The genesis of the MAPPS project was rooted in residents’ concerns, communicated through Houston’s 311 call system, about smoke, odors and dust emanating from nearby metal recycling facilities, and the resultant air quality investigation conducted by the HHD BPCP. Subsequent coverage about the monitoring results in the city’s local newspaper [13,14,15] served to heighten community concerns about the environmental impact of metal recycling facilities located in their neighborhoods. The lack of zoning within Houston raised an EJ issue, as many of these facilities and other industries are in predominantly poor and minority neighborhoods [7]. Building on questions raised by Houstonians and the initial air monitoring conducted by HHD, we developed a research plan, based upon the CBPR model, to address resident concerns. We conducted community air monitoring to measure metals in the air emitted primarily from metal recycling facilities, performed health risk assessments and gathered information about stakeholder perceptions on environmental health as well as on ways to improve communication. Central to the MAPPS project are the intervention and evaluation phases to develop, implement and assess a public health action plan based on risk assessment and community survey findings. Hence, the research to action components of the project align with the CBPR approach to actively engage those impacted by the issue being studied for the purpose of arriving at meaningful and sustainable solutions to eliminate health disparities [26].
Applying CBPR principles was key to the research and action components of our project. One of the underlying principles of CBPR is to recognize community as a unit of identity [26, 32], i.e., to work with individuals who identify with a larger group because of membership and engagement in a faith-based organization, a neighborhood, a political group or a non-governmental organization. Many CBPR partnerships include community groups and governmental entities [33], as does ours. However, the MAPPS project expanded upon traditional partnerships to include representatives from the impacted neighborhoods and from industry. This approach allowed industry members and residents of the project to work together side-by-side with a view of each other as allies, as opposed to adversaries, as we sought sustainable solutions to collectively address community concerns. Also, the project provided an opportunity for the HHD BPCP to partner and work together to resolve issues in ways that had not been attempted before and to consider industry as part of the community. This expanded view of the importance of communication and partnership evolved among all partners.
Another accepted principle of the CBPR process is that of equal partnership and shared responsibility in all phases of the research process [2]. Community (AAH) and governmental (HHD) partners shared budget resources from the grant, but the PI assumed overall control over the project and assumed responsibility for oversight and integration of all aspects of the project, including those spearheaded by the sub-contracting organizations. The research team met regularly and worked together to coordinate plans, communications and outreach throughout all phases of the project. Obtaining written feedback on drafts of materials was more difficult than receiving input orally during regularly scheduled meetings. We encouraged full participation from all members at meetings to develop, implement and monitor project activities. However, consistent with previous reports [34], feedback and involvement among community members sometimes waned when discussions became more technical; when there were frustrations with the academic approach that required adhering to IRB protocols or documenting activities (e.g., interactions with residents or civic and church leaders that would provide evidence of expanded community engagement for evaluation purposes); or when there were other demands on their time. This sometimes resulted in academic researchers assuming a greater role in activities, which served to shift the balance of power among partners. Nonetheless, the academic members of the team made efforts to stay aware of these resulting power imbalances and address them to the extent possible.
CBPR is challenging because of the substantial investment in time that is required to engage community partners [35, 36]. In our study, engagement took place at multiple levels, involving interactions between academics, government and community groups as research partners, as well as interactions between research partners and CAB members, i.e., residents and metal recyclers. Laying the groundwork for the partnership involved spending time on process-related activities to define the partnership and determine how the CAB would operate, as well as to respond positively to invitations to activities and events unrelated to the MAPPS project. The team approach required adaptation and flexibility as progress in achieving project goals was considerably slowed to ensure adequate time for engagement and buy-in of all partners. For example, more meetings than originally planned were needed to allow for full review and approval by the CAB of the project’s brochure (three meetings); key informant interview guides (six meetings); community surveys (five meetings); risk assessment (technical) reports (four meetings); and community reports (four meetings).
CAB members expressed frustration with the amount of time that it took to carry out specific research activities. In hindsight, it might have been helpful to have more clearly explained to CAB members the nature of the research process at the beginning as well as during different stages of the project to help them understand the iterative nature of research. There was also a lack of understanding of the need to adhere to an IRB protocol. For example, there were two protocol deviations due to a Facebook post that highlighted remuneration for participating in our community survey and a webpage post of a picture of a resident completing the survey. In both instances, steps were taken to remove posts as soon as they were discovered and explain why such posts did not provide adequate human subjects assurances. The protocol deviations were reported to our IRB with plans to address them moving forward.
We recognized a power-imbalance between our two diverse groups of stakeholders serving on the CAB. First, the knowledge base about areas pertinent to the project (e.g., metals; metal recycling operations; regulatory requirements of the industry; scientific terminology; environmental pollution and health risk) differed between metal recyclers and residents. Second, the metal recyclers had access to resources that were not available to residents. As examples, the Metal Recyclers Task Force solicited services of an attorney (who has been a member of the CAB from the start of the project), as well as external consultants who provided review of the grant application, the SOP for air monitoring and the risk assessment reports. To address this imbalance, the research team hired an outside consultant to represent community members regarding the interpretation of results from the risk assessment. This power imbalance was also countered in part by AAH, an EJ advocacy group, being a grantee on the study. Finally, the professionalism, energy and commitment of CAB members led to greater trust with each other and this served to diminish the power imbalance as well.
We also recognized an inherent difference in our CAB membership in that the metal recyclers participated during their normal workhours whereas resident members served as volunteers who had to take time from their daily routines or work in order to participate. While we provided lunch prior to our CAB meetings to show appreciation of resident members’ time and provided gift cards a few times throughout the project, it would have preferable to have budgeted annual stipends for them. Another challenge was differing priorities in that the project was of central interest to metal recyclers, whereas residents had broader environmental health concerns that extended beyond the scope of the MAPPS study. The research team did its best to provide resources that could help address resident concerns for matters tangential to the project (e.g., one resident was provided information about HHD resources on lead abatement due to concerns about the potential health impact of lead in paint inside her home).
Mutual learning and capacity building underpin the CBPR process [26]. MAPPS provided opportunities for academic researchers, HHD and AAH to view a single environmental health issue through the lens of a researcher, an advocate, a regulator, resident or metal recycler. The importance of education is central to capacity building [27] and we undertook several activities to heighten understanding about the project: a tour of a metal recycling facility (coordinated by the head of the Metal Recyclers Task Force that was preceded by a hosted lunch); a tour of the MAAML; mini-workshops on air sampling, risk assessment and community surveys; and an invited presentation given by the Texas Commission on Environmental Quality (TCEQ) on the regulatory framework in the permitting process. In CAB meetings, we noted resident CAB members deferred to researchers regarding some of the more technical aspects of the project (e.g., community air monitoring or risk assessment methods). While we attempted to communicate in lay language, the inadvertent use of scientific jargon may have caused frustration and limited full participation of CAB members, as has been noted by others [27].
We adopted and used a consensus decision-making approach throughout the project. Research team meetings and CAB meetings were structured to allow for transparent communication and open dialogue. Often, we organized individual or small group meetings with CAB resident and metal recycling members to review study materials for upcoming CAB meetings to facilitate the discussion and decision-making process. This approach allowed everyone the opportunity to examine the issues and discuss their perspectives, share information and participate in the process. However, engagement was sometimes limited when we attempted to make decisions that built on our research findings. For example, the concept of risk was difficult to grasp, and this led to the research team being asked to determine whether a risk level was “safe” or not.
The CAB generally reached consensus, but not always. For example, the metal recyclers repeatedly asked for air sampling results as they were being collected, but the study protocol had been designed to share these results after all monitoring was completed. There were also differences in opinion among the outside consultants (who were hired by the metal recyclers and the project) about interpretation of risk assessment results and among CAB members about whether these risks should be compared to risks from individual lifestyle choices like smoking. There was both support for, and opposition to, suggestions to include policy initiatives to regulate the metal recycling industry as part of the public health action plan. In the end, this was tabled in part because of insufficient time on the grant to enact legislative or regulatory changes and was to be considered later as part of longer-range initiatives.
Our industry and resident partners played active roles in developing and implementing our public health action plan. Voluntary actions on the part of our recycling industry partners to change practices, processes or conditions in the scrap yard to minimize emissions from metal recycling facilities and improve communication with residents were key elements of the action plan. Without these voluntary actions, the timeline for risk mitigation would have been extensively delayed. Resident CAB members also participated in meaningful ways by developing a colloquial version of key messages from our research findings and organizing and holding “house meetings” to solicit broader input from residents on the public health action plan. Several members of the CAB (from both our resident and metal recycling groups) participated in our Environmental Health Leadership Training. Moreover, our activities led to outcomes broader than the project. For example, AAH hired one of the field interviewers trained for our survey and adapted our survey protocols for use in another community. In addition, HHD developed a program (in response to focus group findings) funded by the de Beaumont foundation’s BUILD program [37] to train volunteers in Near Northside as “block captains” who serve as points-of-contact for residents to communicate their environmental health concerns to the HHD and for HHD to promote their environmental health programs (e.g., childhood lead surveillance program, lead abatement program and asthma prevention and control program).