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So with that I think we're ready to get started.

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I wanted to buy a very quick overview of the Superfund research program or the SRP for many of you on the line who may not be familiar with it, therapy is a peer reviewed competitively awarded grant program that centers on for mandates.

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These mandates address human health effects, assessing risk detection and remediation of hazardous substances.

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The SRP mission is to provide practical science based solutions to protect human health and aims to understand and reduce exposures to potentially harmful contaminants and encourages them support scientists and draw some of the nation's best minds to

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focus on complex problems related to hazardous substances.

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on complex problems related to hazardous substances. So the cornerstone of the SRP are these multi project centers.

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So these centers include projects from both biomedical and engineering disciplines, and they're focused on addressing common problems related to super fun relevant contaminants.

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For us RP systems approach provides a foundation for these p 42 centers research teams that SRP centers collaborate to address specific questions as part of a larger system.

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This infrastructure allows researchers to combine biomedical and environmental field, and work with community members, as well as working with other partners such as EPA GST our tribal nations and US state agencies to provide solutions for existing environmental

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health problems.

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The P 42 centers all it also provide an opportunity to integrate diverse disciplines. And part of this is developing effective risk communication strategies that may be tailored to a community's needs and explore opportunities to integrate communication,

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social science and community engagement to improve risk communication.

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So as part of the series.

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We'll hear from SRP grantees, as well as other colleagues and partners to discuss work to engage with communities and communicate potential health risks. So we hope you stick with us for this session as well as the three additional sessions coming up in October.

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They will also build on lessons learned needs, and next steps.

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Um, so this is the first session.

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So thanks for joining us today. And I also just wanted to let you know that we have three more sessions coming up, and that you can please, please feel free to register for those as well.

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The next one will be on October eight and will focus on combating misinformation and mistrust when communicating health risk.

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On October, 20, our session will focus on engaging communities and tailoring messages to advance equity and justice.

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And finally, on October 22 will host our last session on communication toolkit to communicate environmental risk.

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So after this webinar we encourage you to register, and you should see the link to those registration pages in the chat.

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And then one other quick note is that I wanted to note that this series builds on an SRP workshop we held in June focus on risk communication strategies to reduce exposures and improve health.

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that came up during that workshop. We use feedback from the meeting to identify topics for the webinar that participants wanted to hear more about. If you participated in that workshop or if you didn't, I just wanted to let you know that the workshop website now includes links to a meeting report and workshop resources.

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a meeting report and workshop resources. The resources document not only includes publications that were referenced throughout the meeting, but also provides a nice compilation of communication tools and resources that were brought up during each session.

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So I encourage you to have a look, those resources have also been copied into the chat.

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So with that, it is time to get started I'm really looking forward to three great presentations today.

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So first we will hear from Dr Maya Galvez, and Joseph Wilson from the icon School of Medicine at Mount Sinai, Mount Sinai vida Galvez is a professor of Environmental Medicine and Public Health and Department of Pediatrics at the icon School of Medicine

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at Mount Sinai. She's also the founding co director of the North. New York State Children's Environmental Health Center.

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Joseph Wilson is a program coordinator in the Department of Environmental Medicine and Public Health. Also at the icon, School of Medicine at Mount Sinai.

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He is the lead on Mount Sinai his prescription for prevention project to hear more about them there's more information on the webinar homepage.

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More information about their books and their full BIOS.

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So with that, Maya and Joseph, I will now turn it over to you.

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Thank you so much, Sarah. I'm really thrilled to join you all today Happy Friday, and appreciate you all joining us, and eager to hear the other presenters as well, we're going to be talking about designing and tailoring messages and talk a little bit

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about the work that we're doing here at the icon School of Medicine at Mount Sinai in New York City.

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So I co direct the region to pediatric environmental health specialty in it it's federally funded in the CDC and EPA and managed by the National American Academy of Pediatrics.

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There's a PE Su and each federal region we cover region two which encompasses, New Jersey, New York Puerto Rico and the US Virgin Islands and if you have questions about environmental concerns either as a member of the general public or as a clinician.

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This is a go to resource for quick information that you can then share with families and encourage you to take a look at the wealth of resources available there.

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We're super fortunate in New York State and that the Pacers seeded a network of seven centers in Albany buffalo Syracuse Rochester Westchester New York City and Long Island and we serve as a coordinating center and so there are environmental PDF pediatric

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champions across New York State and if you want to read more about it there's an article on AJPH, talking about that network and we hope that we're the first of many states that have a similar network.

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And so I still do a little bit of general pediatrics, and even myself as a busy clinician, often do not have the chance to get to healthy homes concerns as part of routine while childcare and that is one of the major aims of, of our work of our team here

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at Mount Sinai is ensuring that the child with asthma, who is frequently admitted to the hospital or seen in the emergency room or Mrs.

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School has these environmental asthma triggers addressed in their home as part of preventive care.

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And these resources exist but for too many families that are not connected to these local community based organizations that can provide the healthy homes interventions that they need and promote the health of these children.

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And so these Miss connections are exactly what our team of environmental pediatric clinicians is trying to address and it's led by Dr. Lawrence say jack and Dr.

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Aaron panic, working together with community based organizations and public health agencies to make those connections and get families the resources that they need.

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And it's rooted in something called prescriptions for prevention, which is a screening counseling referral program that gets the evidence base, the wealth of evidence is come out of the research centers across the country and ensure it's translated into

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clinical practice and whether it's information in the Green Book, or a PS Bright Futures which dictates reimburse Civil Services for clinical practice as part of well childcare and prescriptions for Brenton really got this all started, and it was part

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of an interest center collaboration grant through supported by National Institute of Environmental Health Sciences, which brought together five pieces together with community, five community engagement Corps and federal regions 1235 and nine.

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And it's that partnership, and that partner messaging development that we want to share with you more about today, turn it over to Joseph.

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Thank you Dr Galvin.

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So I got to galvanize just mentioned, these prescriptions for prevention were created with a whole community of people, and the motivation for creating this messaging, was to address the gap that we saw between the training health practitioners receive,

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and the guidance they were providing families on environmental exposures such as mode lead radon and even cleaning chemicals. So here we have an image of one of our prescriptions for prevention, and it really shows the point of this project which is to

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provide evidence based action steps and links to community resources. So again here. As you see, this is our prescription on safe for pest control, and we have those resources as well as those action steps that come from the collaboration from many partners.

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Next slide.

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So when creating these prescriptions for prevention, and really any type of messaging we do within our PE su nice trick or with our other partners across environment to help.

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We follow what we call our three key messages model. This really helps guide our thinking and our practice in developing these messages. And this model just has three simple steps, which is what.

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So what, and now what and creating these messages we first want to answer the question, what, what is the problem. How do we define the problem.

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We then want to target So what, why do we care about the issue that we are defining and then most importantly now what, what can we do about this problem.

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How can we move forward to ensure that the families and communities we are serving able to address, whatever their needs are.

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Next slide.

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So here we are breaking down our prescriptions and showing how they follow this key messages model.

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So on the front of the prescription again we have our action steps, which are peer reviewed by a team of experts within pediatric environment to health.

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And on the front of these prescriptions it targets the what and the so what we define the problem and we let the individuals know why we are concerned about it.

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But the bulk of the prescription really focuses on the now what, what can we do to address this particular issue. So in this instance the words and the subway is pest control and how it can lead to asthma exacerbations with the action plan again we have

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the various action steps the family can follow. And on the back we have the list of resources which includes websites hotlines local resources and even referrals to our community partners, if applicable.

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Next slide.

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So these prescriptions are more than just sheets of paper, but they're really meant to be integrated into a patient's clinical care, as Dr. galvus mentioned, these prescriptions are incorporated within our screen Council and refer model, as we are seeing

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and working with families with that model as we are screening families for environmental concerns.

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As we begin to counsel the family these prescriptions are just one of many tools us to help guide the family to either prevent an exacerbation of the issue or to address it head on.

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So, these prescriptions are given out to our community partners within clinical practices. They've been incorporated into our electronic medical record.

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And we also include them in social media outreach and healthy home kits that we provide to families as again they tried to address any environmental concerns.

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Here we have a screenshot from our website we do encourage you to check out these resources, and we even have them organized topically to help families and clinicians and other health practitioners, with the ease of finding a particular topic that they're

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interested in.

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So, as we all know we are still in the midst of this covert 19 pandemic. And we want to make sure that these prescriptions are adapting to the situation that opinion.

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As a result of this we created to cover related prescriptions, one on green cleaning and another one on safer disinfecting in the home. They have been translated into nine different languages and again they follow our key message model of the what, so

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what, and now what we have also shared them with partners, and they even have recipes for safer cleaners and those tips on disinfecting safe.

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xy.

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Now, these prescriptions are not just meant to be within the Pacer within our nice check, but we really want to work with community partners within the region to me God to adapt and to tailor these messages for certain communities.

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Here we have our word burning smoke prescription for prevention, which is being created in partnership with the region to EPA. The purpose of this prescription is to work with the tribal nations within the New York State area on safer tips to burn with

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safety. And again, this would not be possible if not for the collaborative to collaboration with the region to EPA.

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Next slide.

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Here we have an image of all the places you've wasted prescriptions either being current are currently being used, or they have been adapted and localize for particular region.

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Again we are the reason we are within the federal region to, and we have our nice check partners across New York State. They all have taken these prescriptions and adapted them using the local resources within their area to provide to the families and

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communities that they serve.

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In the next few slides we have examples of how they have been used.

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Here we have a description on avoiding asthma triggers, and this was created by our partners in Albany, and they have actually taken a new topic which are to avoid the asthma triggers and have localize it to the region, and we as the center in New York

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City will even using their resources to help localize it for our communities. So again, this is the collaboration both ways.

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It Again it is going beyond region two here we have our partners within the region one pace to, which serves the New England region, and they are creating new prescriptions that address climate change, related health concerns here they're creating a prescription

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on heat related illness.

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Next slide.

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Our partners in Region four which serves to South East and they are based in Atlanta, they have created a prescription that utilizes imagery and language that is culturally sensitive and appropriate for the population that they are serving.

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So again, they are working with collaborators, such as the Center for black women's wellness to address lead and again these prescriptions have an overall key message model, but it's being tailored and adapted to fit their particular region.

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So in addition to following our key message model. Another important element is this community partner messaging development, we cannot just do this work with by just simply following our model, but keeping that work and home, but it is essential to have

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this, these geographically diverse partners with the diverse areas of expertise. This has been done through our NIH s into center collaboration grants, and these individuals that we are working with, including clinicians researchers community partners

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and families, as we are doing this work, and as we are developing these messages with our community partners. A key step is to identify local clinical champions across disciplines.

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These individuals, individuals can be social workers, asthma counselors trainees MDS individuals who understand and see the need within environment to help, and they're able to carry that work for it within their particular discipline.

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I'm not going to hand it off to dr Jarvis to continue this conversation about working with our community partners in developing these messages.

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It keeps us Joseph and we've really appreciated. Joseph, serving as the lead on this program and helping our partners across the state that region in the country, develop and Taylor and then disseminate this to their local communities.

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Thank you, Joseph.

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So evaluation quality improvement is a routine part of this program so the traditional been counting the number of screen the percent, the percentage identified with environmental concerns, and in our experience.

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The Healthy homes concerns have been the top social determinants of health, when implemented as part of a larger screener in the general pediatrics clinic only surpassed by food insecurity.

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During the coven 19 pandemic and so we also shifted to address those needs.

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In this time.

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We're also tracking the percentage of families referred to healthy homes interventions.

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There's a short evaluation survey that's been developed for our partners who are using these resources for continuous quality improvement.

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We always think of any messages a work in progress that can always get better.

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So they're, they're routinely updated, including an annual review of the resources by trainees to ensure that those are up to date, and then Joseph leads our team and providing consults to colleagues that are interested in taking prescriptions for prevention

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and tailoring and localizing them for their local communities.

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And so now I'm going to run through a couple of additional examples above and beyond our prescription for prevention program and many of which are have been led by our community engagement core which is part of our ending, NIH SP 30 Center here at Mount

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Sinai.

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And as a condition whenever we go out to speak with families or communities. We always recognize the fact that parents are prepared to be scared they're ready to hear this information about something that they did wrong, that resulted in x problem in

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their children, and so we acknowledge that up front in any talk and try to encourage families to not think about the past, but think about what they can do moving forward to prevent and reduce exposure and I think that does a lot to sort of clear the

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mental noise that families have, as they begin to listen into a talk on environmental health.

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And so we also share with families that they do the best they can with the information they have at that time. And what we're here to do is give them evidence based information so that they can make the best decision for their family and that made that

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might look different for them from family to family, and if they feel overwhelmed, then think about what's on top of their list and try to do one thing.

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And really keep it simple.

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And when there's scientific uncertainty then err on the side of caution and choose what's known to be safer so those are key messages that we're constantly sharing with families, and the three key messages format that that Joseph introduced to you is

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really from this risk communication template developed by Cavell on Peters, where you see the three key messages on the top and depending on the level of your audience you may need to provide additional supporting facts for each of those key messages.

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And in fact, each of those supporting facts may have three key messages, but it's really important to identify the top line and work with diverse partners to really hone down what are the most important three key messages to share, and it in an effort

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to keep it as simple as possible that guidance up in the upper left hand corner 27 words, nine seconds three messages.

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It's challenging it is hard to get it that simple but it's a good thing to work towards so that people hear the message.

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Clearly and aren't able to take that and act on it, and more from condello and Peter is on communication strategies and this was so helpful to us.

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When I first came to fellowship at Mount Sinai, it was 2002 was in the aftermath of 911 and that was my first task was digesting all the environmental information that we had for families so they can understand the risk of exposures in and around ground

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zero.

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And some of the key strategies are give families on strategies for personal control that's providing them with action steps.

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Choose the comparison. When you're talking about an exposure, especially one that is considered high risk.

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Really think carefully about what is proper comparison for those families and specific to 911 when we didn't necessarily have comparison Valley as we used historical background for New York City, and said this is what the levels in the air of lead are

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now and this is what it was historically and that was that enabled families to put those exposures into context in a way that made sense to them, and then build trust us highly trusted information shows us so really think about who the right key messenger

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is, and make sure you pair them with the key messages appropriate to them and I'm going to share an example with you that I really appreciated.

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This was seven years, the several years ago back in 2011, there was a case of trichloroethylene or TCP exposure at the Bronx, New School not very far from where I trained in residency, and they found levels that exceeded occupational standards for TCP,

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and when that was confirmed the school was permanently closed and moved, two miles south and you can see the bill the school building was a former industrial site that hosted both a lamp manufacturer and an auto mechanic and that's why TC was found there,

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and off gassed into the school building, and a community that already was at high risk for example of asthma known to have I high asthma prevalence and greater risk for learning behavioral issues and then you put this on top of that, and we don't have

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the answers for families about potential impacts on children's health, because it hasn't been adequately studied in this population. And at the first community hearing at a school at the school is actually held at the Bronx High School of Science.

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They sent the school Chancellor, for all of New York City as the key messenger and the three messages that he shared that day, or I'm sorry this should never have happened.

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And there are things that we are doing to make sure this doesn't happen again. And those were his three key messages, and he repeated them over and over again.

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He did not try to explain the science that he was supported by an interdisciplinary team that explain the science, but his three key messages were exactly what I stated and I thought it was a great example of matching the right message to the right messenger

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and sending the top official really showed this community that they care. And so I think this was a good example of risk communication to a local community.

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This is a message map that was developed by one of my colleagues, Dr. Kathy Collins for another school community impacted by dust related to school, maintenance, repair and construction issues that were ongoing during the school year.

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And there was a lot of anxiety in the school related to this and our colleague, Dr. Collins thought it was really important that this be discussed openly and transparently with the children who are hearing some scary things.

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And maybe not be this wasn't really being openly discussed with the children themselves at the developmental stages that they were ready to hear and understand and so we Dr.

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Collins crafted these really clear messages about what was going on every school building needs regular maintenance to keep the school safer the people inside work on the building can create a lot of dust while the work is going on it's important to stay

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healthy by washing dust off your hands, especially before you even after you've been playing outside so giving them strategies for addressing some of those concerns.

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This is another example of a national campaign, led by the CDC.

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A PHA National Environmental Health partnership council I could share the communications work with work group with Adrian Hollis.

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It was launched on national Healthy Schools day in asthma, followed up by World asthma day. And then we're also planning on releasing the third message in October during Children's Health Month.

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And so you can see sort of the key messages and the action items and then referral to the website for additional resources that schools and local communities can turn to for more information and a lesson learned from this social media campaign was that

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it didn't have a lot of branding and when it was disseminated to our partners, they were able to take that message, sort of make it their own and share it with their local communities and so that that ability for disseminate broad dissemination is facilitated

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when you don't have too much branding on campaigns.

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In an effort to lift up new voices in the eh community.

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We were approached our team was approached by aap about submitting blog on baby food and heavy metals after congressional report came out. And we said, fantastic.

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It would be great to do this. We'd love for an amazing medical student that we're working with to be the lead. And she developed the blog, she happens to be a fourth year medical student and a mom of a toddler so directly impacted by this new story, and

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she really crafted a beautiful and powerful story about the questions that she had and what she was doing to to address them. And so really thinking about diversifying the voices in our larger age community and providing opportunities to young trainees

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so they to become their local champions, where they're over there often she's actually believe in Virginia now.

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You can also find our back sheet on heavy metals and baby foods and fruit juices.

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If you have questions about that topic.

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And along the lines of choosing the right messenger.

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Three years ago when we first officially celebrated children's Environmental Health Day, which is the second Thursday. In October, every month it's October 14 this year.

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It's a movement launched by a children's Environmental Health Network.

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We were looking at the proclamation which we have gotten for the first time and it's a pretty amazing thing to have your state recognized ch day. And so we were really proud of that piece of paper.

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And he said, Well, it would be kind of boring for me to get up and read this it would be fantastic if a kid could do it but we recognize that that might be challenging for a child to get up and read in front of an audience.

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But this child on the left, spontaneously, saying the proclamation and had it videotaped, and that's what we played the next day and we call this child are closer because it was so fantastic.

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And he gets the message across so much better than I would have.

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And then really thinking about diverse partners in messaging development and so you see on the left. Our infographic on simple steps to a healthy home environment.

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That really tries to give families Actionable Messages and then you see on the right, one of our partners persons new school healthy materials lab and how they take those very same messages.

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And with their data visualization expertise and graphics design expertise, make it look so much better.

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So really looking for partners who can take messages and make them their own were are my good colleague, Dr. Sara Evans is working on p 30 pilot project with Parsons new school on.

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Specifically, specifically with trainees who are data visualization experts to craft report back of emerging research. And so these are, you can kind of see some of the materials that they're using to explain to families what to flood means, and this

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is now being used both nationally and in an international cohort so it's really growing and you can see how it's being applied to Mexico.

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And then lastly, my last examples are thinking about your messaging format so a graphic novel that was designed by Professor Brodsky's of CUNY law school that was then that premiered at the NIH Film Festival so supporting messages that exist and broadening

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their reach through their audiences, and even coloring books. So thinking about things that reach audiences that are even younger and one other tool that we're working on is a virtual reality video game which is super cool so we're excited when that'll

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be final to be able to share with folks in the educational community.

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For more information you go to go these resources and social media handles, I'm grateful to our supporters, and thank you for your time and listening, and we're open for questions now.

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Thank you so much wider and Joseph that was really great to hear about all the wonderful products you have created by such diverse audiences. I also really enjoyed the simple message guidance and and what to work towards on those, those those hard to

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develop quick messages.

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So thank you again, we do have about 10 minutes for questions. I did want to start by, we had a question asking about all those resources, how to get their hands on those resources and we do have on the webinar homepage, several of those links are available

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in the additional related link. They also are on the slides, there's a PDF of the slides posted there as well. So, for people who are looking for those resources, that's where you can find them.

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So let's get started with some questions.

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The first question I have here is any.

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You want to provide any communication risk communication key lessons learned from your audience.

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When you were developing those messages.

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For us, you know, we really benefited from the partnerships.

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You know, just having so many different folks involved from the editor of the AP handbook on pediatric environmental health to somebody from the Department of Health and formerly around the healthy homes program to our community partners across, you know

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the regions that we mentioned you know that collective input, quite honestly In the beginning we were overwhelmed.

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Sort of like, Oh, where, where do we start, but having sort of designed by committee, really helped us hone down on sort of what we can tackle together first, and then

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really sort of set the stage for future dissemination, because then because they were involved from the get go, they were able to sort of say okay this is how I'm now going to take them and use them which is kind of amazing we're excited that it is in

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use more widely.

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I think family input is really important and then and then checking with families regularly as well so focus groups were held with families, and healthcare professionals to ensure that the language was correct and like I said, that's something that we

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are constantly working on and never consider a product final thinking of these different audiences and stakeholders. So what are some strategies for messaging when the needs of the various stakeholders or communities may seem to be different.

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So for example, a family may be adamant about testing for heavy metals, but the health care providers main priority maybe risk reduction or easing the family's concerned.

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So what, what have you done there, or what are some strategies you have.

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That is a really good question and is sort of a really the crux of the challenges and risk communication and I think that one of the things is to really be open, honest and transparent about what we know and what we don't know.

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And I think that when you do that, rather than sort of overstating or understating findings, I think, families, definitely appreciate and trust the message that much more than sort of like the off handed.

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Oh, it's fine. Right.

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And and and so much and environmental health is so much more nuanced than that. And threading the needle on the nuance is super challenging. And I find that oftentimes we can miss, while a community meeting can be highly effective sometimes the nuance

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misses the mark in those community Miss meetings and sometimes sort of like a more intimate conversation where you can really walk a family through what those nuances are and why the science is, is still emerging on some tough issues, and why we're not

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quite where we all want to be in terms of the preventive framework for environmental exposures, but how we can get there.

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Great, I think.

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When I had one thing is, you know, allowing them to see I think our humanity is when answering that those questions right many of us are also parents we have George's as I i understand where you're coming from, like, I myself also have these concerns,

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a way that will also don't either.

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Hey.

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Um, so you mentioned that the prescription for Prevention's are in the electric electronic medical records. So how does that work, how did you get it in there.

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It is a long time.

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The short answer.

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It takes a lot of championing and patients and flexibility, quite honestly to sort of work with what you can when you can.

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So we, we have paper based prescriptions for prevention in the clinic to that a clinician can readily grab if they want, but it's also integrated into Epic's are really identifying who within.

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We use epic at Mount Sinai, which is our electronic medical record.

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But, connecting with those champions and they may not just be the epic champion but sort of health systems champion within your hospital system.

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Who can then connect you to and say this is important we need to do.

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Okay.

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So can you speak a little bit more about strategies to recruit these champions from the target communities that could be helpful in delivering messages and increasing such a great question and there are a lot of different strategies to do this I'll talk

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Such a great question and there are a lot of different strategies to do this I'll talk about a couple one we have something called an environmental health Scholars Program here at Mount Sinai, that through our nice check Center, the New York State centers.

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It funds a portion of time at our partner centers, and it's it's a specifically to fund them to help advance this work in their clinical setting, and that could that time could be 20 to 30% of their time and so there are trainees, potentially existing

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at your, your academic institutions your hospitals your clinics or Cabos, who's who you could perhaps sort of specify to say okay we want to first tailor this prescription for prevention, specifically for asthma right and so really thinking about the

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lowest hanging fruit. The, the local community resource that you have that you can refer to.

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So that's one way sort of figuring out who the champ the clinical champion sometimes they come to us, we debate you know they just randomly, reach out to us.

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There are summer training programs.

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So for example, our nice check center runs a summer training program for college students medical students, residents. And that's another way to build that pipeline of future champions and IE HS is it, you know, last year, was it last year put out the

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RFA for the environmental pediatrics fellowship program. And so whoever whatever centers get awarded potentially have clinicians that that could have time to champion this type of work locally.

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So I think those are those are sort of the ways that we've identified champions. The other thing is, medical students and mph students who have practiced them time, and are really interested in this kind of work that's focused on prevention.

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It's an amazing way to get a project launched, and oftentimes have funded summer protected time, and are looking for projects and so I encourage folks to connect with trainees who are looking to partner and these efforts.

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Right. Well unfortunately we are out of time and we got a ton of really great questions, so I encourage you to to have a look at those questions, feel free to answer them privately via the chat.

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If you want to will also be sending those to you afterwards so for everyone who did provide a question if you did provide your name we can provide those to Micah and Joseph after the fact and they can get in touch with you.

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There were several questions specific about like, Are there prescriptions for prevention on certain topics like drinking water.

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So if you could have a look at that and if you also want to provide anything for the resources afterwards as well but thank you so much to participants we got a ton of really great questions and I'm sorry we can't continue on, but we do have to move on.

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So thank you again tonight and just for that excellent presentation. It was obviously very thought provoking and we got a lot of really great questions and discussions out of it.

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So thank you again.

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Okay.

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So, it is now time to move on. Next we will hear from Dr.

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Besser or die, doctor, or die is an assistant professor and a researcher at the University of New Mexico SRP center. She also co leads community engagement and dissemination core at the University of New Mexico center for native Environmental Health Equity

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research.

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For more on her bio, please feel free to have a look at the webinar homepage. So as there I will now turn it over to you. thanks again for presenting.

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Yes, thank you. Can you hear me.

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Yep.

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Can you see the slides.

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We cannot see the slides yet.

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Okay.

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Sorry for the technical difficulty.

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No problem. Esther if you need any assistance, just let us know.

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Would you mind sharing my son.

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Certainly we can have our support staff pull those up on the screen for you right now. Thank you.

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So thank you for the opportunity to present to you all.

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I'm bringing you now from New York City to very different part of the United States. We are located on University of New Mexico Health Sciences Center and the UN and Medical Center, which is the abbreviation of metals exposure and toxicity assessment

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on tribal lands in the southwest United States, be located in Albuquerque, New Mexico, and also in over be continuously targeting abandoned uranium mine and file hard rock mine exposures and supporting native communities.

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Can you guys have this like them.

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Okay, perfect.

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So, yes, in, in our area. Then, more than half of the native population in our country are located, and that will still co located and coexist with more than 161,000 abundant hard rock mines features.

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Then we understand are in in direct contact with many of our communities, and on the map and which is provided by in 2017, a very seminal verb by Dr. Lewis and several of 14 members, showing the communities that we are also working with and non IVF focusing

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a lot of these on the Navajo communities. Next slide please.

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And I just wanted to also acknowledge that unite us EPA even 17 years ago 2004, the tribal science council already indicated the difficulty to do tribal types, and they support for environmental health concerns and problems, why they are land base cultures

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that they are frequently in contact with the environment. Also historically and currently I was so targeted and the date of the presence of mining left or right I presented a hard rock mining and also oil and gas industry is continuously in the communities,

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and they reliance on natural resources for day on purpose, and also for maintaining traditional food ice than the traditional diet, and as well. To celebrate do ceremonies costumes and practice language, it's extremely important for done in why in these

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times that the lack of culture is focused and please primary research, especially environmental health concerns lacking. so we target to try to target these questions and problems why we also acknowledge that these governments and the tribal nations are

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start off, times and mean by Next slide please. The also in our work put into a concept and and the balance, which I also added a presentation that was by Dr.

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Gonzalez, she brought this up to June, our presentation of our previous series that we have to understand that the western thinking of board Harvey approach environmental health problem, and also asking people to be participants donate samples for example,

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it always needs to be balanced via the traditional Have you had the community's interest are also in place for that exact purpose and hard also, body and soul as a whole, integrated together in.

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In, or approaching. So, we are not making a decision about what is more important as a personal value rather than supporting the communities, In that sense, we also have to consider a much wider dissemination of not only does the research like we are

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on Harvey communicate but then we create itself the research approach, we have to consider that the study is appropriate for the community. It's also the methodology is acceptable is also understood by the community and AS VAL know deserts are presented

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back and served as needed.

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Also very can be Diaby Next slide please.

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Be understand that many of the, the processes, require longer time. And this also only could be accomplished through a lot of ongoing collaboration and trust building, and I wanted to also point out that the UNM community environmental program health

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program that was funded by dr john lewis already through her trailblazing very hard work, have been over 36 years linked to all these environmental concerns the community applicability also what burden, are the concerns raised to us, and doing this.

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Really bi directional communication, which we also receive a lot of support and capacity building, especially environmental education through the software, Southwest Research and Information Center, and I'm going to use both of the Lucy several of her

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slides and also like from Chris Shuey who are supporting continuously or birth and extend your days to community relations ships. I also wanted to acknowledge their continued support that hit centers and also previously the program by Tony Lewis received

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a lot of support from NIH is continuously supported environmental justice, support and resource research programs Yvi also enjoying a bigger opening for novel birth cohort study being in the NIH echo program.

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This is an, allowing us to follow the children who are born to our number one parent and living on the reservation they also be followed for neurological development and respiratory health and other outcome measures as part of an NIH supported the Office

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of the directors initiative, and part of 55,000 other children forward. So be very also by extending the work of such short in America sky to other communities that they also suffer from environmental injustice, and they concerns they're never really

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God publicity or internet says we have to work toward acknowledging that other communities, also have tremendous metal exposure problem also struggling with providing safe public water source, and we address these through.

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I had success to address these one of these and a large project be trying to pursue and also wanted to acknowledge their native Environmental Health Equity Center, which was already presented by Sorel as well as one of the champions and NIH has support

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program in which we expanded to episode Okay, tried to coordination in Montana, they also had water contamination issues that we trying to address. So, next slide please of monitor focus on the tools, rather than showing results I understand that several

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of the metal exposure potentially a shared interest for us in under on this webinar, but I wanted to share more about the tools that would be very developing because the talking about what I was successful communication strategies, so be used extensively

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maps, one of the reason for this is in rural areas focus you have potentially not needed in New York City for example back into our areas and so still very values they they be are used to using them, and they are accepted tools as at the same time so

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you also show me that was part two facility near project. One of the first publications to be Tufts University to show that the risk mapping is extremely important in rural areas that people also lost potentially historical knowledge there the actual

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besides being located and be also integrate. In that sense, the land use patterns and knowledge aboard, where the community knows there is a certain location what plants are used and these are also incorporate the traditional ecological knowledge we also

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know that these are the traditional cultures are not just paper on one stories The Living experiences and practices. So I've added my new for new newer accomplishments then be added, different level of understanding for mapping, as well, why I'm going

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to also show some of the information that be generally using graphical presentation format. So in that sense. I also showing that this transitioning were applicability to explain in the scientific concept for example, in our studies, what are we doing

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what and why we are collecting samples, but we always use in a graphical presentation format comparisons, so it makes the, the more abstract or molecular events for example here the damage DNA on damaged DNA, more acceptable or easier to follow Yv also

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can present like on the picture results are for comment se and showing high actual measurements of the exposures to estimate trace five carried on in laboratory level.

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Next slide please.

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So it's just one example and I give a big shout out again for for us.

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Mr Shue sent me a slide to show where our location currently in the SI p program, collaborating strongly with Laguna Pueblo on this is to the eastern on right side and then traditionally or be supporting our red water hundred communities in New Mexico

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Mexico side and on newer side a new expanded research by clean 28, and the audience on a site of Navajo Nation.

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meters and blue got 30, and there is also a little information that is US EPA, showing that across Navajo Nation there are 523.

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Uranium mind site features and the various sites or even a larger. So, more than 1100 have a site existence. Next slide please. So supporting the communities, also means that every time we be generated some approaches to estimate this business, as I said,

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as part of the center and Be Heard also Sarah presentation that the center's itself complex multi studies. So in those be explained using graphical format, hide the actual understanding by carrying God's, then the environmental project for example shows

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the mobility of where number uranium are originated from debase get into the water source and also high is dispersed through the vent and other methodological factors, and also understanding how, for example plant uptake could be a mitigating factor which

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was also one of the opportunities we were discussing and suggested as an opportunity for by the tribal communities for the remediation of interest. The next slide please be also.

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Also, are moving not to the novel birth cohort study structure may be explaining, then we do community events and enrollment. Also, as well on discussing the structure of this study, to be able to evaluate battles exposure among the participants.

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What kind of samples we are collecting and what time points. These are happening, the interactions.

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This big clear of what samples are potentially collected and what data is going to be generated. Next likely

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will be generated through these measurement points.

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Participant report back letters that individual used to these are individual report tax avoided by monitoring information and micronutrient values and, and exposure patterns in some sense for 36 medals.

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So let's see this the environmental number two is supported this Burke and all of the information that generated all those us also to create not only just individual values for the metal exposure the portable metals I emphasize the portable means that

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by both, New Mexico State and Arizona State. These four metals are required to be recorded in the medical context, and the follow that guidance as well micronutrient status speech and mentioning also later, zinc, is very important potential mitigate or

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that allows us to evaluate also later and north, si p center other clinical trial. So besides of the participants own research, we generate and the community specific values as well.

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And also adding the national dress, what are the dangers that were generated using the national health and nutritional Examination Survey. The Sony to comment on that that that's where the, why is it very representative and carried out by the center offset

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health statistics at CDC, since 1964, it does not include any tribal lands, or any tribal communities target ugly enrolled for any metals or other organic chemical exposure evaluation.

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So, next slide please. Ben.

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No pressure on the individual letters sent out the also aggregate information by the cohort, which includes the community situation. And then here aggregate data by the participant types of mothers, fathers and two children and across the exposures that

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hear is pre selected by showing you're in a uranium levels in Reno, or setting. And these are used also not only to present back to another who IRB Institutional Review Board requires updates on these of progress on me in the studies and on the tribal

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and in any scientific and deeper and work is really on as an aggregate report back also informs which way the project is going and.

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Next slide please. It just shows that the community level of report back is equally important. So, not only in that say in regular clinical trial contacts you only think about informing your participants.

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Here we are also looking at community level of exposure changes or in cross section of sense to see the snapshot of these exposures.

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Using here micro nutrient information and presenting also the way that's represent our communities.

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And using the who sufficiency level, for example, saying, it shows that several of our participants 61% of the mothers were deficient. And so during the pregnancy that could be also physiological change but as well.

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they find lower than the efficiency levels for think about the foster system. So, why is it important is because zinc is shown through or no just literature data by our own college daughter Hudson and Dr Leo professors in our college bench top research

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for date for more than a decade showed that zinc is actually mitigating effect potentially by in carried out. And part of the potential in molecular activation through or inhibition by arsenic, and also uranium.

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So, what we were looking into hard DNA damage could be prevented through potentially appropriate levels and things sufficient level, and again I emphasize here that these are community level values so the individual values that potentially not that are

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reflected by the US this information just to demonstrate the problem as to target, or creation of the clinical trial. Next slide please.

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Again, on the map utilisation in, in that sense, be, and also added a graphical presentation of the information that you use in communication, back to the tribal on orthorexia is also as well use this information for on report back to the Indian Health

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Service Providers and also demonstrate the need to understand environmental exposures overall in the community as home assessment home environmental measures and not part of any ways, the care in, in that sense, and don't know communities.

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So, I'm Dr. Karen God, the measurements and I need to also acknowledge the 22 metal measurements on the dust which is in the map now showing the red spot then on or the reddish color more than for metal securing these homes.

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They're part of again done on the Navajo birth course study, and the role of participants and the home. Dust presents a certain aggregation and pattern on the Automat why on the right side, showing the uranium unary uranium, then high levels and lower

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levels. All on that almost equally distributed across the clinical sites. So that means also that work is not only looking for potentially hotspots in exposure rather than being need to consider the pathways, and also vectors mitigating these exposures

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that although the dissemination of these material potentially and exposures that much, much, much more and larger range than we ever imagined or or proposed.

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Next slide please. Showing up participants report back a border home assessment data, and do so in these letters, provide very detailed frequently asked questions and also ideas too hard to decrease exposure simple easily implementable research.

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So, an action items. So these letters were developed rewards, or strong team interaction. We have several individuals over 40 employees or team members who are Navajo on working London on Navajo reservation and spent we spent approximately five months

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months in the bi directional editing editing and tailoring these messages what should be in these letters harder, the frequently asked questions to be framed and what messaging is the best depends on those people to not to be stressed that they're not

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to feel even more upset about exposures that they potentially had to deal with or the home contains but at the same time allows them to do changes to have an impoverished themselves be decreasing exposures.

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And I also wanted to give a shout out, and thanks for the opportunity to collaborated on and Morty experts on center calculus Expo Center and Dr. Pearson and Amber Heard.

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Just a group.

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We also be done.

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Dr yeltsin from the USC SAP center and also from Dr. Jensen from Iowa, because the third very stronger boy, to summarize the understanding hardly put backs, our country concerning for us as a field and individuals who are engaging in these communities,

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and any, especially environmental injustice communities, these communications are really important to be happening and the V that's provide support and I didn't stress out and more.

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Next slide please.

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So as I mentioned earlier, our MSRP clinical trial by project.

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Me understands and would like to get your information aboard hot community consoles and bench top research could be integrated and in that says testing a mechanism based risk reduction strategy in only among healthy adults who are older than 18 years

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of age to 64 so we also adjusted the enrollment strategy and the sample means some sense the outreach directionality includes both participants males and females in Next slide please.

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We are also promoting. In that sense, an understanding of heart, the molecular mechanism by either creating their clinical trial and discussion and getting approval is through the chapters that be collaborate being on the user so Mallory Pataki who is

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artist residency feeding or SRP program to show using image Lee, which is really meaningful and traditional to the community, but Mallory herself also a biologists and chemists so she has a so intricate understanding to integrate these just that kind

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of middle middle painting here sewing hi to the zinc is able to mitigate the damage to the DNA, then carried out or happening by this borders, the metals, and I love it I saw her approach integrating both medicine bill gets used in our Great Plains area,

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and also be done, the Navajo vetting basket that provides happiness and prosperity for the family. Next slide please. We understand that it's very overwhelming and, and it's hard to explain every step of the project but we do have to part of clinical

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childbirth, is to engage the members of the tiling as a community to support is to have on excellent artists team we have excellent support, also for that explaining all of these in Navajo language.

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So, it

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is vital for experts on this and is supported by David PK also part of a team of the post so I wanted to show this not only just the timeline may be following the participants but the V have your sample again it vehicles so being complexity of the individual

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report back smell of the community report back that it's needed and require. So, next slide please. That's some tasks that we are working up, and I'm very happy to also report about that even during the pandemic we have a lot of interaction good leadership

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so number who Health Education and Human Services Committee frequently asked, or input as the center, and the risk communication informs really the tribal policymaking.

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And that's something that be the thrive for all these times to to fulfill this is not only just a mandate, it is or or important contribution to, and also respect for all those individuals who participate and support the river.

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What console delegates visiting with us, and I'm Dave also informed it successfully also open up and continue even during the pandemic this clinical trial, we make it very important for us to be present and support community risk mitigation and potentially

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we are hoping that the clinical trial be research in good health outcome measures. Next slide please. Just wanted to also close with pictures on not participating tribal communities, and I would be very happy to answer any questions you have.

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Thank you very much.

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Thank you so that was a really excellent presentation and great to see all the great work that you're doing and loved all the graphics that you that you have developed through your program.

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So, starting with that I actually have one question about that. So I'll start with that one. I really liked the graphics that incorporated tribal artistry.

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Um, can you talk a little bit more about, like, so you worked with the tribal artists on those graphics, or just thinking that that's a great way to involve and hire locals and the risk communication efforts.

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So maybe how that went about sir Mallory could talk to his partner for center. She is artist in residence. She is also as I said she has her bachelor's degree already in sciences, so she has bought two videos to two eyes on both is hard to interpret difficult

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very difficult scientific problems so toxicological approaches, so she herself and artists she's.

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Many, many of our tribal collaborators do for example jewelry very Mallory's excellent in drawing, painting, and so she is the one who, who, through all of our discussions, you always participate she understands and then she creates the imagery that her

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understanding, and then those are tested and community meetings, and people comment on those and they are sometimes they say oh well I don't understand why do i do think that flavor, but it is a back and forth so that's what I want you to also emphasize

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that we do have really excellent open and continuously ongoing communications and every piece of this large center it seems like a really enormous task but every piece is tested, and also got feedback from communities.

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Great think that sounds like a really good process to work with the community on.

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So there were a couple questions about the community level report back.

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So the first one was how into him was community level report back communicated. And what did you learn from that experience, so I know you talked about that a little bit but is there anything you want to add to that.

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Yes, so one part of that is mandatory so in that sense the IRB process of Navajo Nation to protecting and following all of the science is in that boiling and involved Navajo communities requires us to present back.

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So that's part of the squad quarterly report but we also have annual presentations that we spoke about with the progress. So in those we develop specific imagery, so make it easier for us to attend the presentation flows better so it's not know all the

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details but there but community that community aggregated data is nicely presented. So that's fantastic. And I'm also starting to communicate all these with the medical community the Indian Health Service will be very strongly collaborating and even the

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reporting back to old partners who are doing laboratory for on the samples because the process and the use of clinical facilities to Android the pregnant mothers that event demands.

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So they be also communicate to the lab, lab partners and technicians or what happened to the samples here I'm here is the information that we generate, and that's also brings a different involvement and excitement and they participate much meaningfully,

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we had very good success with that as well, to help boards, for example in the GTA area. The, the chapter had their habits serves 25 chapters, so each of those types of participating chapter representative could have questions and they usually asked me

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what participants are formed a chapter I doing, and how that happens. So we go on and, and, of course, we had to protect privacy. That's my emphasizing the aggregated information is extremely important because it's informative and factual but at the same

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time it's not individualized, but every participant receives also they research individual email to them.

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Great.

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So did the highly technical scientific aspects of the study encounter any conflict with the traditional indigenous or tribal concept, but something that you had to deal with.

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Sure.

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I think it's a very exciting project so he the research because BBI learning so much about bodies in the science that really do the easily acceptable.

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We had some questions for example on hobby using the blood samples, and then I usually present some of the data did I generate my own samples or bV have people who are donating for us and and that's a DC that we are not using these samples to test certain

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protocols or based them rather than we are ready to understand the process that's ongoing. So health outcome, as well as I mentioned we enjoy collaborating with CDC.

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So, it is important that they understand that all of the samples side on their standardized quality control process that it's really Val oversold and documented, so no samples arrested or tested on.

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Hey.

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So what community input Do you or your team seek before you plan a risk assessment or risk evaluation project.

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Yes, sir. Well first of all, to understand hot, the exposure assessment could be carried that, for example, some of the survey developments that went into the original project since we started on took several almost years to develop the questions and

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actually the wording of deals, so we can be sure that we generated the appropriate responses and information through that. So we are not off based on what I do, their actual concerns and hot.

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Also historical exposures, for example, needed to be addressed in those surveys. So that's one aspect that we always get input on how do they go ahead.

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Well so creating the measurement tools, but of course the first and foremost is to see if the community is willing to collaborate. That's also required in the IRB process, you need to submit documentation that the chapters for the communities where approach,

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and what process documentation went into that. So, we usually have more of the questions or how actually enrollment are going to happen if people would be burden for example to travel somewhere.

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So that's my these are more technical logistic issues that the communities are also interested in. So we see how that works best and be always accommodate individuals to event to come to the University, if they have things to do in Albuquerque.

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So we always promote or our verbs and tailor it to get to be receiving and getting the best and easiest participation.

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Great, well thank you so much and thanks to everyone we did get some additional questions but we will have to move on and it's time for our third presentation but thank you for that excellent presentation and we'll be making sure to send any additional

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questions to you, And you can follow up with those people individually.

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So thank you again.

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Great, thank you.

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So, next.

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Let me move. Okay, so next we will hear from Dr. Rachel Morel approach an environmental health scientists and professor in the Department of Environmental Science policy and management, and the School of Public Health, UC Berkeley.

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You can read more about her on the registration page. So Rachel thank you again for presenting today, I will now turn it over to you.

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Terrific. Um,

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I see me in presentation mode.

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Yeah. So you can see just slides right.

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Yep.

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All right, so thank you to those who have stuck it out to the end, hopefully, what I talked about today will be useful and it was great. I feel like I have big shoes to fill.

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Thanks for the excellent talks from my colleagues ahead of me.

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So today I wanted to talk a little bit about the mechanics, rather than showing you the tools, I'm going to sort of show you some tools. But I want to get into the mechanics of thinking through how we engage communities and or study participants when

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we develop some of these tools to convey exposures and risks, and the extent to which they can be leveraged to move scientific discovery to action.

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So, one of the premises that I like to emphasize, when we think about community and participant engagement and research translation or, or what I call toolmaking is that it promotes the three R's.

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So, it can enhance the rigor of the work that we do in terms of how we design these tools and materials, the data that we collect and use as inputs to develop the tools or report back for example, engaging communities and ground truth in some of these

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results. To See also where data might fall short, or where we want to fill in gaps, if possible, and then how we interpret that information.

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Then relevance thinking about community engagement really, I think helps us and forces us to scientists to think about fundamental causes of exposures and opportunities for action and I would emphasize both individual level, but also opportunities for

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collective action because very often, as I'll talk about in a bit.

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When we report back results, or people often, you know, get a little frustrated because you know many people actually try and avoid exposures. And yet you know we do things like bio monitoring people discover that despite individual action exposures continue

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continue to occur. And then finally, how do we advance and disseminate the knowledge gained by these tools to push for policy change. And, yeah, I think about my colleagues, prior to me about so really touch on this really nicely so the roadmap for my

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my talk today so I'm going to be talking about three kind of examples. So one is a spatial cumulative impact screening tool. The second one is an online tool that's in the process of development to visualize sea level rise threats to ej communities in

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California.

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And the third is a individual level digital report back tool for reporting bio monitoring results to study participants. And I had a fourth but I don't have time but one that has been funded by the super fun Research Program is a drinking water tool that

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we developed that we have presented on this before so that's why I'm not talking about it today but I'm happy to provide more information on it. If you should wish to get that, as well.

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Okay.

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So,

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as was alluded to prior to today is that you know the research and this scientific discovery process is very iterative and slow.

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And yet communities and study participants, often want information now. And so the tools that we develop, you know, the goal is to leverage the existing scientific evidence to, hopefully, facilitate interventions or elucidate opportunities for individual

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level exposure reduction in to inform decision making. So, online mapping tools for example, can highlight communities of regulatory concern. It can inform how we target, or develop holistic strategies that reduce harmful environmental exposures and in

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the case of the tools, I'm going to show you today advanced environmental justice, and then digital tools for individual report back of exposures again can also do a lot to promote environmental health literacy because they begin to invite a conversation

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when you're returning these results, and you're telling people, for example, what chemicals you found in their intimate environments, whether that's their home or chemicals that you found in their, in their bodies to human by monitoring and again elucidate

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opportunities for individual level and collective exposure reduction strategies.

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So the first example I want to talk about is cumulative impact mapping tool that is now exists in California but evolved over a long period of time, interactively through community engagement and now was being leveraged to inform a lot of decision making.

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So, the California Air Resources Board was which which regulates air quality in California was very interested in seeing whether or not, some form of spatial screening could be used to identify environmental justice communities of concern for air quality

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in the state of California. So we were tasked to help them develop that.

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And, um, but we felt so our team, which included myself and then some colleagues at University of Southern California at Occidental College and.

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In, a coalition of environmental justice organizations throughout the state of California undertook the process of okay so if we were to develop a spatial mapping tool to identify communities that are facing cumulative impact in other words, both multiple

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environmental stressors as well as social stressors. What would be the indicators that we would want to have in that tool, how do we make sure that they're reflecting current state of the evidence and research on environmental and social determinants

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of health. How do we develop indicators are also understandable relevant to different people who would use this mapping tool, including communities, decision makers, the regulatory community.

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And then, how do we ensure that this is going to be useful for things like land use planning or funding allocations or targeted enforcement activities.

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So we spent a lot of time doing focus groups to come up with ideas of great indicators, and then also setting some criteria about ultimately which ones we were going to choose and one of the key criteria were that it had to be based on data that was available

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statewide that data had to be available for free, not something proprietary. It had to be data that could be periodically updated.

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For example, so we had a brainstorm of great indicators, many of which were great ideas but unfortunately there weren't data available to support them but that also kind of helped us narrow it down.

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We took these conversations and meetings throughout the state.

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Just to make sure we were getting broad level feedback that also reflected the regional level environmental and social challenges in different communities across the state.

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So, and then lastly after, I'll show you this but after we develop these maps and we iterative Lee developed them we would engage communities in certain areas in the ground truth of those results, both through, you know, walk through us but also doing

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air quality monitoring and identifying sources where maybe the data fell short and wasn't identifying everything.

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So we settled basically on five categories of cumulative impact and.

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And so those included data sources that got at the proximity, and the location of a multitude of hazards and sensitive land uses.

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Everything from roadways to point an area mission sources. And then, also, data which was very air quality.

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Heavy in the beginning, but looking at modeled and measured air quality data that then we could combine with other sources of toxicity values to create layers of cancer non cancer health risk for example, both from state and national data sources.

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And then Social and Health vulnerability metrics mostly from the American Community Survey. And then, excuse me, indicators of climate change vulnerability, looking at for example heat island risks proportion of elderly living alone, places were projected

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temperatures were expected to increase both nighttime and during the day.

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And then drinking water indicators, which then subsequently became basis for a separate tool that we developed it I'm not going to talk about today but our drinking water tool.

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So we developed this and ultimately after several years of work together created what's called the environmental justice screening method.

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And these sort of again create a cumulative scores based on these buckets that I just described.

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This is the San Francisco Bay area that you're seeing here on these maps, and you can see how the different layers of these maps change depending on which bucket you're scoring.

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And then the one on the lower far right the cumulative impact score combines these into one cumulative impact score. And then we spend a lot of time as you can see by this picture on the right, trying to ground through some of these results in different

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parts of the state through a variety of strategies.

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So, this, this tool then was well timed because California passed a climate change Lon 2006. And one of the things that was part of that law was that we had to all of a sudden industry had to pay for something it was able to do for free, which was in

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that greenhouse gas gases.

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greenhouse gas gases. And so the regulated industries now had to purchase allowances through a cap and trade program. And a lot of those funds were going into California is general fund.

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And so environmental justice communities, helped push through some legislation which ensured that a huge proportion of those cap and trade monies were went into something that's now called the Greenhouse Gas Reduction Fund.

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And so the Greenhouse Gas Reduction Fund was geared towards state programs that reduced pollution and greenhouse gas emissions in disadvantaged communities in California, and it had to enhance the CO benefits of greenhouse gas reductions.

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So 35% of those funds had to benefit vulnerable groups, and 20% and now it's even higher it's closer to 30 35% have to be invested directly in those neighborhoods themselves.

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And so all of a sudden this tool that we developed the environmental justice screening method was became sort of a foundation from which the state could build their own screening tool.

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Because now we needed a tool to identify those communities where those greenhouse gas reduction funds should be invested based on these goddesses for the allocation of these monies.

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So, our environmental justice screening method became kind of a foundational source for what is now known as Kalin by rho screen, we collaborated a lot with Kelly Ba, to, to, sort of, enable them to create their own method.

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And, as many of you may already know that this is now used to help direct the investment of these greenhouse gas reduction funds in what are known as disadvantaged communities.

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And they've actually just, and they intuitively updated but there's a lot of community investment in this column viral screen because they used, you know as kind of a starting point.

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This environmental justice screening method that we develop that had gotten a lot of community out input from the start. And now Kelly ba does an amazing job of doing a lot of community consultation.

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Every time they're updating on this Kalyan virus screen method so they have just finished actually updating to a 4.0 method.

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And, and these are the kinds of programs that the Greenhouse Gas Reduction Fund has been investing and there's been about $11 billion appropriated to date.

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Every year they do a report of all the different kinds of programs that are being funded throughout the state and both communities and municipal governments and NGOs can apply for these monies for different kinds of projects that satisfied the guidance

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guidelines of the greenhouse gas reduction funds.

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So the next example, um, I wanted to provide here is one that's currently in development.

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It's not.

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It's, it's not available online yet. This is a project that is actually partially funded by the greenhouse gas reduction funds through the Strategic Growth Council.

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And this is our project called toxic tides, where we're trying to understand and predict sea level rise in potential threats to hazardous sites in environmental justice communities in California.

486
01:30:01.000 --> 01:30:07.000
And so, we are interested in looking at.

487
01:30:07.000 --> 01:30:11.000
To what extent can we see and provide.

488
01:30:11.000 --> 01:30:28.000
Look at an environmental justice analysis of flooding threats associated with sea level rise in our coastal communities. And then also develop some tools, again in collaboration with community and ej partners, online tools that can inform resilience planning

489
01:30:28.000 --> 01:30:44.000
in these coastal communities that are likely to face significant threats in the near future, due to sea level rise. So, we're, we started. We're doing this in California and we're actually going to be expanding this work throughout the throughout the

490
01:30:44.000 --> 01:30:54.000
country and coastal communities throughout the country. But the goal is, and these are our collaborators here on the left, psi KSR Los Angeles.

491
01:30:54.000 --> 01:31:04.000
West Harlem Environmental Action that has Asian Pacific environmental network, and the Central Coast Alliance for sustainable economy and Public Health Institute.

492
01:31:04.000 --> 01:31:19.000
So we've been effectively developing this online tool that will be released at the end of the year, to really characterize the numbers and types of hazardous facilities that are threatened by flooding.

493
01:31:19.000 --> 01:31:40.000
And I'm also trying to get a better handle of what are those community characteristics of the neighborhoods that are proximate to these hazardous facilities that are likely to face sea level rise threats.

494
01:31:40.000 --> 01:31:42.000
So here's an example.

495
01:31:42.000 --> 01:31:59.000
This is kind of a goofy screenshot here, where the again this is the San Francisco Bay area but what you're seeing here is a map that shows different facilities types.

496
01:31:59.000 --> 01:32:18.000
So the colors represent facility category. And so you can see we have everything from power plants to animal operations sewage treatment facilities hazardous waste treatment facilities try facilities landfills cleanup sites including Superfund sites refineries

497
01:32:18.000 --> 01:32:33.000
fossil fuel ports and terminals and oil and gas wells because we in California. We have a lot of oil and gas production and some that many of these wells are in coastal areas, and some of them are active in, and abandoned wells.

498
01:32:33.000 --> 01:32:37.000
So, the colors represent a facility type.

499
01:32:37.000 --> 01:32:49.000
And then you can click on a project and see a baseline for 2000, or you can project you can look at sea level rise projections for 2015 2100 what you're looking at now is 2100.

500
01:32:49.000 --> 01:33:02.000
And then the size of the circle is the anticipated number of annual flooding events for that particular facility in that projected year period so the larger the circle.

501
01:33:02.000 --> 01:33:09.000
The, the larger number of predicted annual flooding events that are likely to affect that facility.

502
01:33:09.000 --> 01:33:31.000
And then the other thing that you can see is you can hover your mouse over the facility, and you can get information on that facility, including, and then a link to the US EPA is facilities FRS website and it allows you to get more information about what's

503
01:33:31.000 --> 01:33:36.000
going on at that facility, what do they do what are they produce those kinds of things.

504
01:33:36.000 --> 01:33:47.000
And then the gray squares are facilities that are not considered to be at risk from these sea level rise, projections.

505
01:33:47.000 --> 01:33:50.000
The other part of this

506
01:33:50.000 --> 01:34:16.000
map, also shows the locations of areas where you are expected to have the number of at risk facilities, and then you can hover your mouse over that particular place and find out the number of impacted people and also some demographic information related

507
01:34:16.000 --> 01:34:24.000
to that particular block group that is threatened by a large number of flooding events.

508
01:34:24.000 --> 01:34:29.000
So we've been co developing these maps with our agency partners.

509
01:34:29.000 --> 01:34:44.000
And again, a lot of back and forth in terms of how to make these things, user friendly understandable, and how to also kind of, in addition to providing this granular kind of block level information.

510
01:34:44.000 --> 01:34:59.000
We're having a lot of conversations now about how do we create aggregate information that's also going to be useful so that people who kind of get basic take home messages maybe about what's going on in their county, or what's going on in their region.

511
01:34:59.000 --> 01:35:07.000
So, we're developing some infographics that we're going to have on another part of this site.

512
01:35:07.000 --> 01:35:23.000
And we're also developing some case studies, based on the to give some history about how these facilities ended up where they are. And some of the history about why this is a particular ej community so we're going to be having some tabs with case studies

513
01:35:23.000 --> 01:35:29.000
as well, so more in depth case studies.

514
01:35:29.000 --> 01:35:43.000
So the next example we're kind of moving from online tools to individual level tools for reporting back chemical exposures to individual study participants and.

515
01:35:43.000 --> 01:35:59.000
And I'm so it's great to see what other organizations have done because everyone's trying to figure out how we how to do this and how to tailor work for participant communities which are very diverse and unique in terms of their information needs and

516
01:35:59.000 --> 01:36:02.000
how they take in information and how they access information.

517
01:36:02.000 --> 01:36:13.000
So one example here is a cohort study that we've been leading looking at chemical exposures among women firefighters in San Francisco.

518
01:36:13.000 --> 01:36:17.000
And these are our collaborators, on, on the right here.

519
01:36:17.000 --> 01:36:32.000
This is another kind of cvpr study where firefighters themselves women firefighters in San Francisco approached us to collaborate with them because they were worried about what they perceived to be as elevated breast cancer rates in their ranks and they

520
01:36:32.000 --> 01:36:47.000
were interested in their exposures to potential carcinogenic compounds, on the job. So, we designed an exposure study which includes women firefighters and we are comparing them with office workers who are not first responders, you know, it's kind of

521
01:36:47.000 --> 01:36:50.000
a quote unquote control group.

522
01:36:50.000 --> 01:36:52.000
These are our basic studying.

523
01:36:52.000 --> 01:37:10.000
So I'm just going to be focusing on how we have sought to report back chemical exposures to our both our office workers and our firefighters. So when we think about reporting that chemical bio monitoring results to study participants we've spent a lot of

524
01:37:10.000 --> 01:37:27.000
of time doing focus groups interviews in prior studies and a lot of this work around individual level report back has been led by my colleagues and collaborators Silent Spring Institute and so the the tools that I'm going to be showing you are based on

525
01:37:27.000 --> 01:37:36.000
this work together, that, that, and that they have been leading the charge on with us.

526
01:37:36.000 --> 01:37:50.000
So, as a result of a large body of research interviewing, participants from multiple studies, including this firefighters study basically these are the kind of basic information people want to know when you tell them when you're returning results to them.

527
01:37:50.000 --> 01:38:00.000
What did you find how much is it is it high, is it safe. Where does it coming from and what should I do.

528
01:38:00.000 --> 01:38:17.000
So, we have, again, in collaboration with Silent Spring Institute and Julia Brody and within rebel, they're developed this digital exposure report back interface, otherwise known as Derby.

529
01:38:17.000 --> 01:38:38.000
And this is a wonderful kind of software framework that's nimble, so that it can be retooled for different needs of participants or environmental studies, it can it can produce personalized reports both for personal devices as well as computers and or

530
01:38:38.000 --> 01:38:48.000
print, and it's scalable to studies of all sizes, and we've written a lot about it so we're happy to provide additional resources and papers for you to read about it.

531
01:38:48.000 --> 01:39:03.000
For the firefighter study this is kind of a screenshot of what their landing page looks like when they get an email with a link, and a code to begin to access their individual level results.

532
01:39:03.000 --> 01:39:07.000
This is what they've, what they first see.

533
01:39:07.000 --> 01:39:25.000
And then they can get sort of these high level take home messages. So we took we tell them like what are the chemicals that we found in them. And we also highlight when they had either higher levels of the chemicals that we tested for higher compared

534
01:39:25.000 --> 01:39:43.000
to other study participants, or higher as compared to enhance for example again trying to kind of give them the high level messages and then opportunities to dig deeper also given that it takes such a long time to sometimes do all the lab work and get

535
01:39:43.000 --> 01:39:52.000
back to people, we find that we have to remind them of what the original studies were by the time they get this information.

536
01:39:52.000 --> 01:39:58.000
So these are kind of the elements of this chemicals page you get a personal headline.

537
01:39:58.000 --> 01:40:16.000
You, we tell people what the sources are, what the potential health effects are, and then tips for reducing your exposures in this case we're providing tips for kind of the average person and then we're also providing tips that are specific to firefighters.

538
01:40:16.000 --> 01:40:25.000
And then the one thing that we did here to develop our prototype and then test it with our firefighters before we came out with our final version was.

539
01:40:25.000 --> 01:40:44.000
We bio monitored ourselves as part of our study group. And we, we sought to kind of go through that process of discovering chemicals in our own bodies, and then thinking about how to develop this prototype that then we sought feedback from our firefighters

540
01:40:44.000 --> 01:40:45.000
from.

541
01:40:45.000 --> 01:40:49.000
How much time do I have government it left

542
01:40:49.000 --> 01:41:06.000
Yeah, a minute, a minute sounds great. Thanks. Okay, great. So, um, this is ultimately kind of what it looks like we're we're providing this this information and the orange.is the individual participant and then they are compared to the 95th percentile

543
01:41:06.000 --> 01:41:25.000
for at Haines and the median for in Haines. And then these are for p fast. So, in other words, trying to give people the gist of where they are in the distribution amongst or other participants and also for general US population.

544
01:41:25.000 --> 01:41:38.000
Um, so, we're now re adapting Derby for pregnancy cohort very different population, for which we've tested for chemicals during the second trimester.

545
01:41:38.000 --> 01:41:48.000
And we did focus groups, and we have also been doing some serving but our focus groups really wanted to understand why are people participating in the cohort.

546
01:41:48.000 --> 01:41:58.000
And then also what thoughts they have around collective action because as I mentioned, a lot of people like you. They work very hard to avoid chemicals and they still get exposed.

547
01:41:58.000 --> 01:42:11.000
So, we have been doing a lot of retooling and now we're using this with a smartphone interface because, in this case our participants are more likely to get information through smartphones.

548
01:42:11.000 --> 01:42:25.000
So you can kind of see what it looks like and much, much different, but again same software framework, but adapted for a, an iPhone interface or smartphone and.

549
01:42:25.000 --> 01:42:32.000
But again, kind of similar idea, comparing people to N Haines seeing how their they compare to other people in is in the study.

550
01:42:32.000 --> 01:42:45.000
And then we're also trying to give them opportunities not only for individual level action but also Community Action, where they can get involved on reducing chemicals, making it clear that their ability to control their exposures.

551
01:42:45.000 --> 01:42:52.000
There's a lot of things you can do, but there are some limitations and that really reducing exposures is going to require collective action.

552
01:42:52.000 --> 01:43:07.000
So I just want to end by saying that you know these tools development in order for them to be effective and be taken up community engagement is really key in terms of also democratizing the scientific enterprise, and also leveraging these opportunities

553
01:43:07.000 --> 01:43:25.000
to enhance environmental health literacy and move science to policy action. And our goal is to get more from translational research to transformational research as we enhance the level of community engagement and promote participatory science, both in

554
01:43:25.000 --> 01:43:31.000
the science itself and the development of tools, and that's it. Thank you.

555
01:43:31.000 --> 01:43:45.000
Thank you so much for that great presentation that was great to hear how how your work, some really fun maps, and report back data and how your works being used for policy and report back so thank you for an excellent presentation, we have had a bunch

556
01:43:45.000 --> 01:43:46.000
of questions come in.

557
01:43:46.000 --> 01:43:58.000
So I'll start with any plans or ideas for how regulatory or public health agencies might be able to use the toxic tides map or info for decision making.

558
01:43:58.000 --> 01:44:00.000
Yeah.

559
01:44:00.000 --> 01:44:18.000
So there's a lot of interest in the toxic tides map because I'm the Strategic Growth Council and the oceans protection Council and other agencies in California have been doing a lot of resilience planning work.

560
01:44:18.000 --> 01:44:25.000
And there's also a lot of regional effort to do resilience planning to be thinking about future land use decision making.

561
01:44:25.000 --> 01:44:37.000
And then there's also some legislation that is kind of winding its way through our legislature to promote and fund.

562
01:44:37.000 --> 01:44:49.000
Local and municipal level resilience planning and so these kinds of tools are a lot of governments at different levels are really clamoring we've been getting a lot of inquiries because they're, they really want to see our maps we're just trying to make

563
01:44:49.000 --> 01:44:53.000
sure it's, it's ready for prime time.

564
01:44:53.000 --> 01:45:05.000
So yes there's, there's a lot of eagerness, and also a desire to also enhance those maps with as better data become available.

565
01:45:05.000 --> 01:45:17.000
Great. Another question about the map. So how do your live data displays, such as the maps of easy conditions, deal with areas of highly variable demographic data.

566
01:45:17.000 --> 01:45:23.000
For example, homeless homeless populations are seasonal workers.

567
01:45:23.000 --> 01:45:28.000
Yes. So, that is a great question. Um.

568
01:45:28.000 --> 01:45:49.000
So right now, this is an important hole that we have are still struggling to fill is how to better capture extremely marginalized populations that fall under the radar screen, both in terms of being under counted in the census, and imprecise information

569
01:45:49.000 --> 01:45:55.000
about where these communities are are living.

570
01:45:55.000 --> 01:46:13.000
So, we have been trying to kind of fill some of these holes through local knowledge, just because we know that the federal and state databases are kind of missing the mark on this one so it's been kind of a piecemeal approach to fill in with more localized

571
01:46:13.000 --> 01:46:22.000
information about where those communities are located and living and working

572
01:46:22.000 --> 01:46:23.000
great.

573
01:46:23.000 --> 01:46:38.000
So thinking about the firefighters study is the online tool for report back the only is the online tool, the only way that they become aware of their results, or do you also mail a letter or follow up via phone calls, how, how do you report back to that

574
01:46:38.000 --> 01:46:39.000
group.

575
01:46:39.000 --> 01:46:49.000
Yeah, so, um, this online tool allows us to see a lot of things so we get to see when people that weather and people opened up their results.

576
01:46:49.000 --> 01:46:59.000
We also get a sense, we can also track where people are spending time on the website, which has also been super useful for us as we kind of keep retooling and improving what we're doing.

577
01:46:59.000 --> 01:47:05.000
And then the other thing that we do is every time we do a wave of results return.

578
01:47:05.000 --> 01:47:21.000
We generally plan and have a community meeting, that's open to study participants, but also the communities that they represent so often you'll have firefighters who weren't necessarily in the study, but who want to find out what we found out.

579
01:47:21.000 --> 01:47:27.000
And then for those folks who don't want to get stuff on the computer. We can send them paper.

580
01:47:27.000 --> 01:47:40.000
If they prefer so we follow up for people who haven't opened their results to make sure they know they got them and if they don't want to look at them on the computer, we can get them print.

581
01:47:40.000 --> 01:47:42.000
Okay.

582
01:47:42.000 --> 01:48:00.000
So there were a couple of general questions about report back methods as well. So one was how our report back methods influenced by the funding source for the health study. Um, well we've been fortunate in that we've gotten information from me Sorry funding

583
01:48:00.000 --> 01:48:21.000
I mean sorry funding through the for the firefighter study and. And now for the pregnancy cohort study those funding sources are from the California breast cancer research program for the firefighter study and then from NIH echo program for our report

584
01:48:21.000 --> 01:48:24.000
back for the cohort study.

585
01:48:24.000 --> 01:48:28.000
So we haven't they haven't.

586
01:48:28.000 --> 01:48:36.000
They're interested in sort of seeing the end product they haven't really engaged us in a conversation about how we're doing that for our messaging.

587
01:48:36.000 --> 01:48:53.000
We tend to, you know, test our messages with our study participants to see what's working and what's not working and then we do usability testing with prototypes, before we kind of finalize, which is sort of an iterative process where you're asking someone

588
01:48:53.000 --> 01:49:05.000
to kind of go through the instrument and you, you, you ask them a series of questions to make sure the messages that you're trying to convey are getting through, or if people can identify things that just like they don't understand it, you can find out

589
01:49:05.000 --> 01:49:07.000
about it and try and make it better.

590
01:49:07.000 --> 01:49:18.000
So that's kind of been what has influenced what messages we lift up and how and how.

591
01:49:18.000 --> 01:49:28.000
Great. And so, what has been the biggest challenge for engaging stakeholders. When you've been developing these tools.

592
01:49:28.000 --> 01:49:48.000
Um, well for the individual level report back I think one of the biggest challenges is that you try your best to set expectations when you consent people into your study you tell them that you're going, that if they want, you can make their results available

593
01:49:48.000 --> 01:49:57.000
to them. And I would say, well over 95% of the people when you give them the opportunity to get the results they definitely want them.

594
01:49:57.000 --> 01:50:12.000
And I think the key is to always be setting expectations that no matter how hard they try, when we go and do bio monitoring we're going to find chemicals, and then you return the results to people and, and we provide contact information so people can

595
01:50:12.000 --> 01:50:26.000
reach us and ask questions and we can. And so, you know, I, I follow up with a lot of study participants who have questions, and usually the biggest thing is like, I try so hard especially you know for example with mothers are assumed to be mothers.

596
01:50:26.000 --> 01:50:40.000
I try so hard to avoid chemicals and I, it's just so frustrating that I still have chemicals in my body so that's where I'm kind of grateful where like we did some self bio monitoring kind of went through that process, ourselves, and we can have that

597
01:50:40.000 --> 01:50:57.000
conversation about like look I do this for a living, you know, and you could my results I practically got the prize for some of these chemicals and I have no idea how I'm exposed so individual level action is important, and can go a long ways towards

598
01:50:57.000 --> 01:51:11.000
reducing your exposures, but there are certain limitations and you really can't blame yourself for the fact that you still have chemicals in your body or your child may have chemicals in their body and so that requires like really thinking more broadly

599
01:51:11.000 --> 01:51:25.000
more systematically about collective action. What's some of the good news, you know changes around flame retardant laws and things like that and they start to realize this is just bigger than me doing a good job at reading labels and shopping my way out

600
01:51:25.000 --> 01:51:33.000
of the problem like that's those are good things but that's not it has to be coupled with other kind of more collective systematic change.

601
01:51:33.000 --> 01:51:42.000
So that's where the environmental health opportunities for environmental health literacy conversations come in, I think.

602
01:51:42.000 --> 01:51:57.000
Great, well thank you so much for that excellent presentation and it is now time for us to wrap up. If everybody will stick with me for three minutes, we'll just quickly go through a few items to remind you about resources feedback and all the links,

603
01:51:57.000 --> 01:52:00.000
but thank you again Rachel and thank you to all of our presenters today.

604
01:52:00.000 --> 01:52:13.000
So before we conclude let's take a quick look back at the seminar homepage. This will be active From today on, it contains the presentation materials, including links that were in the slide contact information for speakers if you have any follow up questions,

605
01:52:13.000 --> 01:52:27.000
questions, and a link to our feedback form, we ask that you consider filling out the online feedback form we love to get your comments and we want to continue to improve the content and delivery mechanisms for the so please consider filling out that feedback

606
01:52:27.000 --> 01:52:27.000
back form. You can also request a confirmation email from the feedback page as a record of your participation in today's event.

607
01:52:27.000 --> 01:52:40.000
form. You can also request a confirmation email from the feedback page as a record of your participation in today's event. I also want to remind participants have a few ways to stay connected to ensure you don't miss any webinars.

608
01:52:40.000 --> 01:52:44.000
For more information on EPA Clinton webinars, please refer to Blue and.org.

609
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610
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611
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For information about upcoming sessions. You can also follow SRP on Twitter.

612
01:53:01.000 --> 01:53:11.000
I'd like everyone to encourage us one more reminder to join us for the next three webinars in this series, they will be on October eight October 20 and October 22.

613
01:53:11.000 --> 01:53:24.000
And if you go to the link to each registration page you can get a short description of what those will be about our next session will be October, eight and it will focus on designing and framing communication messages so that they're sensitive to the

614
01:53:24.000 --> 01:53:34.000
cultural and social context of communities, and efforts that aim to combat misinformation and mistrust when communicating health and environmental risks.

615
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So please, we encourage you to register for those now. And if you cannot attend our archives will be made available after the events. So you will be able to check out those recordings, as well.

616
01:53:44.000 --> 01:53:53.000
So with that, it's time to conclude today's webinar, if you submitted an online question and we did not have time to get to it. We will be passing those along to presenters.

617
01:53:53.000 --> 01:54:02.000
You also have the presenter contact information as well. If you submitted your question anonymously we cannot provide them with your information.

618
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So if you would like to follow up with them directly. You are welcome to do that.

619
01:54:06.000 --> 01:54:09.000
If you have any additional questions.

620
01:54:09.000 --> 01:54:38.000
Yep, so you can contact them by email or let us know and we can make sure to get those questions to them.