?

5) Line 389, the subtitle ¨Physical and social condition¨, which is not clear, is physical health or physical environment, society or socioeconomic factors?

6) Complement more information about the data (e.g.: year of data, quality).

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachment

Submitted filename: Reviewer 3.docx

PLoS One. 2021 Jun 23;16(6):e0252127. doi: 10.1371/journal.pone.0252127.r004

Author response to Decision Letter 1


2 Feb 2021

Rebuttal

Revision 2

PONE-D-20-06092R1

Ground Truthing” Environmental Risk with Design: Translational Research using a Multi-Site, Multi-City Approach for Iowa’s Diversifying Small Towns

PLOS ONE

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: This manuscript presented a quantitative analysis for the understanding of equity of environment conditions and well being in small towns or rural areas in Iowa, USA. The topic is important and interesting. But, the manuscript is not ready for publication. The current status of the manuscript was poorly written, with too much of missing information, e.g. the data collection was not clear, how the data was analyzed from one step to another was not clearly described, and the most critical issue---the result figures were missing. These issues would generate too much of confusion for the readers. Especially because of the missing of result figures made me can't judge the quality of the manuscript. Therefore, I can't recommend acceptance for this manuscript. My main concerns were on the rigorousness of the study.

1. First, no figures were attached with the recent manuscript. I can only find three figures in previous submission, which might not be the latest version.

RESPONSE: all figures were uploaded through PLOS One’s direction and I have no idea why they weren’t available as part of this submission. Prior to this second revision being sent to reviewers, I had multiple emails with staff at PLOS One to ensure that none of the figures violated copyright. Referring to the above mentioned critical issue, the result figures were actually improved through the review process and reflect the intent of peer review to ensure rigor and clarity when presenting scientific research.

2. Second, I only see three Insert Figure positions (two Figure 2 insert) with figure captions. But the author mentioned Fig 4 (at least once in line 422), and Fig 5 multiple times (e.g. line 448, 468). This is unacceptable.

RESPONSE Fixed the second Fig. 2 reference on line 427 to be Figure 4, and the second figure 3 reference on line 531 and 532 to figure 5. Insert fig 1 was at 252, insert figure 2 was at 358, insert figure 3 was at 374, insert figure 4 was at 427, and insert figure 5 was at 531. I double-checked the manuscript to verify that figures are now accurate and the correct ones are references within paragraphs.

3. The tables were also needed to be confirmed before submitting the manuscript. The footnote of table 2 indicated Table 1. In Table 3, the value format was different in the "Range, Average (Standard Deviation)" column, e.g. first three rows were different. And, what is "m"; is it necessary to write "m"?

RESPONSE: All tables were corrected for labels and in-text reference as needed throughout the document. Cleaned up table 3.

4. The term "ground-truthing" is misleading. The process of ground-truthing is merely one step of their data collection process. As mentioned by the authors: "ground truthing involves driving to locations to visibly verify existing conditions of the built environment [36]". This is a common practice is many social and geographical studies. Based on the aims (as written in section 1.3) and results, the authors did not make any contribution to "ground-truthing".

RESPONSE: This is the second revision of the manuscript and the second time a reviewer has made this comment. I’ve revised the title to eliminate “ground truthing” and replaced it with crosscutting, which better reflects the environmental justice nature of the paper. Similar revisions happened throughout the document. The suggestion is welcome and I hope the new title better reflects the intent of the manuscript.

5. Using previous submission figures. The figure quality (for Fig 1 and 2) is unacceptable to be published. Especially Fig 1, no word in the maps can be recognized except the three location names. Therefore, all things written in lines 254-261 can't be observed from the maps. In addition, the organization of the maps are also not suitable for publications.

RESPONSE: Maps were updated following the previous submission. Nevertheless, I re-processed the maps for a higher resolution. Short of remaking the maps, which would require extensive time unwarranted in a revision, the maps clearly indicate transect locations and buffer overlaps, suitable for replication. Similarly, all figures were updated to higher resolution as part of the first revised manuscript.

6. In section 2.3, the authors described a survey way of data collection, which produced the primary data in this study. The authors should also explicitly mention how many "graduate research assistants" were participated in the data collection process. Moreover, because this is the main data in the study, the authors should also provide a full list of questions in appendix or in the article to tell the readers what data were collected. The only question mentioned by the author was the example of vandalism.

RESPONSE: Added appendix 5 to the appendices showing an image of how survey data was collected in the field. No questions were asked of people, ever, as noted in the ethics statement. As noted in the manuscript, environmental quality variables are from the Cross and Kuller studies cited in the paper, and a complete list of survey questions is available from them upon request. I don’t have permission to publish the survey instrument. Added number of graduate students.

7. Figure 2 in the previous submission is problematic. It presented as a line plots with two lines flow across the horizontal axis, with horizontal axis showing different factors and vertical axis showing the risk of exposures. Line plots can only be used to show trends that have a numerical and continuous horizontal and vertical axes. In this figure, the horizontal axis presented factors, which orders do not have any specific meanings.

RESPONSE: Changed chart to scatterplot style and added categorical labels to the horizontal axis for reference (figure 4 now).

Reviewer #4: This study aims to analyse the correlation between environmental risk and built environmental design and conducts precise analyses to demonstrate how the environment risks correlated with the built environment and vulnerability. The paper is well-organised, but the main worries are about the representation of environment design.

First, since the authors clarify that the aim is to see if there was a double threat of environmental risk and poor built environmental design, but the current presentation about environment design is still weak. The authors talked more about environment design and society (health, justices), how to measure environment design, how to evaluate environmental risks in the literature review, but the relationship between design and environmental risks is less mentioned. [RESPONSE: revised the manuscript throughout to reinforce why environmental design matters and how the study focuses on the intersection of environmental design and risk] For example, in existing findings, what kinds of characteristics of the built environment can exacerbate the environmental risks, and can POE evaluate these characteristics effectively, is it validate to apply POE to study risk-related environment design? Or else, how to explain the usage of variables in table 6?

Second, although the analyses from 3.2, 3.3 and 3.4 are helpful, the necessary explanations of variables in MLM are in a lack, and the results are less convincing, which need more evidence. For example, ¨suggesting that places without easy access by car, bus, walking, or biking have reduced environmental risk¨, which is biased. If people cannot walk and cycle to these places, what is a need to study these places?[RESPONSE: revised this section and provided more detail into the variables used for MLM] The demonstrations about the analysis and results of MLM need improvement.

Additionally, more discussions about the results of MLM are in need. For example, why and how the variables are related to environmental risk from the findings of this paper. In all, the presentation about the correlation between environmental risk and design should be investigated more. [RESPONSE: this is discussed in the results and discussion, I would need to write another paper to go into further detail on this very important point.]

Minor comments: [Response: I don’t know if these are minor. It took quite a bit of time to resolve them, but thanks for the feedback.]

1) In the section of 2.5, the structure of analysis should be clarified more, such as the connections of PCA and MLM analyses.

RESPONSE: added a couple sentence and revised the first paragraph to make these connections clear.

2) Please pay attention to the length of the introduction and literature. The first two paragraphs in literature are repeatable with the introduction, it is better to make them concise.

RESPONSE: Cut the introduction down substantially and eliminated redundant text further.

3) Line 169-170, is this paper the first one to apply the instrument Cross and Küller? If not, it is in a need to mention how others use it in urban and environmental studies. RESPONSE: done and citations added.

4) Line 339-340, to be clear about the vulnerability, is it about healthy vulnerability or social vulnerability?

RESPONSE: revised to clearly indicate social vulnerability.

5) Line 389, the subtitle ¨Physical and social condition¨, which is not clear, is physical health or physical environment, society or socioeconomic factors?

RESPONSE: Revised heading to emphasize that this is the environmental design criteria of physical and social conditions.

6) Complement more information about the data (e.g.: year of data, quality). RESPONSE: updated in appendices.

Decision Letter 2

Tzai-Hung Wen

22 Mar 2021

PONE-D-20-06092R2

Crosscutting Environmental Risk with Design: A Multi-Site, Multi-City Socioecological Approach for Iowa’s Diversifying Small Towns

PLOS ONE

Dear Dr. Shirtcliff,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by May 06 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Tzai-Hung Wen, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: I Don't Know

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: No

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: This manuscript presented a series of analyses including post occupancy evaluation (POE), principal component analysis (PCA), and multi-level model (MLM) to study the parallel communities in several small towns in Iowa, for the understanding of how built environment affect the quality of living and health risks to different people. This is the second time I review this manuscript, and all my previous concerns were addressed in current version. My new concerns are about the MLM analysis and interpretation which I couldn't review for, due to the incompleteness of previous version. There are also some minor issues that require further refine before publication.

1. Figure 2, the Y-axis and legend are missing. I can imagine blue bars are component 1 and orange bars are component 2, but please be explicit as this is a formal publication. In addition, the information in Figure 2 and Table 4 is exactly same, hence redundant.

2. Same as above for Figure 3. And Figure 3/Table 5.

3. For Figure 4, the estimated ‘beta’(s) are known as coefficient(s) or slopes, but the term coefficient is more preferred; and the main issue is that the term ‘beta’ is less formal and not preferred.

4. Second issue about Figure 4 is that in the figure, the Y-axis is written as ‘Increase in Environmental Risk’—how does this MLM slopes can be used to interpret as the ‘increase in environmental risk’? Please explain.

5. The process of running the MLM is not clear. E.g., what is(are) the dependent variable(s) in the ‘multiple multilinear models’ (page 18 line 391)? How does the ‘multiple multilinear model’ works? This line (391) is under section of ‘3.5 POE and MLM’, but no ‘multilinear model’ is described in analysis method section (sec 2.5). Based on the sec 2.5 lines 293-306, as a reader I would expect only one multivariate multilevel model will be presented.

6. Is it valid to compare different models? Related to previous point, it seems unclear, and based on what were written by the authors, there are more than one models in the study and presented in table 6/figure 4.

7. Table 6, I would suggest the authors to use ‘*’ to show the statistical significance instead of italicized. Mystery and complexity are not italicized in table 6, are them not significant? Access were italicized, but according to the table footnote, all but access are significant (p<.05). The description in footnote and written in table is conflict.

8. Please make sure all relevant data is provided. It seems like the data described in sec 2.3---those data collected with the Fulcrum tool--- is not provided by the authors. According to Plos One policy, all data underlying the findings should be provided without restriction. The data in Table 2 is only showing the mean, SD etc., and the data points behind this info should be provided. The raw data in sec 2.4 seems download-able from publicly available source so it should be fine, but it would be better if a cleaned and extracted copy for only the study sites can also be provided.

Reviewer #4: This paper addressed the comments well in the previous version and improved the quality of the paper. Overall, the paper is well-organized, but I still have a few minor comments that need authors to spend more time on that: 1) the introduction is still too long. For section1.1 and 1.2, there is a single paragraph at the beginning, but it is not necessary. These parts are also wordy. Also, the logistic between sections is confusing: why section 1.1 is the literature review? It will be apparent if the authors can make the introduction concise and straightforward. 2) The figures are expected in high-quality, especially for the results, but figure 2 and figure 3 are not qualified, missing the axis, title and legend. The texts in Figure 4 are too close and not clear to read. 3) The limitations of this paper are not mentioned enough, which also embodied in the data collection and qualitative method.

**********

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Reviewer #3: No

Reviewer #4: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2021 Jun 23;16(6):e0252127. doi: 10.1371/journal.pone.0252127.r006

Author response to Decision Letter 2


11 Apr 2021

I have included a response to the reviewers in the attached revision 3 rebuttal letter. Thank you for your generous reviews to date. The manuscript has greatly benefited from this process in terms of rigor and clarity. I hope the revisions meet expectations.

Attachment

Submitted filename: Review 3 Rebuttal.docx

Decision Letter 3

Tzai-Hung Wen

11 May 2021

Crosscutting Environmental Risk with Design: A Multi-Site, Multi-City Socioecological Approach for Iowa’s Diversifying Small Towns

PONE-D-20-06092R3

Dear Dr. Shirtcliff,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Tzai-Hung Wen, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: (No Response)

Reviewer #4: I have no specific comments with regard to the current version. The paper has been improved and meet the requirement after addressing.

**********

Acceptance letter

Tzai-Hung Wen

11 Jun 2021

PONE-D-20-06092R3

Crosscutting Environmental Risk with Design: A Multi-Site, Multi-City Socioecological Approach for Iowa’s Diversifying Small Towns

Dear Dr. Shirtcliff:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Tzai-Hung Wen

Academic Editor

PLOS ONE

Associated Data

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    Supplementary Materials

    S1 File. Appendices.

    (DOCX)

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    Attachment

    Submitted filename: Response to Reviewers.docx

    Attachment

    Submitted filename: Reviewer 3.docx

    Attachment

    Submitted filename: Review 3 Rebuttal.docx

    Data Availability Statement

    All data used in this study has been made available as part of this submission.


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