Date on Master's Thesis/Doctoral Dissertation

5-2019

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Epidemiology and Population Health

Degree Program

Public Health Sciences with a specialization in Epidemiology, PhD

Committee Chair

Zierold, Kristina

Committee Co-Chair (if applicable)

Boone, Stephanie

Committee Member

Baumgartner, Richard

Committee Member

Thoroughman, Douglas

Committee Member

Combs, Ryan

Abstract

Environmental pollution is not distributed equally across members of society. Low-income individuals are more likely to live near waste sites and other sources of pollution, and, therefore, face greater exposure to environmental health hazards. One such community in Louisville, Kentucky, the Riverside Gardens neighborhood, consists of approximately 300 homes that are surrounded on three sides by industry and industrial waste, including a remediated Environmental Protection Agency Superfund site, a former coal-burning power plant and coal ash storage site, and multiple chemical, rubber, and plastic manufacturing companies. Residents have reported elevated rates of cancer and other chronic diseases and have requested a formal health assessment. This dissertation study is the first documented attempt to collect and evaluate health and exposure histories from Riverside Gardens residents. This study used a mixed-methods design conducted in two phases. The first phase of the study employed qualitative research methods. Individual interviews were conducted between March and May of 2017 with 15 residents who had resided in the community for at least five years. Inductive thematic analysis was used to assess the health and environmental exposure concerns of the community. The interview findings, in addition to the specific health and exposure concerns shared during community meetings, informed the creation of a health and exposure assessment questionnaire that was distributed to community members between July and October of 2018 during the second phase of the study (a cross-sectional epidemiologic study). Participants self-reported medical conditions diagnosed by a physician or other health professional and answered exposure-related questions. Prevalence estimates of health conditions reported by 83 adult residents were compared to local, state, and national data from representative surveys using prevalence difference tests. Additionally, health history data were categorized and compared among residents with differing levels of an exposure score that was developed using self-reported neighborhood exposures through binary and multinomial logistic regression analyses estimating odds ratios (ORs), adjusted odds ratios (AORs), and 95% confidence intervals (CIs). Finally, the frequency with which groups of symptoms were experienced was compared between participants who lived closer to and farther from contaminant sources using binary logistic regression analyses. Prevalence estimates of certain musculoskeletal, respiratory, circulatory, and mental health conditions among Riverside Gardens adults significantly exceeded local, state, and/or national estimates. Comparisons within the community found that those with higher exposure scores were more likely to self-report a diagnosis of a musculoskeletal system or connective tissue disease, before and after adjustment for age (OR: 1.39, 95% CI: 1.08 – 1.78; AOR: 1.32, 95% CI: 1.01 – 1.72). Groups of self-reported symptoms did not significantly differ by participants’ home locations. These results, however, are based on a small sample of residents and should be interpreted with caution. Additional research is needed to assess the relationship between exposure to environmental contaminants and disease outcomes among Riverside Gardens community members, including children.

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