Vulnerability, Risk Perception, and Health Profile of Marginalized People Exposed to Multiple Built‐Environment Stressors in Worcester, Massachusetts: A Pilot Project

Abstract

Millions of low-income people of diverse ethnicities inhabit stressful old urban industrial neighborhoods. Yet we know little about the health impacts of built-environment stressors and risk perceptions in such settings; we lack even basic health profiles. Difficult access is one reason (it took us 30 months to survey 80 households); the lack of multifaceted survey tools is another. We designed and implemented a pilot vulnerability assessment tool in Worcester, Massachusetts. We answer: (1) How can we assess vulnerability to multiple stressors? (2) What is the nature of complex vulnerability—including risk perceptions and health profiles? (3) How can findings be used by our wider community, and what lessons did we learn? (4) What implications arise for science and policy? We sought a holistic picture of neighborhood life. A reasonably representative sample of 80 respondents captured data for 254 people about: demographics, community concerns and resources, time-activity patterns, health information, risk/stress perceptions, and resources/capacities for coping. Our key findings derive partly from the survey data and partly from our experience in obtaining those data. Data strongly suggest complex vulnerability dominated by psychosocial stress. Unexpected significant gender and ethnic disease disparities emerged: notably, females have twice the disease burden of males, and white females twice the burden of females of color (p < 0.01). Self-reported depression differentiated by gender and age is illustrative. Community based participatory research (CBPR) approaches require active engagement with marginalized populations, including representatives as funded partners. Complex vulnerability necessitates holistic, participatory approaches to improve scientific understanding and societal responses.

Participatory testing and reporting in an environmental-justice community of Worcester, Massachusetts: a pilot project

“…Data were downloaded from the Scout to a laptop computer immediately after the walk during a picnic with residents, and displayed as time series graph of PM as a function of time (Figure 1 ). The real-time data proved able to stimulate useful dialogue about trends, highs and lows, and implications for respiratory health, especially asthma, a health problem with high prevalence in local children and adults [ 6 , 7 ]. Participants were able to understand more clearly the relationship between PM and asthma since we used the data they helped us collect to talk about their exposure and potential health risks.…”

“…The Main South and Piedmont neighborhoods of Worcester, are the most densely populated, have the highest rates of minority residents, the lowest income, and the highest crime rates in the city. They are recognized as "vulnerable populations" by US Census [ 37 ] and environmental-justice neighborhoods by established criteria [ 6 , 7 ]. Residents are simultaneously vulnerable to physical, social and economic stress: high exposures and low adaptation conspire and can be associated with multiple health consequences.…”

“…STRENGTH had four partners: a community center dedicated to youth development; an environmental outreach non-profit; a community based health center; and Clark University [ 6 ]. Its five parts were: 1) PT&R of indoor and outdoor pollution; 2) learning about residents' health needs and concerns through community-based listening sessions; 3) collaborative survey work, including a household vulnerability survey and an asthma prevalence survey for schoolchildren (focus of [ 7 ]); 4) tackling persistent street trash and illegal dumping strategically; and 5) educating and empowering youth to promote environmental justice. Each was chosen by the partnership because it was: a) a high community concern (expressed in pre-proposal focus groups with residents, by our community partners, and in previous studies); and b) there had been insufficient attention paid to it to date.…”

Mapeamento dos estudos sobre vulnerabilidade em saúde: uma revisão de escopo

“…Com o surgimento do quadro conceitual, os estudos que utilizaram o método qualitativo (Wolffers et al, 2002;Figueredo et al, 2002;Meneghel et al, 2003;Silva et al, 2007;Torres et al, 2010;Abley et al, 2011;Pugh, 2011;Downs et al, 2011;Pimentel et al, 2011;Silva, Saldanha et al, 2012;Nicolau et al, 2013;Lima & Souza, 2013;Bubadué et al, 2013;Atanázio et al, 2013;Muñoz et al, 2013;Mello et al, 2014;Stephenson et al, 2014;Silva, Maftum et al, 2014;Santos, Gomes et al, 2015;Bittencourt et al, 2015;Thompson et al, 2017, Damasceno et al, 2017Vatne, 2017;Tippens, 2017;Zanatta et al, 2018a;Zanatta et al, 2018b;Silva et al, 2018; ganharam destaque até 2010, pois a proposta inicial previa uma construção baseada na síntese e não na fatoração analítica trazida pelos estudos quantitativos (Bonolo et al, 2008;Maia et al, 2008;Berardinelli et al, 2011;Bieler et al, 2012;Lou et al, 2012a;Offidani et al, 2012;Lou et al, 2012b;Anjos et al, 2012;Mussi et al, 2012;Gaviria et al, 2012;Bezerra et al, 2012;…”

Intention to quit smoking and concerns about household environmental risks: findings from the Health in Common Study in low-income housing

“…Concern about exposure, rather than actual exposure, was associated with motivation to quit. Prior studies have demonstrated that perceived vulnerability to environmental toxins may lead to heightened anxiety about these exposures [33, 34]. …”