Community-Engaged Approach to Identify Environmental Health Risk Factors for Respiratory Disease in Appalachia

This project builds on our team's long relationship with residents living in Eastern Kentucky that has allowed us to conduct community-engaged research with this isolated, rural and underserved population. Counties in the region report some of the highest rates of obstructive respiratory illness in the country, including chronic obstructive pulmonary disease and adult asthma. To this end, investigators from the College of Medicine and the College of Public Health, with funding from NIEHS, created the Mountain Air Project (MAP). This study initially conducted an epidemiologic study in Harlan and Letcher Counties to identify potential factors related with chronic respiratory illness. These data were collected from nearly 1,000 homes, many of which were located in difficult-to-reach hollows. A community advisory board (CAB) reviewed preliminary findings from the epidemiologic study and suggested that investigators find a role for youth in these counties to contribute to potential interventions. As approved by the CAB, a feasibility study was implemented in fall 2018 that engaged youth (ages 12- 18) in Letcher County to capture their perspectives of indoor and outdoor determinants of respiratory illness through a participatory action approach called photovoice. During this project, youth were trained on the basics of respiratory illness causes and exacerbating factors. They were also trained on how to capture meaningful photographs and to write captions about each photograph in a journal. In December 2018, a community exhibit took place in Whitesburg, and the exhibit will travel to UK in spring 2019, coinciding with a symposium at the annual Center for Clinical and Translational Science conference. The feasibility study demonstrated significant capacity among outh contribute to environmental health data collection, and the interest on their part to continue their photovoice is ongoing. The next step in this effort will be to build off of the youth engagement in photovoice. Their ability to serve as change agents in the home environment and in their communities will be further strengthened by the proposed study.