TOWARDS ENVIRONMENTAL JUSTICE AND HEALTH EQUITY

Community Stress, Psychosocial Hazards, and EPA

Decision-Making in Communities Impacted by Chronic
Technological Disasters
Psychosocial stress has Stephen R. Couch, PhD, and Charlton J. Coles, PhD
emerged as an important
consideration in managing
environmental health risks.
PSYCHOSOCIAL STRESS HAS levels, particularly in relation to most obvious source of stress re-
Stress has adverse impacts
emerged as an important consid- conditions of chronic environ- lated to environmental contami-
on health and may interact
with environmental hazards eration in managing environmen- mental contamination, conditions nation and disasters is concern
to increase health risk. tal health risks. This is due to experienced by environmental about actual or potential harm
This article’s primary ob- evidence that psychosocial stress justice communities. The article by emanating from the environmen-
jective was to explore psy- has adverse impacts on health and McEwen and Tucker6 provides tal agent. Less obvious, but at
chosocial stress related to may interact with environmental a review of the evidence in sup- times even more significant, is
environmental contamina- hazards to increase health risk. For port of the adverse effects of psy- stress caused by social and cultural
tion. We hypothesized that example, both psychosocial stress chosocial stress on health and its changes that take place in the
knowledge about stress factors1,2 and lead3,4 have been modifying effect on the relation- wake of environmental disasters
should be used in conjunc-
independently associated with hy- ship between exposure to envi- or contamination. The interplay
tion with chemical risk
pertension, and recent studies ronmental agents and adverse between these 2 causes of stress
assessment to inform envi-
have suggested that stress may health outcomes. In this article, can often lead to disparities in
ronmental risk manage-
ment decisions. Knowledge modify the effects of lead on hy- our primary objective explores the impacts (including health effects)
ofpsychosocialstressat con- pertension.5 The emerging studies concept of psychosocial stress, across communities given similar
taminated sites began by on the potential adverse interac- particularly as it relates to chronic environmental challenges. We
exploring the relationships tions between psychosocial stress environmental contamination. We discuss these 2 key causes of stress
among social capital, collec- and environmental hazards have explain how the presence and/or from the perspective of how they
tive efficacy, and contamina- posed paradigm shifting questions perception of environmental con- may drive stress for the commu-
tion at the community level. for the future of environmental tamination may lead to psychoso- nity, family, and individual.
We discussed stress at the health research and practice, and cial stress in the community, fam- Chronic environmental con-
family and individual levels,
particularly, of how to incorporate ily, and individual. In addition, tamination is used interchange-
focusing on stress prolifera-
psychosocial stress considerations we hypothesize that knowledge ably with the term ‘‘chronic tech-
tion, available resources,
into environmental research, risk about psychosocial stress can and nological disasters’’ (CTDs) in this
and coping styles and mech-
anisms. assessment, and risk management. should be used in conjunction article and refers to conditions of
Wethenmaderecommen- Specifically, for communities con- with chemical risk assessment to perceived or known man-made
dations on how to improve stantly exposed to psychosocial inform environmental risk man- contamination of an environment
the use of information on stress related to chronic environ- agement decisions for communi- that persists over time. Tornadoes
psychosocial stress in envi- mental contamination, assessment ties affected by negative environ- race through a community in
ronmental decision-making, of psychosocial stress in addition mental conditions. Although we a matter of minutes, hurricane
particularly in communities to chemical risk assessment focus on chronic environmental impact is measured in hours. A
facing chronic technological promises to proffer policies and contamination, we note that it is CTD, such as a Superfund site,
disasters. (Am J Public
decisions that are more informed. not the only important source of lasts months, years, even decades.
Health. 2011;101:S140–S148.
Necessary steps toward the prac- psychosocial stress in minority and Wolfe and Schweitzer10 charac-
doi:10.2105/AJPH.2010.
tice of incorporating psychosocial low-income communities, and terized CTDs as complex events
300039)
stress into environmental risk frequently occurs concurrently because such environmental con-
management and research include with other sources of psychosocial tamination is often cumulative;
developing an understanding of: stress, potentially resulting in may be latent and not identified as
(1) how stress interacts with envi- stress proliferation. a problem for several years; has
ronmental agents to influence Studies have consistently dem- impacts on humans that may be
health, and (2) stress triggers and onstrated that the experience of delayed, dynamic, or multiple and
coping mechanisms at the com- stress can vary considerably by certain; and its remediation may
munity, family, and individual race/ethnicity and income.7---9 The be technically, economically, or

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 TOWARDS ENVIRONMENTAL JUSTICE AND HEALTH EQUITY

politically infeasible. CTDs differ Canal, New York and dioxin consensus has not been reached on defines the neighborhood context
from natural disasters (e.g., hurri- contamination at Times Beach, a definition of social capital, it is of . . .‘collective efficacy’.’’14 Col-
canes and tornadoes) in that they Missouri. Many minority and generally seen as ‘‘not a single en- lective efficacy is a subjective, cul-
may not be recognized as critical low-income communities contin- tity, but a variety of different entities tural concept; its measurement is
issues by community residents. ue to experience perceived or having two characteristics in com- best extrapolated from individual-
Acute natural disasters promote known CTDs. mon: they all consist of some aspect level data, such as community
action, whereas CTDs promote of social structure, and they facili- surveys and observational studies.
consideration and uncertainty. IMPACT OF CTDS tate certain actions of individuals Both social capital and collec-
There are frequently no obvious ON COMMUNITY who are within that structure.’’13 tive efficacy deal with issues of
responses to CTDs, and signs of STRESS Social capital in a community can control and, alternatively, power-
recovery are less obvious. Unlike be measured by various commu- lessness. Both have been found to
acute disasters that have an obvi- To understand the impact of nity-level indicators, including in- be correlated (negatively) with
ous ‘‘before’’ and ‘‘after,’’ CTDs stress generated by CTDs within come, employment, housing, crime, community stress and (positively)
can become a part of the context a community, it is important to family type, and networking data. with health of residents living in
of community life.10 Unlike natural assess the baseline conditions of For the cultural arena, we use those communities.14---18
disasters, which cycle through a that community, that is, conditions the term, ‘‘collective efficacy.’’ From this perspective, commu-
set of stages and include a begin- before the discovery of contami- Rather than social capital, which nities that experience the least
ning, middle, and end, CTDs trap nation that predict the impact or refers to structural arrangements stress most likely have a high level
a portion of the population in the experience of stress. We can view in a neighborhood or community, of social capital and collective
‘‘warning,’’ ‘‘threat,’’ and ‘‘impact’’ the capabilities for response of collective efficacy refers to the efficacy. These are communities
stages as illustrated in Figure 1. a community to any type of crisis belief that social capital can be that are stereotyped as a New
Such long-term exposure to as falling into 2 related areas: used effectively for the collective England village: those that have
warning and threat places severe social and cultural. good. In other words, ‘‘Personal effective participatory govern-
demands on the coping resources We can conceptualize the ties notwithstanding, it is the link- mental and civic structures, active
of a population.12 Examples of capabilities for effective coping age of mutual trust and shared voluntary associations, residents
CTDs include the polychlorinated response in the social arena expectations for intervening on integrated by friendship and asso-
biphenyls contamination at Love as ‘‘social capital.’’ Although behalf of the common good that ciational networks, and adequate
economic resources for the com-
munity and its residents. The level
of trust between residents, and
among residents, their community
organizations, and larger institu-
tions is typically high.
By contrast, communities with
low levels of social capital and
collective efficacy are likely to
have ineffective local government
and civic structures in which in-
dividual residents do not have the
opportunity to give positive input.
They lack effective voluntary as-
sociations, or when they exist, they
are isolated from the larger com-
munity. Residents lack positive
friendship and associational net-
works within the community; in
addition, they lack economic re-
sources to meet the needs of the
community and its residents. In-
stead of trust within the commu-
FIGURE 1—Comparison of types of disasters in terms of stages of recovery. Adapted with permission from nity and between the community
United Nations University Press.11 and larger institutions, there is
distrust and disdain, and the belief

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 TOWARDS ENVIRONMENTAL JUSTICE AND HEALTH EQUITY

that people cannot count on each and level of human/technological and what can be expected now contamination itself, remediation
other or on larger institutions to involvement. Unlike hurricanes, and in the future).35 strategies, and how to keep resi-
help them meet their needs.18---24 tornadoes, or industrial plant ex- CTDs often put severe strains dents safe. Conflict often pits
When examining what consti- plosions, ever-present environ- on a community’s social capital neighbor against neighbor,
tutes an effective community re- mental contamination over a long and collective efficacy. Specific destroying trust and alienating
sponse to environmental contami- time adds to community-level effects on community social capi- members of the community from
nation, it is a community that has stress in ways analogous to how tal occur in a variety of ways. one another, as well as from out-
some collective power to decide chronic stressors add to psycho- Local government is likely to be- side institutions, which are per-
on and help implement a course of logical distress at the individual come overwhelmed and unable to ceived as ineffective in dealing
action that will contain or amelio- level. Another characteristic of respond effectively because its with contamination issues.
rate the problem. The community CTDs is that they are not seen as structures are not designed to re- Not all contaminated commu-
creates or maintains social soli- acts of nature or acts of God, but as spond to this type of problem. nities experience this destructive
darity, meets the needs of its human/technological interven- External agencies and organiza- social process. We do not have
members, manages social conflict, tions in the environment that may tions, often with little knowledge sufficient research to know why
and finds and utilizes economic be viewed as significantly or pos- about or sensitivity to the cultural some communities are more re-
and social resources. The com- itively beneficial in some ways to context within which they are silient than others when con-
munity, therefore, can be a major the affected community. This working, enter the community to fronted with environmental con-
actor that, along with government greatly heightens the likelihood of provide assistance. Given this lack tamination. However, there is
agencies, and perhaps industry, social conflict within the contami- of knowledge of the local com- much qualitative evidence that
can effectively combat the physi- nated community between those munity, these well-meaning substantiates the argument that
cal and/or social problems caused who greatly fear the consequences agencies underutilize local knowl- communities with low social capi-
by toxic contamination. of contamination and those who edge and resources that could be tal and low collective efficacy have
see the economic benefits (e.g., helpful in solving the problem and, significant problems responding
CASE STUDY a polluting industry) of being in some cases, exacerbate prob- to CTDs.36
worth the risk. lems within the community by A classic example of the de-
A considerable amount of re- Five main elements for the creating social conflict. In addition, struction of social life caused by
search had supported the conten- unique stressors associated with grassroots groups often form to try a CTD is the Centralia mine fire.21
tion that environmental contami- CTDs have been identified from to deal with the contamination In 1962, a mine fire was discov-
nation is most likely found in the literature.29,30 These 5 ele- problem. These groups mobilize ered burning just outside an east-
communities with high propor- ments can occur at all social levels social capital toward achieving ern Pennsylvania mining commu-
tions of residents of color and (community, family, and individ- their ends and can help a commu- nity of about 1000 residents. Over
residents with low income.19,25---28 ual) and include: (1) uncertainty nity to gain some control over the next 20 years, governments at
Generally, communities with con- (related worries about the health contamination-related issues. At various levels spent over $5 mil-
firmed chronic environmental effects of the exposure [both for the same time, grassroots groups lion in unsuccessful attempts to
contamination tend to be socio- the individual and possibly one’s may also foster social conflict put out the fire. By the early
economically disadvantaged and children])31; (2) housing and job within a community, further 1980s, at least 7 citizens’ groups
lacking the social, economic, and security (possible evacuation or diminishing the community’s so- had formed in this small commu-
cultural resources to respond ef- the threat of an evacuation, fear of cial capital. These structural nity, each fighting the others over
fectively. In addition, the social contamination from housing or strains and changes often last a what should be done about the
capital and collective efficacy pos- the community, and possible loss long time. fire. Local government resources
sessed by a community is severely of property value)32; (3) social re- CTDs also affect collective effi- were overwhelmed; state and
taxed by the contamination and its jection (social stigma and discrim- cacy. In cases of contamination, federal governmental response
attendant social processes. ination due to coming from a it is common to see the develop- was slow, piece-meal, and disor-
Community stress triggered by ‘‘toxic’’ community)33; (4) media ment of a ‘‘culture of distress’’ that ganized.
environmental contamination siege (how information is trans- diminishes or destroys a commun- In July 1983, a federally financed
and the buffering effects of social mitted about the community, how ity’s collective efficacy. A major geologic study of the fire revealed
capital and collective efficacy has debate about the community is cause of the culture of distress is that the situation was worse than
been well-studied. CTDs are dif- shaped, and how the ‘‘public fear’’ the destructive social conflict that most people feared.37 At that time,
ferent in important ways from angle could be manipulated)34; takes place in many contaminated the fire was burning under about
other types of disasters and have and (5) cultural pressure (conflict- communities. Conflict occurs one third of the Borough of Cen-
decidedly different social and ing public pressures and implicit over issues such as the severity tralia. The study concluded that the
psychological impacts. Two char- social messages about how to be- of the health dangers from fire would eventually burn under
acteristics are paramount: time have, what information to believe. contamination, the extent of the all of the community. At the time of

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the study, the fire was burning In summary, CTDs generate person examines the resources increasing community distress.56
under fewer than 200 acres of social stresses that eventually available to address the event. The Research has suggested that re-
land. The study stated that the fire translate to psychological stress. processes of primary and second- sponders may enhance coping ef-
could eventually burn under 3700 Frequently, when contamination ary appraisal can occur at different forts by identifying resources for
acres of land. Based on these dire occurs in disadvantaged commu- social levels (community, family, coping or by filling in for certain
conclusions, the federal govern- nities already experiencing signifi- and individual),52,53 and resources absentee resources.57---59 Resource
ment passed a special authorization cant stress from other sources (e.g., have to be examined, particularly loss has been investigated using
of $42 million to relocate Centralia low income, high unemployment, personal resources, to understand a valid and reliable instrument60
residents and businesses that violence, crime), the social stresses stress and its impacts on persons. and a general survey.59 Both of
wished to move. Most Centralians caused by the presence or percep- Hobfoll54,55 suggested general these inventories ask questions
left the Borough by the end of the tion of environmental contamina- categories of resources in his con- and have subcategories based
decade; some have refused to move tion add to the complex mixture of servation of resources model. on Hobfoll’s 4 categories of re-
to this day. At the time of this pressures that, in a way analogous These general categories are: ob- sources.
writing, 9 people still live in to allostatic load (McEwen and ject, condition, personal, and en- One of the most important per-
Centralia. Tucker6), overwhelm social and ergy resources. Each of these sonal resources available to
What happened in this com- cultural resources and defenses categories is described in the fol- humans is the quality of their
munity illustrated the social and found in a community. lowing. social networks; good social sup-
psychological impacts brought Briefly, object resources are port is one of the most important
about by CTDs. The controversy CONTAMINATION AND physical objects and possessions moderators of stress.61 Social net-
generated a very high level of INDIVIDUAL AND FAMILY (i.e., house, car, jewelry, clothing, works and social support mecha-
social conflict that shattered the STRESS etc.). These object resources pro- nisms need to be examined at the
sense of community felt by Cen- vide a safe ‘‘base of operations’’ for level at which they occur (com-
tralians. Long before most resi- Community stress adds to psy- coping; specifically, these posses- munity, family, and individual) for
dents vacated the community and chological stress at the individual sions are often necessary to act in broad stressors that have impact
long before most homes were torn level, which has negative physical a problem-solving manner. Con- across levels. Although the indi-
down, the social community of health consequences for residents dition resources refers to condi- vidual might not categorize these
Centralia had ceased to exist. This of contaminated communities. tions that are valued by people or different levels as discrete cate-
was keenly felt by residents, some Many theories to date have ex- conditions that help facilitate the gories, it is helpful for theorists
of whom, although admitting amined stress and stress-related protection of valued resources. and interventionists to be able to
feeling stress caused by dangers outcomes as they occur in a com- Examples of these conditions can properly assess and categorize
associated with the fire, said that munity or other social setting. A include seniority at work, stable these stressors according to how
fighting with friends, neighbors, common thread in these theories employment, a good marriage, or they affect communities as well as
and family members over what to is the notion of both physical and being a member of a stable family. individuals and how stress coping
do about the fire was much more personal resources.48---51 The indi- Personal resources are character- can influence different levels.
stressful. vidual stress response theorized istics or skills that people possess. In general social-ecological the-
Part of Centralia’s response was by Lazarus49,50 envisioned stress Key personal resources can in- ory, there are hierarchies of sys-
no doubt due to the social, cul- as a transactional process occur- clude job skills, social prowess, tems that affect social, biological,
tural, and historical circumstances ring between events (stressors) optimism, and a sense of personal and psychological levels. After
of this small mining community. that cause changes in the envi- efficacy. Energy resources facili- community-level stress, the next
However, part was also due to the ronment, an individual’s evalua- tate the attainment of other re- important system level to impact
chronic technological nature of tion of these stressors, and the sources; thus, these resources are a person is the family.60,61 The
the disaster itself. Studies of re- individual being able to obtain valued to the extent of allowing structural nature of families helps
sponses to contamination in very resources to cope with or manage access to other resources. Examples to influence which stressors occur,
different types of communities the stressor or the emotions asso- of energy resources can include how members respond to these
have found similar patterns of ciated with the stressor. Lazarus savings (money), credit, owed fa- stressors, and the meaning and
destructive social conflict and termed the evaluation process vors, and knowledge. significance attached to these
psychological stress to those found ‘‘appraisal,’’ and believed that When an individual’s or a com- events.64 The most prominent
in Centralia. These communities there were 2 appraisal compo- munity’s resources are depleted, family stressors for low-income
have included those in rural, sub- nents: primary and secondary. they will tend to use less active, families across cultural domains
urban, and urban settings, in dif- Primary appraisal is the process by problem-based coping and use tend to be economic strain, dis-
ferent parts of the United States, which an individual determines more passive, emotion-based cop- crimination, victimization/vio-
and in different countries the threat level of the event; sec- ing. Changes in coping and re- lence exposure, family transitions,
throughout the world.19,38---47 ondary appraisal is where the source loss have been linked to and family conflict.65 These

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stressors are then exacerbated by externalizing (delinquency, tem- Minority groups might perceive Unfortunately, there are over
CTDs due to both coping with the per tantrums, and disruptive be- greater industry-related health 400 different instances of coping
stress of the event itself and the haviors) and internalizing (depen- risks because they have more ex- in the literature and many differ-
additional drain on resources. The dency, separation anxiety, and perience with toxic exposures, ent ways to conceptualize the ba-
notion of stressors arising from clinginess) behaviors.73 they feel more vulnerable to these sic ways a person can adapt to
other stressors has been termed exposures, and they view such a stressor or stressors. The 3 most
stress proliferation.66 Concepts RISK PERCEPTION AND exposures as a form of injustice. common adaptive strategies are:
such as stress proliferation help to COPING WITH STRESS Other factors related to the greater (1) problem- versus emotion-fo-
explain how early life circum- level of threat perception by mi- cused strategies; (2) approach
stances can affect later health and The demands of a stressful norities include greater proximity versus avoidance strategies; and
well-being as well as how a person event require that a person first to a threat, attachment to place, (3) cognitive versus behavioral
copes with future stress events.67 evaluate the event and the possi- and economic ties to the industry strategies.78 There continue to be
There are a small number of ble implications at the initial stage involved in the technological ex- conceptual problems, however,
research studies on families im- before being able to marshal re- posure. Many community resi- with all 3 approaches as well as
pacted by CTDs. Reports in the sources (secondary appraisal) to dents are aware of the history of categories that are not mutually
literature tended to emphasize address the event. Lazarus49,50 a response. Thus, poorly handled exclusive.77 Studies showed more
that although natural disasters viewed primary appraisal as both disaster events in the past might of a positive relationship between
were more related to direct psy- cognitive and emotional, noting interfere with efforts to address coping and distress (more coping
chological effects, such as acute that the event could trigger affec- community concerns in the pres- and more distress) than an inverse
stress disorder and post-traumatic tive states such as anger, anxiety, ent.25 one (more coping and less distress)
stress disorder (PTSD), the nature and/or sadness. Primary and sec- Coping has significant implica- for technological disasters. Re-
of CTDs resulted in somatic com- ondary appraisals are ongoing tions for the study of stress, both in search has suggested that coping
plaints and fears of future health processes throughout coping. Ap- terms of dealing with short-term should be viewed as a response to
effects. Mothers, in general, be- praisal processes can be complex, acute stress and the emotional and distress or an indicator of it.79 The
cause of their concerns about the and these processes are shaped by physical effects of chronic stress. nature of coping makes it difficult
health of their children, were the individual and group differences, How a researcher conceptualizes to study, because individuals can
group most affected by CTDs.68,69 the hazard or the disaster event, stress has important implications use different forms of coping si-
The research literature has and the relationship to the disaster for work on stress, adaptation, risk, multaneously, which makes it dif-
suggested that marital status may event.53 Primary and secondary competency, and resilience. How- ficult to isolate unique effects.77
also be a risk factor for stress appraisals affect risk perception, ever, there remains a debate in the Given the conceptual and prac-
related to CTDs, especially for which has been increasingly scientific literature about how to tical limitations to studying the
women.70 Solomon found that viewed as part of larger social, best define and categorize coping relationships between technologi-
women who perceived themselves cultural, and political processes. strategies.75 Coping can be de- cal disaster stress, individual cop-
as having excellent spouse support Understanding risk perception is fined as an organizational con- ing, and outcome, it would be
were more vulnerable to stress important to help understand how struct encompassing behaviors, more feasible and effective to take
than women with weaker ties. a community or individual is im- cognitions, and perceptions.67,76 a community-level approach to
These results were interpreted to pacted by chronic environmental Skinner et al.77 argued that coping evaluating stress triggered by
mean that social ties and obliga- contamination. It is also important was also a hierarchical construct a community-scale adverse event
tions could be a source of stress for to note that risk perception in which the lowest level consti- such as a CTD. This community-
married women. The results also changes over time due to reap- tuted ‘‘instances’’ (examples) of level approach would address the
demonstrated that single parents praisal of the stressor, changes in coping, and the higher level was rebuilding and replenishment of
may be chronically exposed to coping strategies and possibly those processes that intervened community resources to reduce
a high level of stress that is difficult resources, and changes to the between psychological, social, and psychological distress.32 Although
to alter, even in the context of context of the stressor and com- physiological outcomes to aid in this approach has been used more
a CTD. munity-wide views.52 adaptation. Skinner argued that with natural disasters, a commu-
Research has found that pa- The research literature found the higher level category should nity-based rebuilding framework
rental stress has also been known gender and cultural differences in be labeled ‘‘ways of coping’’ (di- could also be used for CTDs.
to increase after a technological the risk perception of a disaster. mensions of coping) and should The concept of coping is distinct
disaster.71,72 Studies have found Racial and ethnic minorities in the represent categories by which from other related concepts such
that technological disasters have United States exhibited greater lower levels of coping were nested. as resilience.75 A primary distinc-
resulted in increased problem- perceived risk than non-Hispanic These categories should be con- tion is that coping refers to the
atic behaviors for children and Whites when rating real or per- ceptually clear and mutually ex- process of adaptation, whereas
adolescents, including both ceived environmental threats.74 clusive. resilience refers to successful

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stress outcome. Psychosocial re- factors, community stressors, and stress as conceptualized by other 1. Include an evaluation of poten-
sources known to increase resil- community resources.80 Commu- researchers is greatly needed. Al- tial community psychosocial
ience include positive emotions nity stressors can be particularly though one caveat of a single stress in planning and scoping
(optimism and humor), cognitive difficult to assess given their mul- community index might be to actions in a community affected
flexibility (positive explanatory tiplicative and diverse nature. mask the influence of individual by significant contamination.
For agency personnel charged
style, positive reappraisal, and ac- We know that, in general, com- stressors,87 a valid and reliable
with ameliorating environmen-
ceptance), meaning (religion, spir- munity stressors can be physical community assessment measure
tal contamination, it is critically
ituality, and altruism), social sup- and psychosocial. Physical has great potential to study stress
important to be aware that the
port, and active coping style.61 stressors can include factors such impacts on health outcomes. This
problems confronting contami-
There is little literature on resil- as noise, temperature, humidity, measure combined with an allo- nated communities are not only
ience as it relates to CTDs, but it visible light, radiation, and partic- static load index could ultimately related to technical clean-up
can be expected that the chronic ulate matter.81 By contrast, demonstrate how community im- and physical health, but also the
nature of this stressor and the psychosocial stressors can in- provements can lead to lower bi- social aspects of the commu-
constant drain on resources will clude conditions such as crowd- ological burden and improved nity. In many contaminated
make a successful community ing, social disorganization, health and wellness. communities, a destructive so-
outcome seem remote. racial discrimination, CTDs, Many unexplored areas of re- cial process develops that exac-
community violence, family tur- search remain regarding the ef- erbates the psychological and
CONCLUSIONS moil, and economic depriva- fects of the interaction of psycho- physical health impacts on
tion. 82,83 These physical and social stress and toxicant exposure community residents. Specifi-
The contribution of stress to psychosocial stressors can be on human health. Community cally, if the psychosocial im-
pacts of chronic environmental
ill health is well-documented. exacerbated in low income and and social scientists wonder
contamination are unrecog-
McEwen and Tucker6 articulated ethnic minority communities84 about the representativeness of
nized, risk management deci-
its direct effects on health and due to structural limitations and contaminated communities in
sions may fail to adequately
indirect influences on the health reduced resources as well as the current body of research that address community needs and
impacts of chemical stressors in other reasons. documents mostly destructive may make the social process
the environment. For many low social processes. It is as yet un- even more destructive. Work-
income and racial minority com- Data Gaps and Need for explained why different com- ing in partnership with a com-
munities, psychosocial stress is Further Research munities with the same socio- munity provides opportunities
experienced from typical factors The ultimate success of any economic status react differently to recognize the multiple
such as economic strain, violence, assessment model is its helpfulness to being exposed to environ- stressors at play in the commu-
etc., and chronic environmental in assessing the impact of the mental toxicants. nity, and also possibly decrease
contamination/CTDs. In this arti- contamination in terms of com- the development of social
cle, we provided an overview of munity risk appraisal.85 This as- Recommendations stresses and increase the social
how CTDs drive stress at the sessment should be compre- Research on CTDs was suffi- capital and collective efficacy
community level, and in addition, hensive enough to provide cient to show some best (and available to a community to
respond to contamination.
highlighted the concept of stress information on how to effectively worst) practices agencies imple-
2. Establish a positive relationship
proliferation in these communi- mobilize resources (formal and ment to incorporate psychosocial
with local leadership and com-
ties. We concluded that assess- informal) to address the commun- stress in assessments of environ- munity groups. Although this
ments in these communities to ity’s concerns and assist in the mental contamination. Recogniz- might seem obvious, positive
drive risk management decisions community’s development, and ing the presence and potential in- involvement of local leadership
and studies/research to assess the improve the overall health and fluence of psychosocial stress can and community groups with
health impacts of chronic envi- wellness of community residents. provide agencies with more accu- the process of environmental
ronmental contamination should To this end, research is needed to rate assessments, and therefore clean-up and/or containment is
concomitantly evaluate psychoso- develop and/or test current com- enable the implementation of crucial. Open, honest commu-
cial stress at the community, fam- munity stress indexes. There has more health protective plans to nication that accurately and
ily, and individual levels, in addi- been promising work on the psy- deal with the potential and/or realistically conveys the risks of
the situation and the processes
tion to chemical risk. chosocial hazards scale related to actual dangers posed by the con-
involved in response is essen-
Community stress assessment lifetime cumulative lead exposure, tamination. We recommend the
tial to building trust, and trust is
continues to be an ever evolving, cognitive functioning, and stress- following actions to improve the the most essential element
multidisciplinary phenomenon. producing elements of neighbor- use of information on psychosocial needed to build a positive re-
Community stress has been oper- hood environments.86 Further stress in environmental decision- sponse from community resi-
ationally defined as an interaction work in the utility of this scale in making, particularly in communi- dents. The best outcome of
between neighborhood context terms of capturing community ties facing CTD: community involvement is to

Supplement 1, 2011, Vol 101, No. S1 | American Journal of Public Health Couch and Coles | Peer Reviewed | Environmental Justice | S145
 TOWARDS ENVIRONMENTAL JUSTICE AND HEALTH EQUITY

empower community residents address the unique features of indicators of resources and predict early hypertension incidence in
to have some control over what CTDs and greatly improve problems associated with en- young adults in the CARDIA study?
Coronary Artery Risk Development in
is happening in their commu- multidimensional outcomes of vironmental contamination, Young Adults. Arch Intern Med.
nity; the worst outcome is to clean-up efforts. A follow-up and therefore help the agencies 2000;160:1495---1500.
render the community and its recommendation is to use and communities to develop 2. Jonas BS, Lando JF. Negative affect
residents collectively and indi- multidisciplinary teams to ex- effective and comprehensive as a prospective risk factor for hyperten-
vidually powerless. Govern- amine sites from several per- responses. j sion. Psychosom Med. 2000;62:188---196.
ment involvement with both spectives for an improved un- 3. Cheng Y, Schwartz J, Sparrow D,
outcomes clearly illustrates how derstanding of the true impact et al. Bone lead and blood lead levels in
relations to baseline blood pressure and
agencies are a major part of of a contamination event. About the Authors the prospective development of hyper-
these outcomes, whether they 4. Acknowledge commonalities of Stephen R. Couch is with Academic Affairs, tension in the Normative Aging Study. Am
CTDs and the uniqueness of Pennsylvania State University, The
are positive or negative; like- J Epidemiol. 2001;153:164---171.
Schuylkill Campus, Schuylkill Haven,
wise, grass roots organizations each community. Finally, being Pennsylvania. Charlton J. Coles is with 4. Martin D, Glass TA, Bandeen-Roche
can also have positive or nega- sensitive to the similarities and Division of Toxicology and Environmental K, et al. Association of blood lead and
differences of contaminated Medicine and the Environmental Medicine tibia lead with blood pressure and
tive impacts on community
and Educational Services Branch, Centers hypertension in a community sample
stress, depending on whether communities can help all
for Disease Control/Agency for Toxic of older adults. Am J Epidemiol. 2006;
they empower members and agencies to deal more effec- 163:467---478.
Substances and Disease Registry, Atlanta,
other community residents, or tively with the social aspects of Georgia. 5. Peters JL, Kubzansky L, McNeely E,
help render them power- contamination disasters. Each Correspondence should be sent to Stephen et al. Stress as a potential modifier of the
less.21,35 It is important for disaster is shaped by the dis- R. Couch, PhD, Academic Affairs, The impact of lead levels on blood pressure:
tinct culture of the community Pennsylvania State University, The Schuylkill the Normative Aging Study. Environ
agency personnel to understand Campus, 200 University Drive, Schuylkill Health Perspect. 2007;115:1154---1159.
in which it takes place. At the
the social dynamics brought Haven, PA 17972 (e-mail: [email protected]).
same time, due to the nature of 6. McEwen B, Tucker PG. Critical bi-
about by contamination and to Reprints can be ordered at http://www.
ological pathways for chronic psychoso-
CTDs, there is a pattern of ajph.org by clicking the ‘‘Reprints/Eprints’’
draw upon the professional and link.
cial stress and research opportunities to
social response that often takes advance the consideration of stress in
local expertise needed to help This article was accepted October 10,
place that is distinctly different chemical risk assessment. Am J Public
operate in such communities. 2010.
from the response of commu- Health. 2011;101(suppl 1):S131---S139.
3. Collaborate among government
nities to natural disasters. 7. Marmot MG, Rose G, Shipley M,
agencies. Continued collabora- Contributors Hamilton PJ. Employment grade and
Agencies need to be aware of
tion between government S.R. Couch and C.J. Coles shared in the coronary heart disease in British civil
this and develop their actions drafting of the Introduction. S.R. Couch
agencies, such as Environmen- servants. J Epidemiol Community Health.
on the specific characteristics drafted the sections, ‘‘Impact of CTDs on 1978;32:244---249.
tal Protection Agency (EPA)
associated with social re- Community Stress,’’ ‘‘Case Study,’’ and
(environmental protection and ‘‘Recommendations.’’ C.J. Coles drafted 8. Adler NE, Marmot M, McEwen B,
sponses to CTDs. Stewart J, eds. Socioeconomic Status and
public health) and Centers for ‘‘Impact of Environmental Contamination
5. Assessment. Finally, we recom- on Individual and Community Stress,’’ Health in Industrialized Nations: Social,
Disease Control (CDC)/Agency
mend that the EPA and ATSDR, ‘‘Risk Perception and Coping With Psychological, and Biological Pathways.
for Toxic Substances and Dis- Vol 896. New York: Academy of Sci-
as the 2 main federal govern- Stress,’’ ‘‘Conclusion,’’ and ‘‘Data Gaps
ease Registry (ATSDR) (public and Need for Further Research.’’ S.R. ences; 1999.
ment agencies responsible for
health), is recommended for Couch and C.J. Coles both proofread and 9. Marmot M. The Status Syndrome:
assessing and ameliorating en-
knowledge sharing and general helped revise the entire article. How Social Standing Affects Our Health
vironmental contamination and and Longevity. New York: Henry Holt and
pooled resources. The CDC/
its effects, work together to de- Company; 2004.
ATSDR as public health agencies Acknowledgments
velop common assessment in- 10. Wolfe AK, Schweitzer M. Anthro-
are particularly well-versed in The contents of this paper were presented
addressing the social and psy- struments that can be used in at ‘‘Strengthening Environmental Justice pology and decision making about
contaminated communities. We Research and Decision Making: A Sym- chronic technological disasters: mixed
chological aspects of a disaster, posium on the Science of Disproportion- waste remediation on the Oak Ridge
including the development of recommend that these agencies
ate Environmental Health Impacts,’’ reservation. Paper presented at: American
indexes to measure social vul- review the many community, March 17---19, 2010 in Washington, DC, Anthropological Association annual
nerability and toolkits for as- family, and individual assess- and supported by Environmental Protec- meeting; November 20---24, 1996. San
ment instruments that currently tion Agency (EPA) Contract 1110-109. Francisco, CA.
sessing community resilience,
The authors of this paper would like 11. Couch SR. Environmental contami-
resources, and communication. exist and develop a set of in-
thank the following organizations, EPA, nation, community transformation, and the
However, these tools have struments that would be best CDC, ATSDR, Michael D. Baker, and Drs. Centralia mine fire. In: Mitchell JK, ed.
mainly been utilized in the suited for the assessment of psy- Bruce McEwen (Rockefeller University), The Long Road to Recovery: Community
context of natural disasters, chosocial stress and stages of Pam Tucker (CDC/ATSDR), and Nweke Responses to Industrial Disaster. New
Onyemaechi (EPA), for their guidance York: United Nations University Press;
and their potential in assessing social response in contaminated
and input during the conceptualization 1996.
technological disasters has not communities. Such a set of in- and writing of this article.
been fully realized. Collabora- struments could be used to 12. Kroll-Smith JS, Couch SR. As if
exposure to toxins were not enough: the
tions with EPA could lead to complement chemical and
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