Through collaboration between researchers and community partners in an urban and rural setting, this project is identifying methods to address environmental health priorities in each setting, applying personal monitoring to measure individual-level heat exposure, and using ground level and satellite-derived data to estimate health-relevant heat and air pollution indices at a community scale. We expect application of a community-engaged research strategy may result in identification of novel risk factors for heat-related morbidity and mortality. The project is designed to inform development of innovative adaptation planning specific to urban and rural settings.
The questions we are addressing include: Are there significant differences in heat exposure between rural and urban communities? How accurate are weather stations or remotely sensed predictions of individual-level heat exposure in urban or rural communities? Are there unique behavioral, physiological, or physical environmental risk factors for heat exposure in urban and rural communities?
Community Involvement Includes
Project design and implementation
Siting and maintaining neighborhood temperature monitors
Communicating findings to stakeholders
The climate in both study areas is humid subtropical, with normal summer maximums of 90°F and91°F in Birmingham and West Central AL respectively.
Urban population: Birmingham, AL is the largest city in Alabama with an estimated population of 212,413, where 26% of the population lives below the poverty line and 73% are African American.
Rural population: West Central AL, or The Black Belt region, originally named for the rich black topsoil, includes some of the most economically disadvantaged counties in the United States. Seven Black Belt counties (Dallas, Marengo, Monroe, Lowndes, Perry, Sumter, and Wilcox) are represented in the current project, with an initial focus on Wilcox County, with an estimated total population of 11,670 (72% African American), and 40% living below the poverty line.
Historical context: A historical context is useful in understanding the significant health and economic disparities that exist and hence the need for a community-engaged approach. The syphilis study conducted in Tuskegee, AL eventually led to modern bioethics and human subjects protections, yet mistrust of the primarily white medical profession is still prevalent today. Violence experienced during the Civil Rights Movement likely still plays a role in the racial division seen today, and high rates of health disparities are noted in previous studies as well as in our analysis of birth outcomes (Kent et al. 2013).
Primary Community Partner Organizations in Birmingham and Black Belt: In Birmingham, we are partnering with Friends of West End (FoWE) 501(c)3, which serves to educate, engage, and advocate for Birmingham’s poorest and most medically underserved neighborhoods and has implemented several health-related projects. In the Black Belt region, we are working with the West Central Alabama Community Health Improvement League (WCACHIL) 501(c)3, which has partnered with UAB researchers on numerous projects for over 15 years through the CDC-funded Prevention Research Center (Center for the Study of Community Health). WCACHIL employs Community Health Advisors to educate and bring community members together on specific public health topics.
Solidify community-based networks in urban (Birmingham) and rural (West Central) Alabama.
The primary goals of this component are a strengthening of the community and researcher problem-solving capacity while providing the social context needed for developing an accurate picture of exposure and behaviors, physical environments, and physiological parameters associated with those exposures in urban and rural settings.
Hold community advisory board (CAB) meetings in urban and rural communities.
Conduct community-wide workshops in urban and rural communities.
Measure heat and volatile organic compound (VOC) exposure in urban and rural communities using stationary monitors and remotely sensed exposure metrics.
Through community workshops and use of satellite-derived maps, identify representative residential neighborhoods and locations within where community members frequently spend time outdoors.
Deploy a network of data logging temperature monitors and VOC passive samplers in urban and rural communities.
Researchers then evaluate remotely sensed land surface temperature and land use datasets (green vegetation fraction and % impervious surface) as predictors of exposure in urban and rural environments.
Determine personal exposure to heat in urban and rural communities
Through community partnerships, recruit participants from representative residential neighborhood types within urban and rural communities.
Train participants to wear monitors to measure personal heat exposure for one week during the summer.
Researchers then compare personal exposure measures to stationary monitors and remotely sensed exposure metrics.
Community Advisory Boards (CABs)
The CABs were formed by the team to engage local expertise, ensure research is in line with community priorities, and identify appropriate research strategies to addressing the environmental concerns identified by community members in our previous focus groups and surveys.
Decision making progress: Any CAB member can raise an issue to be voted upon.
Regular meetings, communication and reporting: A quarterly phone meeting with semiannual in person meetings were agreed upon. Agendas are drafted by the PI and circulated to CAB members for edits 1 week prior to meetings. Communications and venue, as well as aid in identifying transportation to the meetings are coordinated by WCACHIL and FoWE. Monthly reporting of all relevant activities to the CAB members from the research team was agreed upon. Reporting, including updates, meeting minutes, and agendas are communicated via email and on a shared project management website.
Membership: CABs maintain membership at nine and have a balance between: 1) researchers, 2) community-based organizations/community members, and 3) governmental or non-governmental issue-based organization representation.
Community-wide workshops in urban and rural communities
Communication and dissemination of progress and gathering of feedback from the wider community have been identified as a priority by the CABs. Annual workshops serve as a means of communication between residents, and community and academic partners. A panel for a breakout session “The Rules of Engagement: Fully Involving Communities in Collaborative Research” at the UAB Community Engagement Institute as well as focus groups and presentations at the Black Belt Institute have been two examples of these workshops.
Siting and maintaining neighborhood temperature monitors
Community workshops and continued discussion and planning with community partners led to identification of representative neighborhoods for placement of stationary temperature and VOC monitors. Community partners led the specific placement of the stationary monitors and collaborated on checking and collecting the monitors at the end of the exposure period.
Community and academic partners worked together in the planning and study design for personal monitoring. They successfully recruited, consented, trained, and followed up 180 participants (90 in Birmingham, 90 in West Central AL) in the Summer of 2017 for the collection of personal temperature and pedometer measurements.
We identified a few challenges that we have encountered that are common to community-engaged research. Relationships with academic researchers and community partners need time to develop trust. Understanding and negotiating the different priorities (scientific or community interests) and timelines between community partners and academic researchers can be challenging. A third challenge is how to communicate effectively through various means of technology (balancing preferences and feasibility between in-person meetings, phone calls, emails, or a shared webpage).