Product Details

Author Information

Corresponding Author
Madeleine Scammell
Boston University School of Public Health
Dept. of Environmental Health
715 Albany St. T4W
Boston, MA 02118
United States
p: 617-638-4454
MLS@bu.edu

Authors (listed in order of authorship):
Judy Ou
Boston University School of Public Health

Carly Carlin

Rosa Maria Olortegui

Junenette Peters

Roseann Bongiovanni
Chelsea Collaborative

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences, Social Work

What specific topics does your product address?

Access to health care, Advocacy, Asthma, Built environment, Cancer, Chronic disease, Community assessment, Community coalition , Community development, Community engagement, Community health , Community organizing, Diabetes, Disabilities, Diversity , Domestic violence, Environmental justice, Environmental health, Epidemiology, Health behavior, Health disparities, Health equity, Housing, Immigrant/refugee health, Interdisciplinary collaboration, Mental health, Minority health, Nutrition/food security, Overweight/obesity, Partnership building , Physical activity/exercise, Primary care, Social determinants of health, Urban health, Community-based participatory research

Does your product focus on a specific population(s)?

Immigrant, Latino/Hispanic, Urban

What methodological approaches were used in the development of your product, or are discussed in your product?

Community needs assessment, Community-academic partnership, Community-based participatory research , Qualitative research, Quantitative research, Survey, Interview

What resource type(s) best describe(s) your product?

Best practice , Evaluation tool, Manual/how to guide, Reference material (i.e. annotated bibliography), Toolkit

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

Urban environmental justice populations are exposed to a variety of environmental and social stressors, including pollution, neighborhood crime and financial instability. Deciding which interview instruments to use when attempting to characterize these stressors is challenging. It involves locating previously published instruments from disparate disciplines, and then evaluating question type and content in light of the population to be studied. Although existing instruments are often evaluated for validity and reliability, community-based studies may have unique contexts and community researchers may wish to tailor instruments to their own purpose as well as develop new questions. Moreover, researchers may want to use qualitative and quantitative research methods. A community-based participatory study of social and environmental stressors in the City of Chelsea, MA, included use of an interview guide containing questions on the topics of: chemical exposures of concern; social and economic concerns; behavioral risk factors for disease; self-reported health outcomes; and perceptions of the environment. The interview guide included open-ended questions that provided participants with opportunity to expand upon the information gathered by the closed-ended questions, and to provide further information about their perceptions. This annotated interview guide provides references to previously published interview questions, including those derived from pre-validated instruments relevant to characterizing social and environmental stressors in urban communities, as well as questions that were adapted or developed as part of the research project (questions originating in focus group interviews with community members.)

2. What are the goals of the product?

The goal of the annotated interview guide is to make a comprehensive collection of interview questions and tools available in one place to academic and community researchers seeking to identify community concerns related to perceptions of the neighborhood environment, chemical exposures, social and economic challenges, behavioral risk factors for disease, and self-reported health outcomes. The wide breadth of data obtained can be used in analyses related to health outcomes and health-related behaviors as well as for advocacy purposes.

In addition to descriptive statistics that characterize the number and types of issues covered by the interview, the closed-ended questions can be used in regression models to investigate associations between participant concerns and health outcomes. These closed-ended questions include instruments that measure, among other concepts, social cohesion, perceived neighborhood conditions, ethnic identity, and exposure to community violence, self-rated health, and depressive symptoms. Including the original sources in the annotated guide achieves the goal of making background literature available for researchers.

Responses to the open-ended questions can also be coded and analyzed to characterize the full range of stressors affecting residents, to explore residents’ meaning or understanding of concerns (2) and to examine patterns in residents’ responses to questions about their environment. For example, the open-ended questions contain information about specific noises and odors that disturb residents, responses to violence experienced by residents, park use and physical activity patterns, and observations about their residential neighborhoods.

Most of the open-ended questions in this interview guide were created during and after focus groups with community members that identified the community’s specific needs and interests. These questions inquire about residents’ opinions of their city, exposure to violence, feelings about safety, satisfaction with local schools, and preferences for use of parks. The quantitative and qualitative data can be presented within community and city council meetings to support the need for community improvement.

3. Who are the intended audiences or expected users of the product?

This annotated interview guide was designed to be used by academic researchers and community groups/community researchers to inform interview studies focused on public and environmental health, and social and environmental stressors. It is meant for use in studies attempting to characterize community concerns via one-on-one interviews. The original interview guide is available in both Spanish and English languages.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

The original interview guide was meant to be used in a structured verbal conversation between interviewer and study participant that can be completed in 45 to 90 minutes. It was designed to be conducted face-to-face, using cue cards and a map of the city to which participants can refer. The guide also includes a place to record the geographic coordinates of the participant’s place of residence at the time of the interview, the date of the interview, and the name of the interviewer and accompanying note-taker.

We used cue cards for a select number of questions that required the participant to respond on a scale. We also used cue cards to map out calendar months and fast food eateries for participants. The questions that relied on cue cards for the participant response are noted in the guide.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

The majority of EPA risk assessments conducted in the past 35 years focus on individual chemical agents and single health endpoints in an effort to characterize the risks of a chemical agent to human health (1). However, populations are exposed to multiple chemical agents that can interact with each other and with human physiology in a way that increases risk for adverse health outcomes. Little is known about human exposure to multiple chemical agents and their resulting health effects (2). Human populations additionally experience non-chemical stressors that may increase risk for poor health and increase sensitivity to chemical exposures. Non-chemical stressors describe conditions or exposures, such as low income, poor diet or food insecurity, unsafe neighborhoods, poor housing, and lack of access to health care (3).

The field of cumulative risk analysis examines chemical and non-chemical stressors. Current investigators within the field acknowledge the need for new methods for analyzing cumulative risk (3). This project builds on previous research in cumulative risk by exploring new methods to analyze co-exposure to chemical and non-chemical stressors (4). With funding from the National Center for Environmental Research at the US EPA, Science to Achieve Results (STAR) program, we developed the interview guide to collect, code and characterize information about chemical exposures, social and economic concerns, behavioral risk factors for disease, self-reported health outcomes, and perceptions of environment and quality of life from residents abutting an urban designated port area in the City of Chelsea, MA (5, 6).

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1. Sexton K. Cumulative Risk Assessment: An Overview of methodological approaches for evaluating combined health effects from exposure to multiple environmental stressors. International Journal of Environmental Research and Public Health. 2012;9(2):370-90.
2. Carpenter DO, Arcaro K, Spink DC. Understanding the human health effects of chemical mixtures. Environ Health Perspect. 2002;110 Suppl 1:25-42.
3. Sexton K, Linder SH. Cumulative risk assessment for combined health effects from chemical and nonchemical stressors. American Journal of Public Health. 2011;101:S81-S8.
4. US Environmental Protection Agency (EPA). New Methods for Analysis of Cumulative Risk in Urban Populations 2013 [cited 2015 June 18]. Available from: http://cfpub.epa.gov/ncer_abstracts/index.cfm/fuseaction/display.abstract Detail /abstract/9278/report/0.
5. http://www.chelseastar.org/
6. Payne-Sturges DC, Korfmacher KS, Cory-Slechta DA, Jimenez M, Symanski E, Carr Shmool JL, Dotson-Newman O, Clougherty JE, French R, Levy JI, Laumbach R, Rodgers K, Bongiovanni R, Scammell MK. Engaging communities in research on cumulative risk and social stress-environment interactions: Lessons learned from EPA’s STAR Program. Environmental Justice. 2015; 8(6): 203-212. doi:10.1089/env.2015.0025.
7. Officials Beaming over New Street Light Contract. The Chelsea Record. March 28, 2013 [cited 2015 Nov 11]. Available from www.chelsearecord.com.
8. Ou JY, Levy JI, Peters JL, Bongiovanni R, Soto JG, Medina R, Scammell MK. A walk in the park: The influence of urban parks and community violence on physical activity in Chelsea, MA. International Journal of Environmental Research and Public Health. 2015. 13(1), 97; DOI:10.3390/ijerph13010097.
9. Rothman EF, Bair-Merrit M, Tharp AT. Beyond the Individual Level: Novel Approaches and Considerations for Multilevel Adolescent Dating Violence Prevention. American Journal of Preventive Medicine. 2015. 49(3), 445-447. doi.org/10.1016/j.amepre.2015.05.019
10. Johnson RM, Parker EM, Rinehart J, Nail, J, Rothman EF. Neighborhood Factors and Dating Violence Among Youth: A Systematic Review. American Journal of Preventive Medicine. 2015. 49(3):458-66. doi: 10.1016/j.amepre.2015.05.020.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

This cross-sectional study is the result of community-university collaboration between the Chelsea Collaborative in Chelsea, MA, and researchers at Boston University School of Public Health (BUSPH) Department of Environmental Health. The mission of the Chelsea Collaborative is to enhance the social, environmental and economic health of the community and its people. They achieve their mission through community organization and education.

Investigators from the Department of Environmental Health at BUSPH offered knowledge and expertise in qualitative and quantitative interview methods and large national surveys (BRFSS and NHANES). Our researchers sought to develop an interview guide that would build from existing guides and that would also include questions specific to the Chelsea community to ensure the guide is representative of and inclusive to the population it is sampling.

In Winter/Spring 2011, project staff presented the study objectives and received input on the types of questions to be asked during the interviews with the following meetings or committees sponsored by or organized with the Chelsea Collaborative:
Chelsea Collaborative leadership retreat (January), Chelsea Collaborative staff meeting (February), Chelsea Green Space committee (January and February), Chelsea Latino Immigrant Committee (February), Chelsea United in Defense of Education (February and March), City-Wide Tenants Association (February), Environmental Chelsea Organizers (March), Vecinos Unidos / Neighbors United (February and March), and the Shanbaro Community Association of Somali Bantu in Chelsea (March).

The interview guide was drafted with the input from all of the above meetings, all co-investigators at BUSPH and the Collaborative, as well as investigators at the BU SPH Department of Community Health Sciences with expertise in exposure to violence and neighborhood effects on health (9,10). Sections of the final interview guide focus on: Social Environment, Ethnic Identity, Physical Environment, Individual Health, Life Stressors, and Community Involvement.

Questions that came specifically from our meetings with community committees focus on: community lighting of streets and walkways, odors, trash pickup and recycling, relaxation and recreation, use of parks, religious affiliations and community participation, parents’ participation in schools, language barriers, cultural adaptation, and other immigrant issues. The questionnaire was then translated into Spanish and piloted with Spanish-speaking members of the Chelsea Collaborative.

Members of the BUSPH team and the Chelsea Collaborative team identified the census tracts and blocks where we recruited participants based on consideration of demographics from Census 2000 data (e.g., renter occupancy rates, density, race/ethnicity, language and educational status of residents) and known proximity to environmental amenities and hazards. We also agreed on targeted recruitment numbers for each area with the intention of achieving a very diverse study population that also reflects the demographics of the City.

Detailed study protocol were approved by the Boston University Medical Campus Institutional Review Board.

Interviews were conducted with 354 residents of Chelsea, Massachusetts, living within a designated port area, a multilevel highway, and other potential sources of environmental pollution. Chelsea residents may also experience stress resulting from the city’s high violent crime rate, and its large Latino population may experience additional stress from problems related to acculturation, immigration, and access to health care resources.

Recruitment occurred between December 2011 and June 2013 via door knocking between 9 am and 8 pm on weekdays and weekends. Cable television channels and flyers posted at community centers, clinics, homes, and local events publicized the study. Eligibility criteria included being 18 years of age or older, Chelsea residency for six months or more, English or Spanish language, and current residence in five census tracts near the designated port area. Interviews were conducted at participants' homes, or our partner’s Chelsea office. Geographic coordinates of participants' homes were also recorded.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The questions contained within the interview guide needed to fulfill several functions. The questions needed to cover a wide breadth of topics relevant to social and physical stressors, to accurately measure the social and physical problems experienced by Chelsea residents, and to reflect the community’s concerns.

In order to choose questions that fulfilled these requirements, BUSPH conducted focus groups and interviews with the following community groups to identify issues of concern: Chelsea Collaborative employees, the Chelsea Green Space committee, Chelsea Latino Immigrant Committee, Chelsea United in Defense of Education, City-Wide Tenants Association, Environmental Chelsea Organizers, Vecinos Unidos / Neighbors United, the Shanbaro Community Association of Somali Bantu in Chelsea.

After meeting with these organizations, BUSPH researchers found pre-validated survey instruments and instruments that were used in similar studies, and also reflect concerns voiced by the community organizations.

The guide also contains original questions that were created to address community concerns. Specifically, the questions regarding park use habits and the location of physical activity were included due to interest from the Chelsea Green Space Committee; questions about trouble with landlord-tenant relationships were from the City-Wide Tenants Association; and questions about access to care and discrimination were included due to input from the Chelsea Latino Immigrant Committee.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

In the process of conducting the study, our investigators met many community leaders, researchers and EPA officials who were interested in seeing the interview guide for their own purposes. Recently Boston University School of Public Health and Harvard T.H. Chan School of Public Health jointly launched a Center for Research on Environmental and Social Stressors in Housing Across the Life Course (CRESSH). CRESSH investigators are developing interview guides for measuring social and environmental stressors related to housing. We are hopeful that this annotated guide will enable investigators to quickly identify the source of questions they would like to use, including if those previously unpublished questions that originated in the community. For this reason, we would like it to be a publicly-accessible product to inform community and city-wide policy across the topics of health, education, housing, and social services.

Data gathered from this interview guide will be used to examine novel methods of evaluating cumulative risk. The data gathered by this interview guide has already been presented in public meetings with Chelsea residents, and used in meetings between the Chelsea Collaborative and the City of Chelsea.

Specifically, the Chelsea Collaborative has used questions in the guide about street lighting to advocate for improved public lighting in many neighborhoods. Their efforts culminated in the contracting of 1,627 new LED streetlights in neighborhoods across the city in 2013 (7).

Data obtained in the interviews was also shared with representatives from the Chelsea Police Department and the City of Chelsea Board of Health at their leadership retreat. Furthermore, the data was used by the Board of Health to launch a new home inspection ordinance to try to address structural problems that would result in the exacerbation of pests. Additionally, analyses have been conducted from the interview results regarding the use of parks and exposure to community violence, physical activities, and depressive symptoms for residents of Chelsea.

10. Please describe why you chose the presentation format you did.

The interview guide is a word document that can be printed out and distributed to multiple interviewers, and used with multiple interviewees. We developed an annotated guide because we wanted to know specifically which questions originated in the community we were working with, so that interventions could be targeted more to the community’s preferred needs.

One example is the question raised by the Green Space Committee at the Chelsea Collaborative. They suggested we add the question “what parks do you use and why?” to understand the relationship between physical activity and other social stressors such as crime rates. If we hadn’t had meetings with community groups, we would not have thought to ask such a question in the first place. As a result, a doctoral student in the Department of Environmental Health at BUSPH was able to use data from this question to inform her first doctoral publication (8) and that information has been used to inform community efforts focused on the development of parks.

The purpose of publishing a guide that shows where questions come from was to help other researchers design interview guides and expand the data that might be available of community responses to these questions.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

One strength of the interview guide is its incorporation of community concerns into the formation of the questions. Questions that are specific to the community provide an opportunity to target data collection and inform interventions that will specifically address concerns voiced directly from the community members who experience them. For instance, data from the guide has already shown to be relevant in many community campaigns in Chelsea, with the LED streetlight campaign as one example (6).

Another strength is our focus on the neighborhood level through this interview guide. We asked participants to self-define their neighborhood and answer questions with that in mind. Previous studies use census tracts or blocks as a surrogate measure of the neighborhood, which do not reflect the same geographic areas as self-defined neighborhoods.(5) Because we ask neighborhood-specific stressors, our data directly reflects community residents’ perceptions.

Another benefit of asking about self-defined neighborhoods is that this product, built from the bottom-up, can inform interview guides on larger scales, such as that of an entire city or county, while still managing to consider voices from within the community in their questions.

Limitations of this study include the fact that all questions rely on self-reporting, therefore use of this product would best be coupled with other datasets that may measure environmental and health conditions more objectively. For instance, we compared perceptions of violent crimes with actual rates of violent crime. At the same time, we know that perceptions drive behavior more than actual data, so our shortcoming of asking perception-driven questions could also be seen as a strength.

One final concern is that our cross-sectional data was only captured at one point in time, and future studies might look at exposures and behavior over a longer period of time to draw comparisons and patterns from the findings.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

The focus groups, meant to generate questions from the community, created safe spaces for open dialogue and collaboration among city residents. The questions that were added to the original interview guide draft echoed the personal voices and opinions of the Chelsea community, and allowed for mutual respect and shared teamwork. The questions, as mentioned before, also created new research questions that had not been considered for our academic team of researchers at BUSPH. We interviewed a variety of community groups with varying focuses (education, immigration, housing, environment, neighborhood) in order to collaborate with the greatest scope of residents who would bring up concerns of environmental or social stressors in the community. Our partners, listed previously, included:
Chelsea Latino Immigrant Committee, Chelsea United in Defense of Education, City-Wide Tenants Association, Environmental Chelsea Organizers, Vecinos Unidos / Neighbors United, the Shanbaro Community Association of Somali Bantu in Chelsea.

Detailed study protocol were approved by the Boston University Medical Campus Institutional Review Board.