Assessment and Impact of a Summer Environmental Justice and Health Enrichment Program: A Model for Pipeline Development

Abstract

The need for more enrichment programs for underrepresented groups in the health sciences particularly the environmental health sciences is considerable. The implications of chronic racial/ethnic differences in scientific training are best illustrated by the disproportionate number of health professionals from underrepresented groups. For example, African Americans comprise 13% of the total U.S. population but only account for 4% of U.S. physicians and in 2006, only 7.2% of all bachelor's degrees and 8.6% of all master's degrees awarded to African American were in the health sciences field. In an effort to increase the representation of persons of color in the health sciences, we used our existing community university partnership between the Low Country Alliance for Model Communities, the University of South Carolina, and the University of Maryland-College Park as the basis for a summer enrichment pilot project. The major aim was to provide academic experiences for underrepresented undergraduate and graduate students in the environmental health sciences, specifically on how to perform scientific research in environmental health sciences, learn about environmental justice and public health issues, and work closely with environmental health researchers on community-based participatory research projects. We set out to evaluate the process and feasibility of the pilot and several themes emerged from our qualitative inquiry that included: 1) need for strengthening research skills at the collegiate level; 2) lack of knowledge of environmental justice and environmental health issues; 3) need for practical experiences within the community; and 4) expansion of the project beyond the summer.

Introduction

The need for more enrichment programs for underrepresented groups in the health sciences particularly the environmental health sciences is considerable. There is literature that supports the positive influence that science-based enrichment programs have on the general population, girls, and gifted students;¹ however, significant disparities still exist among persons of color. Demonstrating this persistent educational inequality over the past ten years, the National Science Foundation (NSF) data published by Slovacek et al. (2012) reveals a five-fold difference in the proportion of Hispanic, African-American, and Native American students graduating with a bachelor's of science degree and a ten-fold difference in the proportion graduating with doctoral degrees in the sciences when compared to their Asian and non-Hispanic white counterparts.² Slovacek et al. (2012) attributes these trends to the following factors: (1) inadequate preparation for collegiate science and mathematics in high school, (2) the lack of financial assistance in paying for college, and (3) an unwelcoming campus climate and feelings of social isolation.²

The implications of these chronic differences in scientific training are best illustrated by the disproportionate number of health professionals. For example, African-Americans comprise 13% of the total U.S. population but only account for 4% of U.S. physicians.³ In 2006, 7.2% of all bachelor's degrees awarded to African-Americans were in the health sciences which is slightly lower than the 8.6% of African-Americans receiving master's degrees in health sciences.⁴ When analyzing U.S. Department of Education data from 1985–2006, we observed an overall increase (148%) in the number of African-Americans gaining a bachelor's degree in any field.⁴ Despite some success, there is still a substantial disparity that exists among persons of color in the environmental health sciences when compared to traditionally overrepresented groups.

In an effort to increase the representation of persons of color in the health sciences, partnerships were developed to reduce the significant disparities between overrepresented and underrepresented groups matriculating with science degrees required for entry into the health professions. Slovacek et al. (2012) describes how the first interventions to increase the number of Hispanic, African-American, and Native American health science graduates were based on partnerships between the federal government and institutions of higher learning. Examples of programs sponsored by the National Institutes of Health (NIH) Minority Opportunities in Research (MORE) framework includes the Minority Access to Research Careers (MARC), Bridges to the PhD, Minority Biomedical Research Support (MBRS), and the comprehensive MORE Programs at California State University, Los Angeles (CSULA).²

Among students participating in the MORE programs between 2000 and 2008, 83% graduated with degrees in the sciences during the study period while 57% entered graduate programs at the culmination of the study.² When matched with students not participating in MORE programs, only 55% graduated with degrees in the sciences and 16% continued their education as graduate students in the sciences.² There were some limitations in evaluating the efficacy of MORE programs when matched to the comparison group, but overall students supported by MORE programs had higher grade point averages at graduation, took less time to complete their degree, and were more likely to graduate with a science degree and enroll in master's and doctoral programs.²

There are numerous accounts throughout the literature that support the utility of enrichment programs, but perhaps the least documented are community-university partnerships created to increase the presence of underrepresented persons of color in the health sciences including the environmental health sciences. The Partnerships for Health Professions Education (PHPE) was created in 1997 by the federal Health Resources and Services Administration (HRSA) to address the paucity of African-Americans in health professions.³ Their comprehensive approach required the collaboration of academic institutions and community partners to create programs based on the following principles: (1) early interventions, (2) hands-on educational activities, (3) science curriculum supplementation, (4) role modeling, (5) mentoring, and (6) career guidance to help stimulate student interest in science and health professions.

Participating academic partners in the PHPE project included Morehouse School of Medicine (MSM), Clark Atlanta University (CAU), Georgia State University (GSU) School of Nursing, Morehouse College, Morris Brown College, and Spelman College;³ all of which are historically black colleges and universities with the exception of GSU. Community and corporate partners included the Atlanta Public School System, Upscale magazine, Bell South, 100 Black Men of Atlanta, and the Atlanta Area Health Education Center.³ Academic, community, and corporate partners worked collectively to create a pipeline of educational opportunities from elementary school to college that would foster the interest of underrepresented students in the sciences.

While the organizational structure and purpose of the partnership were sound, the PHPE project only received funding for a three year period (1997–2000) which is an insufficient timeframe to quantitatively evaluate success. The need for such enrichment programs is evident as the number of underrepresented groups within the health sciences continues to decline. The PHPE project provided a model of how an academic-community partnership could be used to target underrepresented groups at an early age, and with persistent exposure to the sciences throughout their educational career, students would be more inclined to pursue health sciences as their career trajectory.

Despite the benefits of enrichment programs for underrepresented groups, they seem to be difficult to sustain which may account for the low number of available programs. Nevertheless, the Health Professions Partnerships Initiative (HPPI), established in 1996,⁵ which challenged health professional schools to improve the curricula and educational programs of partner school districts and colleges continues to flourish. The HPPI was funded by the Robert Wood Johnson Foundation and W. K. Kellogg Foundation, and has since been evaluated to determine specific factors for the success of their academic-community partnership. For example, health professions schools associated with successful partnerships encompassed a strong vision and commitment to the community, the professional school leadership and staff listened to the needs and concerns of its partners, the different organizational structures of professional schools and public schools and the differing demands on public school teachers were understood by all participants, and leadership had prior experience in diversity programs.⁵

Furthermore, public schools involved in successful partnerships shared the same intensity of vision and leadership; involved schools of quality, commitment, and consistency among principals and teachers; provided ongoing support of teachers through professional development activities, curriculum materials, and development, as well as adequate compensation; and parent and family involvement.⁵ The purpose of this article is to describe a Summer Enrichment Program (SEP) pilot project at the University of South Carolina that provided opportunities and practical experiences for undergraduate and graduate students to encourage them to pursue research careers in environmental health sciences with a focus on environmental justice and environmental health disparities.

Background

Several reports on national environmental health have indicated that populations of color and low income populations are differentially exposed to poor environmental conditions^6,7 and that these groups are more likely to reside in close proximity to waste facilities.⁸ Race, more than any other factor, also plays a role in the spatial distribution of environmental hazards⁸ leading to poor and negative health outcomes as well as disparities in health.^7,9

The southeastern region of the United States, has seen its share of disproportionate burden of environmental hazards in neighborhoods of color. This is reflected in the efforts led by community groups to address environmental injustice and racism in their local areas. The ReGenesis project in Spartanburg, SC and the West End Revitalization Association (WERA) in Mebane, NC are two examples of communities that experienced unhealthy land uses, lack of basic amenities, burden of diesel truck activity, Superfund sites, and other toxic industries.^10–12

Like many of the cities in the Southeast (and the nation), North Charleston, SC hosts numerous environmental hazards that result in differential burden for racial/ethnic and poor populations.^13,14

In Metropolitan Charleston particularly North Charleston, SC, a paucity of research has occurred to understand the cumulative impact that sources of air, water, and soil pollution including historic industrial activities, operation of the local incinerator, several Superfund sites, and heavily-trafficked highways have on the overall exposure burden on these communities as other economically disadvantaged.^12,15 Limited monitoring and community-based surveillance has occurred to understand the spatial and temporal variation of the exposure of local populations to pollution released from the myriad industrial, point, and non-point sources in the region and how this cumulative exposure has affected environmental quality, community health, quality of life, and neighborhood vitality and sustainability.^13–14,16 Without action-oriented community-driven research and advocacy efforts, effective progress will not be made in reducing exposure and preventing pollution.^10,11

The community-university partnership between the Low Country Alliance for Model Communities (LAMC), the University of South Carolina (USC), and the University of Maryland-College Park has used the community-based participatory research (CBPR) framework and collaborative problem solving model (CPSM) principles to study and address environmental injustice, public health, and revitalization issues in North Charleston, SC.^13–14,16 This partnership acted as the foundation for the pilot summer enrichment program.

The National Institute of Environmental Health Sciences (NIEHS)-funded project is significant to the area because it studies the cumulative impacts of pollution on the environment and health of maximally exposed populations in the Charleston area for the first time. Employing the CBPR framework and CPSM principles, the project addresses the following specific aims of this partnership are to: (1) assess the geographic distribution of pollution sources in North Charleston, SC, (2) quantify levels of particulate matter (PM) and heavy metals near industrial and non-point sources of pollution in economically disadvantaged neighborhoods in North Charleston, SC, and (3) increase community capacity to reduce exposure, prevent pollution, and improve public health through community-based outreach, education, and training.^13–14,16

Pilot Project Overview

The summer enrichment pilot project was developed as an extension of the community-university partnership parent project for two specific reasons: (1) to address the third aim of the parent grant and (2) to provide research experiences for underrepresented undergraduate and graduate students in the environmental health sciences. The specific aims of summer enrichment program (SEP) were to increase participants': (1) knowledge of the scientific research process including community-based participatory research, (2) knowledge of environmental justice and health issues, and (3) skills using geographic information systems (GIS) for mapping of environmental health disparities.

The project selected six undergraduate and four graduate from underrepresented racial/ethnic groups from local universities and colleges including the University of South Carolina, Allen University, and other historically black colleges and universities (HBCUs) in South Carolina. The enrichment program offered participants an opportunity to learn about how to perform scientific research, receive instruction on environmental justice and public health issues, and have a chance to work closely with environmental health researchers representing a variety of USC departments.

Undergraduate students from Allen University, South Carolina State University, and Trident Technical College participated in a ten week summer enrichment program. The program began on June 1 and ended on July 31, 2010. The students received training in the first few weeks of the program on the scientific research process, environmental justice and health issues, CBPR, and mapping using GIS. Students learned how to collect data on the location of environmental hazards, pollution-intensive facilities, and other land uses in neighborhoods in North Charleston, SC. During two field trips, students walked through LAMC neighborhoods using global positioning system (GPS) units to obtain latitude/longitude coordinates of various assets and hazards. These “walking maps” helped LAMC community members map out the different types of infrastructure, assets, and environmental features in their neighborhoods.

An additional component of this training was to help students learn how to use ArcGIS 9.3 to import latitude/longitude coordinates from their GPS maps and examine spatial relationships between mapped features and local demographics. Students were trained on the use of GIS to perform mapping and assessment of spatial disparities using the ESRI ArcGIS tutorial and also Google Earth's mapping tool to assess spatial disparities.

In the second half of the summer, the students applied the skills they acquired by mapping GPS data and a dataset of facilities, pollution, and census data (i.e., percent non-white, percent poverty, percent less than high school education, median household income). The students also assessed spatial disparities using the methods learned earlier in the training. Students also visited the National Oceanic and Atmospheric Administration (NOAA) Hollings Marine Laboratory located in Charleston, SC to learn about the research efforts in progress on the coast of South Carolina and the connection between sentinel species and human health.

Students learned first-hand about community-based participatory research by working directly with community members, being coached and mentored at all stages through weekly research meetings, review of written materials, and several evaluations during the summer. There was consistent collaborative interchange with the students, so that it was a learning process for both the project staff and students. As part of that process, students learned how to communicate their results to different audiences including scientists, community advocates, and local stakeholders in Metropolitan Charleston. At the end of the internship, students submitted a final paper and presented their results to the community at the July 2010 project meeting of the parent grant research team in North Charleston, SC at the Accabee Community Center.

This project also provided doctoral level graduate students an opportunity to serve as project coordinators and research mentors to the undergraduate students. Four USC graduate students were recruited to plan, implement, and evaluate the pilot program. These students developed and scheduled workshops, were responsible for the day-to-day activities, met regularly with the students to assist with their research projects, and conducted an evaluation of the SEP.

Methodology

This study employed qualitative data collection methods to evaluate the process of this pilot project. This consisted of three major components: (1) student weekly journals, (2) student surveys and (3) staff/mentor surveys. The purpose of this evaluation was to measure the usefulness and feasibility of the project. Although we were not specifically measuring outcomes, we have included some of the successes from the project.

All six SEP participants were female; three from North Charleston (the target area for the parent project) and three from local HBCUs. The students varied in their disciplinary backgrounds. Two from the sciences (one specifically from environmental health), three were social science majors and one was an accounting major. Students were hired as temporary employees for payment, and worked from 9 am to 5 pm each weekday. In addition, four doctoral-level graduate students from the USC's Arnold School of Public Health were hired as graduate assistants (GAs) for the project in May 2010 to help prepare project materials and organize enrichment activities. Three GAs were from the Health Promotion, Education, and Behavior department; and one was from the Health Services Policy and Management department. There were three females and one male. The GAs represented different stages of the doctoral process (e.g., pre-qualification, doctoral candidates, first year). The GAs divided the duties and responsibilities of the project to make the implementation process easier.

Each week the SEP participants were asked to document their experiences with the project. They were given weekly prompts and asked to submit their journal entries. These journals were kept confidential and only shared with other staff persons (e.g., GAs and mentors). In addition, they also were allowed to share both their personal and work-related experiences. Students were also given an open-ended survey at the end of the project. Responses were submitted to the evaluator electronically. Student responses were compiled and coded for themes. They were asked the following questions as they related to their overall experiences with the pilot project.

1. What were your expectations of the Summer Enrichment Program you participated in at USC? Were your expectations met, why or why not?

2. What would you add or change about the Summer Enrichment Program?

3. How has being a participant in the Summer Enrichment Program impacted you personally, professionally, academically, etc. (e.g., your program, knowledge, research interests, skills, etc.)? Please be specific.

4. What are some things you learned about yourself as a result of participating in the Summer Enrichment Program?

5. What suggestions would you make to the principal investigator (Dr. Wilson) about the program?

Seventy-five percent of the day-to-day staff completed an open-ended survey about their experiences with the pilot project at the conclusion of the program. Their answers were coded for themes and in some circumstances were combined with student responses. The following questions were included on the survey.

1. What were your expectations of the interns chosen for Summer Enrichment Program? Were your expectations met, why or why not?

2. What would you add or change about the Summer Enrichment Program?

3. How has working with the Summer Enrichment Program impacted you personally, professionally, academically, etc. (e.g., knowledge, research interests, skills, etc.)? Please be specific.

4. What suggestions would you make to the principal investigator (Dr. Wilson) about the program?

Lastly, one of the six mentors completed an open-ended survey about their interaction with the students and experiences with the project. Data from all three data collection methods were combined and analyzed by generating themes. These themes were confirmed by a second reviewer for reliability.

Results

Themes

Three levels of responses were identified in the responses. These included: (1) individual level, (2) programmatic, and (3) community. All sub-themes fell into one of the three categories of responses. Both the students and the staff were consistent in identifying those areas that needed improvement and where the benefits could have been greater, as well as identifying several positive aspects of the SEP pilot project. These included, but were not limited to: (1) skills development, (2) knowledge and information, (3) practical experiences, (4) the need for expansion of the project, and (5) general thoughts about community involvement.

Individual level

Students and staff mentioned in their responses that the students did not have the same academic knowledge and would have benefited from having a course on the basics of research. Only one student had a previous course in research, but she also indicated that she needed a refresher in order to accomplish what was expected of the project. The students were unclear about the full research process, which became clear to both them and the staff, when they were “sent” to conduct independent research. Students were unaware of how to conduct scholarly term searches. A few even mentioned they were too embarrassed to ask for help. The following were comments concerning their prior experiences:

I need the skills to critique and analyze a particular article. With these skills I will be able to understand and perform writing a research paper.

I need to know proper research formatting and basically to write a research paper.

I thought everyone else had taken research before, so I didn't want to ask what to do next.

When asked about her expectations of the students, one of the GAs wrote: “The interns had limited knowledge or research, which ultimately impacted their confidence in conducting research. Despite having limited knowledge, all of them embraced the experience.”

Secondly, although the purpose of the summer enrichment pilot program was to expose underrepresented students of color to environmental justice and health research, we believe the program would have had more of an impact if it involved a curriculum with an equivalent amount of knowledge-based learning and application. Participants attended presentations on topics specifically related to environmental health and professional development, but minimal time was allotted for items that would have more immediate personal and professional impacts.

For example, the one-hour resume writing seminar could have been expanded to include resume development, job searches, cover letter development, as well as learning about jobs that may or may not be suitable for science, public health, or other health-related majors. If more time were allotted for resume writing, participants may have used their new and improved resumes to apply for science-based work study positions, or included them in application packets to graduate schools or for internal and/or external funding opportunities.

“I am unclear about what I really want to take up in grad school, so I hope this is a good opportunity.” This sentiment was expressed by the GAs as well. The GA stated:

I believe future students could benefit from a structured program that gives them an opportunity to explore a research career as well as to enhance their professional development & giving the students an opportunity to audit one or two courses (e.g., summer, mini or online course) would give them firsthand exposure to graduate level work.

These [undergraduate] students are coming to us already at a disadvantage. The more life and professional skills we can provide the better equip they will be to explore non-traditional careers.

A central theme specifically identified by one student that resonated across the surveys was the importance of building confidence. Both undergraduate and graduate students felt that the program was instrumental in building their personal confidence and competencies in public health particularly knowledge about environmental health issues, research skills, and comprehension of different career opportunities in the environmental health field.

I was grateful for this opportunity and I'm glad I was giving the chance to participate. This program has really giving me a different outlook on life when it comes to meeting goals and achieving them. Also being a part of this program has expanded my writing skills as well as being able to present in front of people.

Assisting with the SEP enhanced my supervisory skills and afforded me the opportunity to work with undergraduate students which is one of the reasons I am pursuing a doctorate.

Programmatic level

Interestingly, many of the students mentioned that they were not prepared to conduct independent research. They expected their days to be structured and filled with activities. This project was fashioned partly after a summer enrichment program at the University of North Carolina at Chapel Hill known as the Summer Program for Graduate Research Experience (SPGRE).⁹ The SPGRE program allowed students to have independent research and study time and so it was included in our program. The students indicated that they would have preferred to have more structured and scheduled time for formal learning and skills building. This may have been a direct result of their inexperience with research and environmental health or from their past experiences in their academic training.

Again, a more structured program was indicated, especially by the GAs:

More structure to the curriculum & I believe these programs [should] provide opportunities for students to engage in activities that they would not normally have.

The students had way too much free time that they did not know how to deal with. Independent study time is such a graduate level concept. More and consistent structured activities will be more beneficial to the project.

Many of the respondents felt that this experience should be progressive over time, that is, start early in the college experience and continue through professional education. One student commented that: “to have the summer camp every summer and have it to where students can be able to start their freshman year all the way to their senior year in college and if possible continue until grad school as well.”

One of the GAs commented that the research training should be extended to include additional training beyond the summer. The GA stated that the program should “not limit the final deliverable to a poster, but perhaps a more involved demonstration project of some kind & This project should extend into the school year, allowing students to develop their skills over a longer period of time. This would also give them the opportunity to participate in the project more intensely.”

Community level

An understanding of how the students' experiences in the SEP can be translated into improvements in the community was especially important given the aims of the parent grant. Three of the six students were chosen to participate in the SEP because they were residents of the target study area. Project leaders were interested in identifying students from the community which would encourage buy-in and a sense of urgency to assist with the project beyond the summer. One student confirmed this notion: “[this] is essential to my community and other low income areas & this program can give me the skills that I need to handle the real world and change some of the many environmental disparities that other individuals and I have experienced.”

Outcomes

Since participating in the SEP, 50% of students have maintained their involvement in the implementation and research phases of the parent grant. One student from Allen University, a HBCU in Columbia, SC, continues working with the research staff to develop, coordinate, implement, and evaluate project activities. She began working full-time with the project as a research assistant after she graduated from college. Participation in the SEP program provided her with invaluable experiences and skills, particularly as it relates to environmental health.

She has expressed an interest in pursuing a Master of Public Health degree at the USC Arnold School of Public Health and plans to continue to work with the team as a graduate student. Although no formal interview has been conducted, she has expressed to the project staff that she has gained valuable personal and professional skills to help her develop a career in public health. She, too, is from a coastal city similar to North Charleston and can relate to the environmental injustice experienced by the residents.

The other two interns actually live within the target community and have been instrumental in the implementation of project activities and data collection since the SEP's conclusion. Both served as health educators for our summer camp sessions assisted with soil sample collection in the target neighborhoods during 2011 and 2012. They attended and assisted with community workshops and continue to provide “community” expertise in educational and research-related components of the project. One of the participants has recently been hired as a part-time field research coordinator to lead data collection efforts specifically air monitoring of particulate matter (PM_2.5 and PM₁₀) in the North Charleston area. Although still in school, this position is providing her with much needed hands-on experience in environmental health.

As a follow-up to our original evaluation, we are scheduling personal interviews to explore the impact of the SEP on the careers of the participants. Most have graduated from college and moved on, but those that have continued to work with us on the project may be able to provide some additional insight into pipelining students into environmental health, environmental justice, or CBPR careers.

Conclusion/ Lessons Learned

There were a few limitations to this evaluation and certainly lessons learned from the experience. The major limitations were related to the actual evaluation. For example, responses tended to center on how the SEP could be improved as opposed to what participants gained from their SEP experience. One reason may have been the specificity of the questions themselves (e.g., leading the respondents to answer negatively) and the understanding that this evaluation would be used to improve future programs for both the students and the staff.

Another problem with the evaluation was that the SEP was funded one week before it was scheduled for implementation. As a result, evaluation tools had to be developed over the course of the program. Each week, participants were to answer one or two questions about their experiences in the program. Developing evaluation materials beforehand would have allowed participants to keep a real time journal of what they would have liked to improve upon such as research skills, a list of questions associated with specific topics, or on topics that they wanted more information about. Through journaling, participants may have also been able to identify topics that they could work on as a research project rather than having the topic selected for them. In addition, evaluations would have provided a pre- and post-assessment of participants' experiences and feedback on what was or was not useful.

Another important lesson we learned from the pilot program related to the fundamental role that communities play in the development of programs established to protect their health and well-being. Prior to, during, and post program implementation, the Community Advisory Board (CAB) of the parent project was actively involved with the SEP. Each CAB member shared information about the SEP at their neighborhood association meetings, church functions, and throughout the community, which enabled us to easily identify qualified candidates for the enrichment program. Using an iterative process, the CAB organized a group interview, and identified three individuals to represent at least one of the seven LAMC neighborhoods. The CAB's role in the recruitment process helped to ensure that the community was involved in every phase of the research and indirectly built community capacity by training, educating, and enhancing the skills of community members.

Although we were not measuring outcomes for this evaluation, we felt they were worthy of mention. Immediate outcomes for the project included that the students developed poster presentations that contained information on their literature reviews on environmental health and justice issues associated with spatial disparities of pollution-intensive facilities and unhealthy land uses in Metropolitan Charleston. These posters presented data related to their block assessment research on ecologic features of the built environment in LAMC neighborhoods and were presented at the Day of Neighborly Needs in 2010. The Day of Neighborly Needs is an annual event where community members receive an update on the community-university environmental justice and health partnership, research results, positive success stories, and also learn about other public health issues and ways to address these issues. Thus, the students contributed to the overall knowledge of the community about the extent of environmental justice issues and approaches that could be employed to address these issues.

Footnotes

Acknowledgments

We would like to acknowledge the work of staff and students who helped to make this summer enrichment program a success. We also acknowledge funding that we received from the National Institute for Environmental Health Sciences (grant number 1R21ES017950-01 and 3R21ES017950-1S1).

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