Grantee Research Project Results

The central objective of the Community Outreach and Translation Core (COTC) was to create, implement, and assess strategies to translate and apply the findings of the Southern Center on Environmentally-Driven Disparities in Birth Outcomes (SCEDDBO) into relevant information for women of childbearing age, families, community groups, policy makers, and health care professionals. The COTC conducted environmental health outreach and education directed at low income and minority women and their children; enhanced the capacity of disadvantaged communities to understand threats posed by environmental contaminants; and provided a bridge between campus research, communities and policy makers. The specific aims of the COTC were to:

The Community Outreach and Translation Core (COTC) was an integral component of SCEDDBO, translating and disseminating research findings to the scientific and neighborhood communities. Over the project period, the COTC developed a wide and diverse network of collaborators among federal, state and local agencies; universities; and community groups. Activities with these diverse partners cover a broad spectrum of children'’s environmental health issues, ranging from birth outcomes to lead poisoning prevention, environmental exposures, and obesity. Importantly, the COTC responded with detailed information to numerous requests from private citizens about a variety of environmental health concerns. Topics have ranged from lead and mercury exposure to electromagnetic fields, chloramines, and exposure to rubber crumblets. These requests were received through both the CEHI toll-free number and via the CEHI Website.

 

We describe here four major contributions, which reflect Specific Aims 1-4, of the COTC during the project period. Specific Aims 5 and 6 were a part of the COTC’'s daily mission. The end of the project has not lessened the commitment of the COTC to continue to serve the community. The COTC remains dedicated to fostering environments where all children can prosper.

 

Community Assessment Project. In Durham, North Carolina, there is continued city-wide concern over quality of life issues including neighborhood safety, housing quality and poverty. During the summer of 2008, a team of COTC-trained assessors conducted an on-foot, curb-side assessment of approximately 17,000 tax parcels in Durham, evaluating the built environment on 57 variables using handheld Global Positioning System (GPS) devices. The exercise was repeated again in the summer of 2011 over a larger geographic area that included roughly 30,700 tax parcels. Built environment data were combined with Durham crime data and tax assessor data. The two phases also captured 40% and 70%, respectively, of the physical addresses for participants in the Project B cohort, providing a detailed characterization of the local neighborhood environment for a significant subset of participants. In collaboration with the GISSA Core, CAP data were summarized into seven Neighborhood Health Indices. These indices have been linked to outcomes from Projects A and B. Our collaboration with community partners at all stages of the tool development, data collection and dissemination of results provides a model for engaging the community in an active research program. The COTC has disseminated the CAP results to multiple audiences (community members, public health professionals and government officials) through publication of a descriptive report, creation of web-based resources, and in-person presentations. COTC personnel attended community meetings across the network of community-based organizations to discuss and display the results of the CAP and work with interested stakeholders on how to utilize the CAP results in their community development efforts. The COTC will continue to disseminate the CAP results to multiple audiences (community members, public health professionals and government officials) through publication of a descriptive report, creation of web-based resources, and in-person presentations. The need extends past the project end date.

 

Building Capacity in Health Professionals. COTC investigators partnered with nursing programs to develop and present curricula to nursing students on environmental exposures and maternal and child health. A comprehensive project was designed to develop environmental health curricula for nursing students, nursing faculty, and practicing nurses. Supplemental funding from EPA’'s Environmental Education Grant Program has enabled collaborations with the Ecology Center in Ann Arbor, MI, to produce this curriculum. The resources developed during this project provide: (1) an organized synthesis of current information; (2) foundational knowledge for nursing school faculty; and (3) subject modules on environmental health concepts that can be incorporated into existing nursing curricula.

 

The COTC partnered with the GISSA Core to offer no-cost, hands-on training on environmental health issues, including the built environment, to public health professionals throughout North Carolina. Four all-day sessions were attended by 65 participants representing 18 NC counties, 18 different program areas of state government, 7 non-profit organizations, and Durham city personnel. This course has broad ranging public health applications including policy guidance, community outreach and education and program planning. The training was accredited for continuing education credits for Registered Sanitarians (the professional certification common to county health department personnel).

 

The COTC also partnered with the UNC School of Nursing and Healthcare without Harm to co-sponsor an environmental health symposium for practicing nurses. The symposium, Environmental Considerations in Nursing Practice attracted nationally recognized speakers and an audience of 60 practicing nurses. The event also was accredited for Continuing Nursing Education credits. COTC staff participated in all aspects of the planning and execution of this conference. SCEDDBO Director Marie Lynn Miranda presented the keynote address.

 

Culturally Appropriate Advisory Materials on Environmental Contaminants. The COTC created and delivered culturally appropriate advisory information on methylmercury-contaminated fish consumption for low income expectant or nursing mothers with low English proficiency. COTC collaborated with the NC Women, Infants, and Children (WIC) Program to design, test and deliver appropriate risk communication materials relating to NC fish consumption advisories for methylmercury and federal advisories for a number of commercial fish species. The Latino population is at risk of methylmercury exposure from fish consumption, but may not be effectively reached through traditional fish advisory communication methods. Together with staff from the NC Nutrition Services Branch (within the Department of Health and Human Services), we created an outreach model for communicating complicated environmental health information to pregnant or early postpartum Latina women. The intended audience was the nearly 17,000 Latina women who participate in the Supplemental Nutrition Program for WIC in NC. Of all of the Latino babies born in NC in 2005, 53% were born to mothers who participate in the WIC Program. In particular, we were interested in designing and testing culturally/linguistically appropriate messages and message delivery formats for fish consumption advisory information. The COTC established a number of dissemination efforts to distribute the mercury-contaminated fish consumption advisory materials that were developed for Latino families (see Figure 8). Because the materials were distributed to families primarily by nutritionists in the North Carolina Supplemental Nutrition Program for WIC, considerable effort was expended to reach this audience. A series of webinars, accredited for continuing education credits for Registered Dieticians, were held for all WIC staff in North Carolina. The webinars were attended by 109 participants representing 66 out of 88 (80%) of the WIC clinics in North Carolina. This work was adopted as part of the standard messaging from WIC counselors to WIC enrollees after the COTC personnel trained the counselors. This project also serves as a prototype for identifying best practices for communicating complex environmental health messages in a culturally sensitive context.

 

 

Strong Partnerships. COTC staff collaborated with a variety of regional, state and federal advisory groups including the American Lung Association Advisory Group, the Durham County Health Department Community Health Assessment Working Group, and the Obesity and Chronic Disease Committee of the Partnership for a Healthy Durham. In addition, SCEDDBO Director Marie Lynn Miranda was appointed to serve on the EPA's Children's Health Protection Advisory Committee (CHPAC). The CHPAC is a federal advisory committee established in 1998 to provide independent advice to the EPA Administrator on regulations, research and communication issues relevant to children's environmental health.

 

SCEDDBO investigators and the COTC PI, in particular, have established longstanding relationships with multiple community and organizational partners throughout NC and nationally. These include the NC Department of Environment and Natural Resources, Children'’s Environmental Health Branch; the NC Department of Health and Human Services, Occupational and Environmental Epidemiology Branch; the NC Center for Geographic Information and Analysis; state and local health departments throughout NC, as well as in other states (AR, CA, CO, IA, ID, IN, KS, LA, MA, ME, MI, MN, MS, MT, NE, NH, NM, NY, PA, SC, SD, TX, UT, VT, WI); the Southeast Pediatric Environmental Health Specialty Unit; and a host of community-based organizations and public health advocacy groups. SCEDDBO investigators also have established connections with physicians, pharmacists, religious leaders, day care centers and community centers. Furthermore, SCEDDBO investigators have developed relationships with agency officials from the Centers for Disease Control and Prevention (CDC), Department of Housing and Urban Development (HUD), the National Institutes of Health (NIH), and the U.S. EPA.

 

For all 7 years, COTC investigators mentored students from Duke University and the University of Michigan in the “Break the Cycle” project sponsored by EPA Region 4, Emory University, the Institute for the Study of Disadvantage and Disability, and the Southeast Pediatric Environmental Health Specialty Unit. The selected students presented environmental health data from SCEDDBO projects (Ouyang, 2011; Dadabhoy, et al., 2012; Modlin and Maxson, 2011; Gruber and Maxson, 2012; Henderson and Maxson, 2009; Koehrn and Keating, 2009; Martz et al., 2013; Henry et al., 2013). A conference was held in Atlanta, GA, every spring. In May 2011, Dr. Pamela Maxson gave the keynote address at the conference (Maxson, 2012).