Two communities, one highway and the fight for clean air: the role of political history in shaping community engagement and environmental health ...
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Sprague Martinez et al. BMC Public Health (2020) 20:1690
https://doi.org/10.1186/s12889-020-09751-w
RESEARCH ARTICLE Open Access
Two communities, one highway and the
fight for clean air: the role of political
history in shaping community engagement
and environmental health research
translation
Linda Sprague Martinez1* , Noelle Dimitri2 , Sharon Ron3, Neelakshi Hudda4 , Wig Zamore5, Lydia Lowe6,
Ben Echevarria7, John L. Durant4 , Doug Brugge8 and Ellin Reisner5
Abstract
Background: This paper explores strategies to engage community stakeholders in efforts to address the effects of
traffic-related air pollution (TRAP). Communities of color and low-income communities are disproportionately
impacted by environmental threats including emissions generated by major roadways.
Methods: Qualitative instrumental case study design was employed to examine how community-level factors in two
Massachusetts communities, the City of Somerville and Boston’s Chinatown neighborhood, influence the translation of
research into practice to address TRAP exposure. Guided by the Interactive Systems Framework (ISF), we drew on three
data sources: key informant interviews, observations and document reviews. Thematic analysis was used.
Results: Findings indicate political history plays a significant role in shaping community action. In Somerville,
community organizers worked with city and state officials, and embraced community development strategies to
engage residents. In contrast, Chinatown community activists focused on immediate resident concerns including
housing and resident displacement resulting in more opposition to local municipal leadership.
Conclusions: The ISF was helpful in informing the team’s thinking related to systems and structures needed to
translate research to practice. However, although municipal stakeholders are increasingly sympathetic to and aware of
the health impacts of TRAP, there was not a local legislative or regulatory precedent on how to move some of the
proposed TRAP-related policies into practice. As such, we found that pairing the ISF with a community organizing
framework may serve as a useful approach for examining the dynamic relationship between science, community
engagement and environmental research translation. Social workers and public health professionals can advance TRAP
exposure mitigation by exploring the political and social context of communities and working to bridge research and
community action.
Keywords: Traffic related air pollution (TRAP); research and action, Community based participatory research, Public
health action
* Correspondence: lsmarti@bu.edu
1
Macro Department, Boston University School of Social Work, Boston, MA
02215, USA
Full list of author information is available at the end of the article
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Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 2 of 16 Background other highways. As noted in Table 1, both communities In the United States (US) and abroad, communities of are disproportionately impacted by transportation and color and low-income communities are disproportion- air pollution. Their ranking on environmental indicators ately impacted by environmental threats including noise including particulate matter (PM) smaller than 2.5 μm, and emissions generated by major roadways [1–3]. Ozone, diesel PM and traffic proximity and volume Pollution sources including manufacturing facilities, en- (daily traffic count/distance to road) for both communi- ergy plants, highways, airports, and toxic waste sites are ties are similar. Both communities rank higher than 90th frequently situated in communities of color and low- percentile in traffic proximity and volume, i.e., these income areas [1, 3–5]. Unfortunately, environmental communities have higher exposure to traffic proximity policies are often not enforced at these polluted sites than where 90% of the US population lives. Both com- and resident complaints are inadequately addressed [1]. munities also have the same percent of people over 65 Resident action at the community level can be an effect- and under 5 years in age. ive mechanism for catalyzing change, particularly when The Chinatown District has a higher percent minority efforts are informed by data [2]. As an approach, and low-income population overall, however, it should community-based participatory research (CBPR) com- be noted that the segment of Somerville along the high- bines inquiry and collective action and has gained popu- way is home to a higher percent of people of color and larity as a strategy for elevating health-related priorities low-income households that the city overall as shown in in marginalized communities [6–8]. Fig. 2. Figure 2 shows the percentile ranking of the block CBPR emerged on the health research scene nearly groups in the two communities compared to all block two decades ago and is seen as an effective approach to groups in US for two demographic indicators (percent of tackling inequities in health [9, 10]. CBPR is specifically population that is considered minority, percent of popu- designed to generate research that can inform policy and lation considered low-minority) and an environmental practice and catalyze change through the active engage- indicator (proximity to traffic). ment of community members in local decision-making As a first step in this work we set out to explore how processes [11–13]. In the context of environmental each of these two communities were defining and en- health research CBPR was catalyzed in part by funding gaging stakeholders in an effort to better understand support from the National Institute of Environmental how each community would translate knowledge into Health and Science (NIEHS) [14]. Moreover, because it practice. Both communities were included in an effort to emerged in the context of health equity work, CBPR is understand differences in their approaches to research specifically intended to drive changes to promote health translation and the ways in which they were or were not equity and justice [13]. Moving from research to com- successful. As such, this paper specifically explores the munity action necessitates broad community engage- research question: what are the approaches to commu- ment to shift public will. This is particularly true in the nity engagement employed by organizations in Somer- case of advancing environmental justice, which often in- ville and Chinatown in efforts to mitigate the effects of volves policy change and modifications to the built en- TRAP? What emerged was a story about the role of pol- vironment, as well as shifts in both public and private itical history in present day efforts related to community sector practice. Communities are complex adaptive sys- engagement in public health promotion and policy advo- tems [15], and successful strategies to advance health, cacy, as well as the importance of leveraging existing ad- such as policy and practices to reduce inequities in vocacy efforts and infrastructure. We provide a brief pollution exposure, likely vary across and within com- background on the Community Assessment of Freeway munities [16]. This variability poses challenges for docu- Exposure and Health (CAFEH) partnership, a multi- menting and replicating best practices [16]. university and multi-community consortium that studies This paper explores strategies to engage community a broad range of TRAP-related issues, and our guiding stakeholders in efforts to address a wide-spread environ- model, the Interactive Systems Framework (ISF) [20], mental justice concern: the effects of traffic-related air followed by a detailed description of the research meth- pollution (TRAP). TRAP is defined as the complex mix- odology, and a discussion of the study results. Findings ture of gaseous and particulate pollutants present in tail- contribute to the literature by expanding our under- pipe and non-tailpipe emissions from vehicles. standing of how community-level factors influence the The City of Somerville and the Boston, MA, dynamic relationship between science, action and policy Chinatown neighborhood (Somerville and Chinatown practice in communities and municipalities. hereafter), just 3.5 miles apart, are two very different communities (see map Fig. 1). The CAFEH partnership Nonetheless, both share a history of marginalization Between 1956 and 1963 the Massachusetts Department and exposure to TRAP from Interstate-93 (I-93) and of Transportation (DOT) began construction on the first
Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 3 of 16 Fig. 1 Map of Somerville and Chinatown. Layers for the map were obtained from mass.gov and map was generated using ArcMap10.5 portion of I-93, which runs 24 miles north from Medford mitigation practices. The results of this work were used to the New Hampshire border [21]. The section of I-93 by the partnership to inform solution-oriented research that runs south from Medford through Somerville and and community action [24]. Boston was completed in 1973 [22]. At the time, both Over the course of the CAFEH partnership leadership Somerville and Chinatown were both home to large pop- has shifted between community and academic stake- ulations of new immigrant, low income and working- holders as has the level of engagement. Early on re- class residents. Over the course of planning and con- searchers led the effort with guidance from community struction, state officials and planners were met with op- members, but more recently as the scientific knowledge position from activists and organizers who mobilized developed by CAFEH (and other research groups) has ma- large-scale protests in response to community concerns tured, community leaders have taken a leadership role in about the adverse effects of the highways on resident translation of study findings into action through develop- health and well-being [23]. Protests were successful in ing protective interventions at both the community and stopping some highway construction, but not I-93, and individual level. These shifts have also led to increased dis- although there were mitigations promised to Somerville ciplinary diversity among the team including a greater role for the highway, they never materialized [22, 23]. for social scientists, architects and urban planners, among In 2006, 33 years after the construction of I-93, local a team that was initially made up primarily of environ- resident organizers who had been actively contesting the mental engineering and public health researchers. highway and examining its health impacts on Somerville Within the original project, US Environmental Protec- residents, initiated a partnership with university re- tion Agency (EPA) funding provided early critical sup- searchers, launching a research and action agenda plemental support to two of the lead graduate students. focused on TRAP [24]. CAFEH emerged from this part- Once the partnership was established, the team also de- nership in 2008 and continues today. The resulting body veloped and submitted proposals for additional research of research focuses on near-highway pollution and that led to funding from US Housing and Urban health in communities bordered – and some cases di- Development and the National Heart Lung and Blood vided – by I-93, including Somerville and Chinatown. Institute [2, 25]. These grants allowed team members to The community research partnership began with fund- pursue research complementary to their environmental ing from NIEHS with the aim of evaluating the relation- epidemiology work including testing interventions such ship between TRAP exposure and health, increasing the as air filtration aimed at reducing exposure and health knowledge base to inform policy and the development of risk [26].
Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 4 of 16
Table 1 Percentile ranking for Somerville and Chinatown area compared to all block groups in USA for environmental justice
indexes, environmental indicators, and demographic indicators from EPA’s EJSCREEN tool (https://www.epa.gov/ejscreen) [17]
Somerville Chinatown
Environmental Justice (EJ) Indexes
EJ Index for Particulate Matter (PM 2.5) 52 78
EJ Index for Ozone 51 81
EJ Index for NATA* Diesel PM 36 93
EJ Index for NATA* Air Toxics Cancer Risk 50 83
EJ Index for NATA* Respiratory Hazard Index 49 84
EJ Index for Traffic Proximity and Volume 80 99
Environmental Indicators
Particulate Matter (PM) 13 14
Ozone 26 25
NATA* Diesel PM 80-90th 95-100th
NATA* Air Toxics Cancer RiskSprague Martinez et al. BMC Public Health (2020) 20:1690 Page 5 of 16 Fig. 2 Percentile rankings for block groups in Somerville, MA & Boston, Chinatown compared to block groups in US for two demographic indicators (percent of population considered minority and percent of population considered low-income) [18] and an environmental indicator (proximity to traffic) [19]. data was obtained from US EPA’s EJSCREEN (https://www.epa.gov/ejscreen) Control and Prevention in 2008 to help bridge connec- System and, (3) the Prevention Delivery System [28]. To- tions between science and practice with the goal of im- gether these components are designed to create the condi- proving evidenced-based interventions [28, 29]. The ISF tions for translating new innovation into practice. includes three components: (1) the Prevention Synthesis Community stakeholders are critical to each component and Translation System (2) the Prevention Support of this framework [30, 31].
Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 6 of 16
Fig. 3 From Research to Action
CAFEH, through community partnership, has gener- interviews, observations, documents and audiovisual re-
ated substantial evidence for association between TRAP sources [38].
and poor health [32–34], specifically, the ultrafine The study draws on three data sources: key informant
particle component of TRAP. Ultrafine particles are interviews (n = 15), ongoing analysis of weekly meeting
smaller than 0.1 μm in diameter (for comparison, the minutes and direct observation of research and commu-
thickness of human hair is ~ 70 μm), and as a result they nity meetings (n = 10). A summer of data collection
can penetrate deep into the body where they can be methods can be seen in Table 2. All protocols were
translocated to various organs. Patton et al. measured reviewed by the Boston University Charles River Campus
spatial and temporal differences in traffic-related air pol- Institutional Review Board, protocol #4434X. Interviews
lution in these neighborhoods and reported ultrafine were transcribed verbatim and reviewed by the research
particle number concentrations of 30,000 (IQR: 49,000) team for accuracy.
and 26,000 (IQR: 26,000) particles/cm3 in near-highway
neighborhood in Somerville and Chinatown, respectively Key informant interviews
[35]. CAFEH research showed that long-term exposures Initial interviews with project steering committee mem-
to ultrafine particles were associated with biomarkers of bers in April to May 2017 and follow-up interviews in
cardiovascular disease risk, specifically in Chinatown and December 2018 with key partners and a subset of com-
Somerville [32]. This work was among the first to show mittee members in Somerville and Chinatown focused
health associations with exposure to ultrafine particles on community process. The study was announced at a
and was based on painstaking efforts to measure near- project meeting and interviews were scheduled by email
roadway gradients of pollution, develop mathematical at a time and location convenient to participants. At the
models to predict exposure, and then assign individual- time of the interview a script outlining the procedures
ized exposures to residents in the near highway commu- (available as a supplementary file), elements of consent
nities [32, 35–37]. Guided by the IFS, we now seek to were reviewed and participant questions about the study
inform policy and practice in an effort to mitigate TRAP were addressed. A semi-structured interview guide ex-
exposure. To inform our work, we first sought to ploring participants’ roles on the project; participation
advance our understanding of how community-level and leadership; perceptions of decision-making, inclu-
factors influence the translation of research into practice sion and engagement; and expectations and goals was
to address TRAP exposure. used. In addition, community context, outreach and en-
gagement strategies, as well as strategies for community
Methods action related to TRAP were examined. Finally, percep-
A qualitative instrumental case study design was tions of community-level factors influencing research
employed. Instrumental design involves selecting a par- translation and potential challenges and levers were
ticular case in order to understand specific issues or queried. Interviews were recorded and transcribed.
challenges [38, 39]. This approach is widely used in so- Transcripts and recordings were then reviewed to verify
cial science research and focuses on the study of a case their accuracy. Participants were contacted for follow-up
in a real-life, present-day setting [38, 39]. Data include on an on-going basis over the course of the study.Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 7 of 16
Table 2 Data collection summary developed codes using NVivo by labeling and naming se-
Data Collection Methods n Time Point lected text. Third, the researchers sorted codes into pos-
Key Informant interviews 15 Baseline sible themes and explored relationships between themes
Observations 10 Ongoing
and codes across levels [40]. Fourth, the researchers fur-
ther reviewed and refined the themes to ensure the data
Reports 2 Baseline
within each theme was both cohesive and distinct [40,
Meeting summary log 1 Ongoing 41]. Fifth, the researchers identified the larger story
within the data in collaboration with participants [40],
Further, additional interviews were conducted with two and elicited feedback from members of the steering
Somerville activists who led opposition to the highway committee. In the final phase of analysis, the researchers
in the 1960’s. selected illustrative quotes to produce a succinct, cogent
story of the data within and across the identified themes
Observations from the three sources of data [40].
Observations were conducted from April 2017–December
2019. The overall goal of the observations was to examine
dynamics and participation at meetings and public forums Results
associated with the project. Observations were planned in A total of 15 key informant interviews were conducted
collaboration with the project steering committee. Mem- with project partners and community stakeholders and
bers of the steering committee introduced the researchers 10 community meetings focused on TRAP were ob-
at community meetings and events and explained the served. Interview participants included academic re-
goals of the study. Permission was requested to record searchers and staff (4), community leaders (5), planners
meetings, when feasible, depending on participants’ com- (3), residents (3). Meetings included community plan-
fort with being recorded, the size of the event and the ning meetings, informational sessions and planning
acoustics of the meeting space. At large forums additional charrettes. In both communities initial planning meet-
note takers were present and introduced to the group. ings were informational and or explored community
Comprehensive notes were taken during and at the cul- health related priorities with an emphasis TRAP. Later
mination of each observation. Observation notes were meetings in Somerville focused on sound walls as a
typed and then analyzed thematically. strategy to mitigate TRAP, meanwhile in Chinatown the
focus was on buildings and then incorporating TRAP in
Document review the Chinatown Master Plan.
Project documents included health lens analysis protocols, Although Somerville and Chinatown fought steadfastly
charrette processes, weekly meeting plans and agendas, against the construction of I-93, both lost parts of their
and committee meeting minutes. The researchers engaged communities to make room for the highways, and were
in continuous data collection and analysis, and provided then left to address the adverse health effects of TRAP.
feedback to the steering committee periodically. As one participant observed,
Data analysis … both of these communities were influenced by the
Two types of data analysis were employed, holistic ana- building and development of I-93 and the Mass Pike.
lysis of the whole case, and embedded analysis of specific Chinatown, half of it was destroyed; Somerville, they
parts of the case [38]. A chronology of events was exam- fought against the highway and it was built against
ined in addition to key themes to assess the complexity their wishes. So, in both communities … boundaries
of the case [38], two members of the research team inde- … were largely defined by the construction of the
pendently coded the interview transcripts and developed highways. It goes way back. It is very deep.
a codebook. Each data source was coded inductively, fo-
cusing on the data itself without preconceived categories Yet, despite their shared past, the present-day ap-
[40, 41]. The researchers also reviewed and analyzed proaches to public health activism in Somerville and
community meeting minutes and notes from direct ob- Chinatown are quite different. Our findings highlight the
servation of community meetings. role of contextual factors, namely politics and power, in
First, the researchers read each interview transcript influencing public health action related to TRAP. Two
multiple times to immerse themselves in the data, to illustrative case studies are presented. Community con-
search for meaningful patterns [40], and to reflect on text is followed by a discussion of local activism and pol-
their questions and reactions to the codes [42]. The itical power. We then situate each of the communities in
researchers discussed the initial analysis to ensure context describing their relationship to I-93 as well as
consistency in their analytic approach [43]. Second, they strategies for community change and residentSprague Martinez et al. BMC Public Health (2020) 20:1690 Page 8 of 16
engagement past and present, culminating with plans for 4931 Somerville public school students, 53 languages
public health action to mitigate TRAP. are spoken [22]. Further, the CAFEH work has been
situated primarily in East Somerville neighborhoods,
Somerville which are closest to I-93 and are substantially more
Somerville is a densely populated city located 2 miles diverse than the city as a whole. In the neighbor-
northwest of Boston with a population of over 79,000 hoods near I-93, half of the residents are people of
living in 4.1 mile2 [44]. This work has focused on east color, compared to the city average of 3 in 10 resi-
Somerville which lies adjacent to the highway, and not dents of color [22]. Of note, some new immigrant
the western and northern segments of the city. These populations, such as Brazilians, are less visible in the
different areas have different demographics that are census as they don’t fit squarely in US racial and eth-
quite different. A greater proportion of residents in the nic categories [49]. One participant described the di-
near-highway neighborhoods are people of color and verse immigrant communities in Somerville:
foreign-born than the city overall [45]. According to the
census, 70% of the population identifies as White, 10% … in Somerville [language demographics] are almost
identifies as Hispanic or Latino, 10% Asian, 7% Black or equal Portuguese, Spanish, Chinese, Haitian Creole,
African American, less than 1% American Indian/Alaska and there are an awful lot of others here. When
Natives and 3% identify as other race [46]. Among people have to move out of town they don’t like it,
Somerville residents, 24.8% (19.8 k people) were born and many people come back and spend their days or
outside the US as of 2017 [44]. weekends here.
Somerville is described as a racially and ethnically di-
verse community; more specifically, as being home to Rising housing prices associated with redevelopment
large numbers of new immigrants. This theme emerged and gentrification have priced many lower income
in key informant interviews as well as in meeting mi- people out of the Somerville housing market. However,
nutes as planners talked about the importance of en- even though they may not be living in the community
gaging non-English speakers and immigrants. The they return for social activities as well as for church,
extensive diversity in Somerville is not apparent at first markets, health services and civic associations [47, 49].
glance. Outsiders might characterize Somerville as a pro-
gressive upper middle-class white community. This runs Activism and political power in Somerville
in stark contrast to the community’s working-class roots, In conversations with community partners about the
which at the time of economic down turn in the mid-to- present research and action study, they indicate
late 1900s, earned it the nickname “Slumerville”, when Somerville has a long history of community activism
the community was struck by high unemployment rates, among residents. Participants noted City residents have
disinvestment and political corruption [47]. worked to protect land use and to limit development ex-
At the turn of the century Somerville was an epicenter pansion in Assembly Square and other neighborhoods:
of the new immigrant working class. Ostrander [47] de-
scribes Somerville in the late 1800s as a city run by … a number of us first started thinking about … par-
Yankee Aristocrats on the backs of Irish bricklayers. In ticipating in how the city evolves, particularly areas
the early 1920’s the Irish gained political power in with large-scale developments about 20 years ago. Ini-
Somerville and new immigrants from French Canada, tially, we worked in parallel with city government. We
Italy, Portugal and Greece took their place at the bottom focused a lot at Assembly Square because it is as big
of the economic ladder [47]. According to participants, as downtown Boston from North to South station and
blue collar workers still comprise approximately 33% of it was largely underutilized after the manufacturing
the population today: businesses left post WWII. We had citywide meetings,
large charrettes, … we were working in parallel
… I characterize the population in thirds. I would with city government … the larger developers …
say one of the thirds is the old blue-collar commu- upper hand … After that we got in a series of
nity, which still lives here. One third is the young ed- pretty large lawsuits that we largely wrote our-
ucated, but not at this point wealthy, population selves against the four biggest law firms in Boston
and then the third is the immigrant population. in real estate and environmental litigation. It took
five years, in the meantime we had written zoning
A closer look at the public schools of Somerville and lots of other things. … we ended up winning
today reveals a robust immigrant community with three fully prosecuted lawsuits in three different
48.2% of the school children speaking a language court venues on three different principles of law,
other than English [48]. Among the population of which took a number of years to play out.Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 9 of 16
H partnership. Leveraging these relationships has
… STEP [the Somerville Transportation Equity Part- benefited the team, as the participation of political
nership, a grassroots coalition] … went to every leaders has continued across public health action
meeting [Green Line planning meeting] … and put planning meetings in Somerville.
1500 people in three meetings … the state didn’t
want to do the Green Line, they wanted to substitute Interstate-93, TRAP and public health action
entirely non-Somerville projects even though the In Somerville, 1950 marked the beginning of neighbor-
Green Line was the single largest environmental hoods being leveled to make way for the “inner belt” of
mitigation project for our violations of the Clean Air the expressway, this included the “Brickbottom” and
Act and the state of limitation plan which is how States Avenue Neighborhoods [47]. Expansion of I-93
surface transportation relates in federal regulations was a public works project that impacted Somerville into
to the Clean Air Act. So, following that kind of the 1970s and residents actively protested. One inform-
massive unity of citizens [referring to residents at ant reflected on the political context of resident activism
Green Line meetings] and elected officials and during this time:
others, the state relented and decided to go ahead
with the Green Line. During the period when (a key informant) and her
crew were trying to fight I-93, Somerville had incred-
These are two examples of resident activism in Somer- ibly corrupt politics. Everybody was on the take.
ville. The CAFEH partnership itself was the result of They had very little influence because of what was
years of resident action through the work of the Mystic going on at the political level. … that was what
View Taskforce, which catalyzed Somerville Transporta- really screwed things up, decisions were made that
tion Equity Partnership. As described by partners, Mys- didn’t make any sense. There was as much activism
tic View Taskforce contested through litigation as in Somerville [about corruption] as there was about
Somerville Transportation Equity Partnership actively fighting the inner belt.
organized residents, using both capacity building and so-
cial action. In their interviews, Somerville partners talk According to Ostrander (2013), “the city administration
about organizing and working with city officials and is moving away from this private patronage to a ‘good gov-
state representatives as opposed to working against ernment’ approach” (pg. 38) in an effort to create distance
government. from the corrupt government system of years past [47].
Residents have been fighting I-93 in Somerville for
When a developer came in and wanted to build a ren- many decades. Another key informant, a lifelong resi-
tal building next to my Stop and Shop and we fought dent of the East Somerville States Avenue neighborhood
to make that condos, and it is going to be condos … it commonly referred to as “the nunnery” given its proxim-
hasn’t been passed yet, it is under consideration. That ity to a nearby convent, described the different initiatives
is one thing we have been working on with the city for residents took on, including marching in the streets with
a long time, but the city is undergoing a zoning re- banners, canvassing door-to-door and in the case of her
vamp so it is part of that whole process. brother-in-law, literally laying down in the mouth of a
bulldozer:
Ostrander (2013) argues residents in Somerville are
able to actively engage in political activity through We lost half of our neighborhood on Wisconsin Ave,
“voluntary associations” (p. 38) because of the absence people moved out because they didn’t want to deal
of a strong elite business class or “urban regime” with all the construction going on and didn’t want
[47]. This leaves space for the active involvement of to wait until their house was gone.
residents to influence local decision-making [47]. We
also saw this quite clearly in Somerville efforts to en-
gage local leadership in discussions around public We requested I-93 go underground, we were against
health action related to TRAP. Early Somerville meet- the elevation. We formed the East Somerville Com-
ings included strong participation from local elected mittee Action group, the first active group in the city;
officials and state representatives. During these early we were civically involved for a long time, and then
meetings, political figures spoke about the impact of expanded, this included mostly neighbors, commu-
TRAP and the importance of the research partner- nity members. We were protesting, the group stood
ship. This participation was largely the result of where the excavation was going to happen. We can-
relationships between community stakeholders and vased door to door, except it was too late, the road
political officials that pre-dated the work of the CAFE was planned and construction began.Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 10 of 16
This history of highway expansion continues to impact with local immigrant serving organizations and
the Somerville community in significant ways. Somer- English language classes, community partners sought
ville is the only municipality in Massachusetts that has to engage internal stakeholders and build community
over 200,000 vehicle miles traveled per day per square capacity. These sessions provided background infor-
mile and the only one with 15,000 diesel trains per year mation on TRAP and offered a venue for residents
per square mile. A major commuting corridor to Boston, to share their ideas and make recommendations,
I-93 and two arterials (Routes 28 and 38), together carry informing the planning process. One partner shared
250,000 vehicles per day through Somerville [50]. These how the Health Lens Analysis process informs the
pass-through commuters come from outlying municipal- charrette approach:
ities on their way to Boston and Cambridge. While over
25% of Somerville households have no cars and over … at the resident level, this is where we are excited
50% of residents use public transit or bike or walk to about the Health Lens Analysis [it] is a way to have
work, residents are subjected to high volumes of traffic the ultrafine in the conversation, and kind of nesting
and diesel rail pollution because of the seven diesel com- that within communities’ concerns related to par-
muter rail lines traveling through the city, along with ticular projects that may either increase people’s ex-
heavy highway traffic and the location of the Massachu- posure to ultrafines or generate more ultrafine
setts Bay Transportation Authority Commuter Rail particulates. So, having conversations that blend
Maintenance facility [50]. what community priorities are especially health de-
In 2006 the residents approached researchers to study terminants and how something like ultrafines play
the health effects of I-93 [51]. The goals of the Somerville into that conversation and using that as a way to
partnership with respect to research and action were two- have a community lead or at worst community in-
fold, to increase awareness and to decrease exposure. One formed response to dealing with the issue.
participant shared their vision for this partnership:
These conversations gave participants an opportunity
I would like to be able to say that we come up with to discuss the most effective targets and identify goals
some real solutions to reduce people’s’ exposure. for each target. External targets include municipal lead-
Technical solutions that are beneficial to people in ership and policy makers who have the ability to influ-
new housing and old housing. So very concretely ence local policy and transportation and highway
those are what I would like to see happen. On a planning.
community level in terms of people’s understanding,
being able to engage in a way that people learn that … helping on the formation of policy pieces whether
one it is an issue they need to be concerned about, it be guidance or regulation on how understanding
but two, that they may have some wherewithal to of the ultrafine exposure plays into development it-
address these kinds of issues so that it is transferable self or transportation related decisions or really any
to other things that people are concerned about. So, land use decisions. Part of it is also bringing it into
building capacity to address needed change, would broader conversations that when people are looking
be something that I would like to see. at existing conditions or talking about alternatives
or actions, making sure that is a part of a conversa-
Stakeholders identified both internal and external tar- tion as part of the [Project Partnership Name] piece
gets for public health action. Staples (2016) defines tar- itself.
gets as individuals or institutions that action groups
activate or influence to bring about change [52]. External
targets have the decision-making power to help the … while I do think that there is kind of a way to in-
action group realize its goals, and as internal targets, the fluence up to the state I think most of our focus is
community members themselves are engaged in the kind of our regional scale and going down. Part of it
initiative [51]. is both kind of municipal leadership, including those
Somerville stakeholders are using community de- who are elected, and municipal staff, like planners,
velopment strategies to engage internal targets. people in community development, people in the en-
These have included information sessions and out- gineering or public works side of municipality. So,
reach events. Similar to the community engaged building awareness but also an actionable awareness
planning process, embedded in the health lens ana- around air quality exposure, particularly ultrafine
lysis, the charrette process provides residents with as part of that conversation. So what ways they can
data and engages them in discourse, which can build alter their work or change what they consider when
community awareness [53]. Through partnerships they look at plans of attack to make change.Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 11 of 16
Chinatown’s city streets are among the most congested
… the municipal side I think two ways we have come in the city, as traffic gridlocks with commuters entering
at is are one, especially in Somerville, working with and exiting the highways to work in the downtown fi-
the [Project Partnership Name] group on what a nancial and commercial district. For decades, the neigh-
zoning ordinance might look like if it was taking borhood’s primary outdoor recreational space has been a
these exposures into account. So that was looking at basketball court between on and off ramps serving I-93
zoning that might create a district where people and I-90. Construction of new housing and a new school
might fall into an area that could be impacted by immediately next to the highway are ongoing. Unlike
ultrafine particulates and maybe subjecting them to some near highway neighborhoods where residents
a couple of additional steps to assess whether or not spend large parts of their days away from home, a ma-
that exposure exists and if so how they would miti- jority of adults and children (attending the local school
gate it. So, doing that within a legislative piece. which is also right next to I-90) are in Chinatown most
of the time on most days. Chinatown was also one of the
In Somerville, the conversation related to TRAP and original CAFEH study areas with high levels of TRAP,
public health action has centered on sound walls. Al- including ultrafine particles [51].
though, sound walls cannot eliminate TRAP, they can
reduce exposure [54, 55]. Moreover, those most im- You know, I think the [Project Partnership Name]
pacted by TRAP are also impacted by noise. Partners project over the years it already has increased a lot
have leveraged their strong ties with local officials as of people’s awareness of air pollution as an issue.
well as the broken promises of the state to propose But I don’t know that people really, that other than
building sound walls near exposed neighborhoods. Their thinking about it when you open your window, that
overall approach to resident engagement draws on a there is really a lot that people have been able to do
long history of environmental health action. It has been about it on an individual level.
top-down working through partnerships with local offi-
cials and state representatives to pressure transportation In Chinatown, residents’ concerns about TRAP are sit-
leaders. They have employed a collaborative community uated in the community’s larger concerns about the
development approach, which began with educating health of the community, with initiatives focused on
leaders and now residents. They have broadened their practical solutions to benefit individual community
campaign to ensure all segments of the community are members. Chinatown organizing has been primarily fo-
engaged partnering with local immigrant serving organi- cused on community development, specifically afford-
zations and hosting meetings in Portuguese, Haitian able housing and resident displacement as a result of
Creole and Spanish. gentrification. One key informant reflected on the com-
munity’s top priorities:
Chinatown
Boston’s Chinatown is a historic neighborhood in down- I think the biggest challenge is that it [air pollution]
town Boston. I-93 construction through Chinatown was is just not the top priority issue for the community.
completed in the late 1950s, demolishing homes and cut- People are concerned about much more immediate
ting the historic Chinese Merchants Association building in issues, like having a stable housing, jobs. But yeah, I
half. Massachusetts Turnpike construction then displaced think that is probably the biggest difficulty.
hundreds more residents from 1962 to 1965, just prior to
the 1965 liberalization of immigration law, which led to a These sentiments were echoed by another key inform-
major increase in the Chinese American population. Today, ant who reiterated the interest Chinatown residents
I-93 and the Massachusetts Turnpike (I-90) together carry share in seeing real changes that benefit the community.
300,000 vehicles per day through Chinatown [51]. Residents are more focused on immediate concerns as
Chinatown has experienced successive phases of trans- opposed to TRAP:
formation, first through urban renewal, which razed
hundreds of housing units for highway construction, … there are a lot of more pressing changes that are
then through expansion of the Tufts University Medical going on in … Chinatown. I think specifically about
School and Medical Center, and most recently with a the threat of gentrification and displacement, and
massive influx of luxury and market rate high-rise that a lot of these threats are very imminent, in that
development associated with Boston’s downtown people while interested in talking about maybe
revitalization. Each of these phases has brought in- sound barriers and health disparities, might not be
creased traffic and development challenges to Boston’s as interested in investing a lot of time to talk about
smallest and lowest-income neighborhood. a threat that feels a lot less on their doorstep.Sprague Martinez et al. BMC Public Health (2020) 20:1690 Page 12 of 16
The community’s focus on the need for real, action- has been a central part of community engagement as ev-
able change including increased access to green space in idenced by a key informant:
the neighborhood, was echoed by a key informant:
And if you go back 60–70 years, those were commu-
I would like to see us make some actual change that has nity people’s homes and they were razed during
an impact on the Chinese community members that we urban renewal. And it was just after urban renewal
work with. You know, so maybe making sure that one of they gave the land to the highways, and then the
the new affordable developments or at least a develop- land they didn’t give to the highways, there was a
ment with a significant amount of affordable housing small amount of replacement housing built, and the
has a good air filtration system, or making some changes rest of it they gave to Tufts, I think actually most of
to the Reggie Wong Park, that would be helpful. it was to the Floating Hospital at that time. So that
kind of history is important for people to feel like
Elderly residents, in contrast to younger working fam- yeah oh we actually do have a right to that land, it
ilies, have been the most available and engaged group of is not just that Tufts has a right to this land, we
Chinatown residents involved in these community initia- don’t.
tives. One informant described the active role elders as-
sume in the community:
Activism and political power in Chinatown
I mean I think that the sector of the community that is Whereas Somerville is a small densely populated city
probably easiest for us to reach out to and that we have with its own government structure, Chinatown is one
tended to rely on, are the elderly, because the elderly of many distinct neighborhoods in the city of Boston.
residents, most of them are living in subsidized housing As such, gaining access to political power has looked
of some type and they are the most active residents in quite different. The neighborhood has been historic-
the community because they have time on their hands, ally marginalized, leading community leaders and ac-
they are stable. … whenever you have a communal tivists to cultivate a bottom-up, grass roots approach
meeting it is always the elderly that you can really to engaging residents and advocating for the commu-
count on them to come out. And you know Chinatown nity’s needs [56]. This advocacy has included both
Resident Association it is mixture of generations but it community development and social action approaches
is predominantly those elderly. … we have pretty exten- to community organizing [56]. The community has
sive ties with the home base of active elderly residents, engaged in a conflictual and contesting relationship
and they are also the most active voters. with local government officials over time in order to
address residents’ needs. More often than not resi-
In order to engage residents in CAFEH’s work ad- dents have had to contest local power dynamics as a
dressing air pollution, it has been important for commu- strategy for grassroots change. This long history of
nity leaders to situate the research in Chinatown’s social action has contributed to outreach and engage-
history. One informant revisited the central role the ment infrastructure that is highly effective due to
highway plays in the community’s history and experience strong social capital and community cohesion, as was
of disempowerment: described by key informants:
I mean I guess we just talk about it in relationship I mean I think the main community assets are it is a
to Chinatown’s history. And you know, because I fairly organized community, so we already have the
think the presence of the two highways it is really a resident association, we already have CPA [Chinese
part of Chinatown’s history, always being the disem- Progressive Association, a partner to many [Project
powered community and having land taken from the Partnership Name] studies]. And there are a few in-
community and not being protected residents like dividual tenant associations that we have ties with.
other neighborhoods. I think we connect it to reinfor-
cing and educating people about the history. And
then which is connected, so we try to connect it to I think the tactics that we use are pretty common,
other issues, because in a lot of ways we have to like we will use the Chinese media, we will print
understand the history to feel like we have the right flyers, every once and a while we will print a news-
to stand up and fight for things…. letter that we might distribute, we do events, like in
the summer we do Chinatown block party with a
Helping Chinatown residents better understand and few different organizations and kind of use that as
appreciate the history of the land in their neighborhood an educational fair. And then you know workshopsSprague Martinez et al. BMC Public Health (2020) 20:1690 Page 13 of 16
in the different housing developments as well as worked collaboratively alongside younger residents to
community meetings we usually hold in the Quincy identify solutions to these concerns. A number of
school cafeteria. That is where the Residents Associ- younger residents voiced appreciation for the oppor-
ation holds its meetings and it is just a really com- tunity to learn more about Chinatown’s history from
mon meeting space. I don’t think there is anything community elders.
particularly creative about our strategies, I mean From the perspective of community leaders, the
sometimes not so much around [Project Partnership charrette increased awareness of the air pollution is-
Name] but around our Chinatown Stabilization sues in relation to health and helped to link air pollu-
campaign we have done some artistic things too. tion issues with other community concerns related to
both health and development. In addition, it was re-
Chinatown partners were highly effective in bringing ported that the planning charrette was successful in
out diverse intergenerational groups of residents to early gaining attention from the city, particularly Boston
community meetings and forums. Residents were ac- Transportation Department, The Boston Planning and
tively engaged in discussions about TRAP during early Development Agency /PLAN: Downtown, and Depart-
Health Lens Analysis meetings; however, housing and ment of Neighborhood Development. The Boston
development, as well as safe streets for walkers, preserv- Planning and Development Agency and Department
ing cultural resources, and quality open spaces emerged of Neighborhood Development have sat in on all of
as pressing concerns in meetings in addition to TRAP. the Master Planning Implementation Committee
meetings and have been generally supportive of the
Interstate-93, TRAP and public health action CAFEH-led Health Lens Analysis and community-led
Chinatown, today, remains a minoritized community neighborhood plan update – providing data when re-
and although there is a strong political will and high quested and looking for opportunities to align the
level of resident participation, structural oppression re- community process with theirs.
mains. Moreover, historic disinvestment and In sum, both the Somerville and Chinatown cases
marginalization coupled with the neighborhood’s central speak to the importance of political history in shaping
location in the city, have left Chinatown primed for gen- approaches to both community engagement overall and
trification and displacement. Early conversations about public health action. Moreover, the highlight the value
the Health Lens Analysis were focused on thinking of existing community partnership and advocacy infra-
about mitigating TRAP in the context of new develop- structure in shaping the success of community research
ment. As community conversations progressed the dia- partnerships. Both communities are organized quite dif-
logue shifted to a focus on the neighborhood Master ferently in their approaches leveraged past advocacy
Planning process, and, more specifically, how efforts to work to catalyze TRAP-related public health action.
mitigate TRAP might be built into the Master Plan and
the community’s overall strategies for the future. This Discussion
approach gained considerable endorsement from We found the ISF to be a helpful framework for or-
neighborhood residents as was evidenced by a commu- ganizing assessing activities related to dissemination
nity planning charrette attended by 90 participants. Also, activities associated with research translation. In order
notable was how truly bilingual (English-Cantonese) it to support the needs of community partners, Preven-
was. tion Synthesis and Translation System, CAFEH con-
ducted community outreach through English language
From being part of other translated meetings, this classes, press releases, community forums, and neigh-
one felt a more genuine presentation of materials in borhood meetings. They also employed educational
two languages – with the presentation being gener- materials for local dissemination to stakeholders from
ated in Cantonese and facilitators actively trying to various community sectors including residents. Des-
make space for non-English speaking residents in pite the benefits of these initiatives, the absence of an
small group conversations. internal communications strategy for the dissemin-
ation plan was a limitation.
Through a series of breakout groups, residents par- A Health Lens Analysis was then conducted to help
ticipating in the charrette were encouraged to adopt a the communities examine TRAP through a health
holistic view of health and visually mapped out how lens. Materials developed were used in the context of
to address community concerns including the need Health Lens Analysis meetings to engage stakeholders
for green space, improved pedestrian safety as well as more broadly in TRAP related discussions. This
commercial and residential displacement. Intergenera- process allowed community stakeholders and residents
tional collaboration was evident as older residents to think and dialogue about TRAP in the context ofSprague Martinez et al. BMC Public Health (2020) 20:1690 Page 14 of 16
community related health and development priorities. Supplementary Information
At the same time, it was challenging it was challen- Supplementary information accompanies this paper at https://doi.org/10.
1186/s12889-020-09751-w.
ging because many of the policy and programmatic
changes desired will require a long-term effort, and Additional file 1. Baseline Interview Script was used to collect data
awareness raising conversations occurred without from steering committee members and project partners.
clear pathways for individuals to take immediate pro-
tective steps. Nonetheless, the Health Lens Analysis
Abbreviations
process and associated planning charrettes served as a CAFEH: Community Assessment of Freeway Exposure and Health;
Prevention Support System. Beyond capacity building CBPR: Community Based Participatory Research; DOT: Department of
planning charrettes resulted in digestible community Transportation; EPA: Environmental Protection Agency; ISF: Interactive
Systems Framework; MA: Massachusetts; NIEHS: National Institute of
reports and resources available to stakeholders for use Environmental Health and Science; PM: Particulate Matter; TRAP: Traffic
in further public health action. Moreover, the team Related Air Pollution; US: United States
was able to further develop its understanding of inter-
ventions and to hone targets and asks for outreach. Acknowledgements
We thank the many people who contributed to this work, including faculty,
We found the notion of the Prevention Delivery System
students, community partners and members, staff and volunteers.
did not fully align with our goals as they related to pub-
lic health action to inform policy practice. This is largely Authors’ contributions
because our partners set out not to implement a specific LSM: Conceptualization, Methodology, Formal analysis, Writing - Original
program but to inform policies at the municipal and Draft. ND: Methodology, Formal analysis, Writing - Original Draft. SR:
Conceptualization, Writing - Original Draft, Validation. NH: Conceptualization,
state level in an effort to transform practice. Although Writing - Review & Editing, Visualization. WZ: Conceptualization, Writing -
municipal stakeholders are increasingly sympathetic to Review & Editing, Validation. LL: Conceptualization, Writing - Review &
and aware of the health impacts of TRAP, there is not a Editing, Validation. BE: Writing - Review & Editing. JLD: Writing –Review &
Editing, Visualization. DB: Conceptualization, Supervision, Project
local legislative or regulatory precedent on how to move administration, Funding acquisition. ER: Supervision, Conceptualization,
some of the proposed TRAP-related policies into prac- Project administration, Writing - Review & Editing, Validation. All authors
tice. As such, we found that pairing the ISF with a com- have read and approved the manuscript.
munity organizing framework may serve as a useful
approach for examining the dynamic relationship be- Funding
This study was funded by the National Institute of Environmental Health
tween science, action and policy practice moving for- Sciences, Grant title: Near Highway Pollution: From Research to Action
ward. This will be critical in ensuring follow up to the (R01ES026980) and Grant title: Home Air Filtration for Traffic Related Air
Health Lens Analysis process results in shifts in policy Pollution (R01ES030289).
practice.
This work is not without limitations. Although mul- Availability of data and materials
A copy of the interview protocol has been provided. More information
tiple forms of data collection were employed including about the CAFEH study and available data reports can be found at: https://
meeting observation, interviews and documents review, sites.tufts.edu/cafeh/
the vast majority of baseline interviews were collected
with internal stakeholders (i.e., members of the CAFEH Ethics approval and consent to participate
This research was reviewed by the Boston University Charles River Campus
research team). Moving forward, interviews with exter- Institutional Review Board, Protocol number 4434X.
nal stakeholders in each community including residents
will be critical to understanding the extent to which re- Consent for publication
search findings and the community action that followed The study was determined to be exempt. Written consent was waived. A
have been translated to policy practice. The ISF was consent script was reviewed with participant and documented by the
evaluator.
helpful in informing the team’s thinking related to sys-
tems and structures needed to translate research to
Competing interests
practice. Linda Sprague Martinez is a youth engagement consultant for Americas
Promise Alliance and an external evaluator for CCI Health and Wellness, Inc.
Conclusions All other authors have no disclosures.
The current study has important implications for public Author details
health action. Public health practitioners need to be 1
Macro Department, Boston University School of Social Work, Boston, MA
aware of the of the diverse sectors that comprise com- 02215, USA. 2Boston University School of Social Work, Boston, MA 02215,
USA. 3Metropolitan Area Planning Council, Boston, MA 02111, USA.
munities as well as interests, priorities and politics both 4
Department of Civil and Environmental Engineering, Tufts University,
across and with factions of the community. Moving for- Medford, MA 02155, USA. 5Somerville Transportation Equity Partnership,
ward, conducting power analyses in the community Somerville, MA 02145, USA. 6The Chinatown Land Trust, Boston, MA 02111,
USA. 7The Welcome Project, Somerville, MA 02145, USA. 8Department of
using a community organizing framework would be Public Health Sciences, University of Connecticut School of Medicine,
beneficial. Farmington, CT 06030, USA.You can also read
