 Great. So good morning, everyone. My name is Linda Young, and I am a program officer with the Board on Chemical Sciences and Technology here at the National Academies. I want to extend a warm welcome to those in person and online to our workshop, indoor chemistry and environmental justice, housing consumer products and health risk. This is the first of three workshops. Next month, we will meet back here on October 18 for our second workshop, which will focus on emerging areas of indoor chemistry. And we, we will put the link on the chat and momentarily. Today we gather to discuss a subject of increasing significance in our daily lives, indoor chemistry. It is a topic that impacts our health, comfort and well-being, often operating in the background, but with profound consequences. This workshop will have a special focus on recommendations from the consensus study, why indoor chemistry matters, as they relate to environmental justice. We will explore how indoor chemistry intersects with issues of equity and social justice, recognizing that not all communities have equal access to healthy indoor environments. Before proceeding further, I want to share a bit of housekeeping rules. For those participating online, we encourage you to take part in the Q&A sessions at various points throughout the workshop will open the floor for questions. If you have a question, please type it in the chat box. Our moderators will do their best to ensure your questions are addressed. For those in person, we have microphones in the aisles. If you're able to walk to the microphone, please ask your questions there. If you're unable to access the mic, please raise your hand and we will bring it to you. I would like to express our gratitude to the Alfred P. Sloan Foundation. Their generous support has made this workshop possible. I also want to take a moment to give a special thanks to our workshop planners. Drs. Ellison Carter, Rima Haver, Gillian Middlestead and Heather Stapleton. Their tireless efforts have been instrumental in shaping today's event and ensuring its success. We would also like to thank the Environmental Protection Agency, National Institute of Health, Center for Disease and Control, and the Alfred Sloan Foundation for their continual support throughout the duration of the consensus study. Finally, thank you to our staff, Ms. Brenna Alvian and Darlene Groh. Your invaluable support and handling the administrative and logistical operations for the workshop made all the difference. Thank you for your tremendous contribution. In closing, I encourage all of you to engage actively, ask questions and share your perspectives. Together, we can gain a deeper understanding of why indoor chemistry matters, particularly in the context of environmental justice. Let's embark on this journey of openness, discussion and action towards healthier indoor spaces for all. Up next, I would like to introduce Dr. Rima Haver. Dr. Haver is an Associate Professor of Environmental Health and Spatial Sciences at the University of Southern California. She currently leads the Exposure Sciences Research Program in the USC Southern California Environmental Health Sciences Center. Her research aims to understand the effects of complex air pollution, mixtures and climate change related exposures in the indoor and outdoor environment on the health of vulnerable populations. Dr. Haver's expertise spans measurement, spatial temporal and GIS based modeling and mobile health approaches to assessing personal exposures and health risks. She received her Doctor of Science in Environmental Health from Harvard TH Chan School of Public Health in 2012. Dr. Haver, welcome. Thank you very much, Dr. Nunn for that introduction. Thank you everyone for being with us here today online or in person. I'm going to give you a brief overview of the recommendations from our why indoor chemistry matters study and report that we will be focusing this dissemination workshop on these coming two days. So, why was the study even assembled as we probably all have an appreciation by now right, the indoor environment contributes significantly to human chemical exposures and health risks. Our chemistry play is a really important role in moderating or driving these exposures to a suite of indoor air pollutants and and many of you might be very aware of the sort of tremendous effort and focus on outdoor air pollution and outdoor exposures but the indoor environment historically at least has been less well studied. The first statement of task when this committee and study was assembled was that the National Academies of Sciences, Engineering and Medicine will convene an ad hoc committee of scientific experts and leaders to consider the state of the art science regarding chemicals and indoor air. Specifically, we were tasked with sort of reviewing and summarizing new findings, but previously under reported chemical species reactions and sources, as well as how they're distributed in the indoor environment, and how these indoor chemistry findings fit into the context of what we already know about the link between chemical exposures, air quality and human health. And today specifically we're focusing on environmental justice considerations within that larger context. So briefly just to acknowledge my colleagues and the committee that contributed to this report we were led by Dr. David Dorman and had 16 fantastic members that we all thoroughly enjoyed working together on this study and disseminating and the project was led by Dr. Megan Harris and Dr. Linda Nyon now from the academies with huge support and funding from our sponsors. So briefly again, there are multiple indoor sources of chemicals and some of you might appreciate sort of the different nature of these sources and this is just a nice graphic from the report that summarizes a few examples. Because these emissions tend to happen indoors in these enclosed spaces concentrations can really exceed outdoor levels or concentrations. Some of these could be episodic some of these could be continuous humans themselves emit some indoor chemicals and pollutants, and some things can get formed indoors from primary chemicals. We know in the research community at least very little about how all these sort of joint and cumulative exposures are impacting human health risks across different time scales over life courses. Again, as I mentioned this sort of space has been less well studied than the outdoors. Now several different factors can contribute to exposure variability across individuals and populations, and also to health disparities. And as I mentioned the focus of today is really on environmental justice and how certain groups or subgroups of the population could be disproportionate exposed to these chemicals indoors and also more vulnerable to their effects. And these factors are many they range from being very close or cited next to outdoor sources of pollution from substandard housing as a big emphasis and construction materials and practices. Energy efficiency home ventilation management occupancy and climate change, not the least of course legacy pollutants and so on so forth. So really we're trying to focus today on how all these factors. You know related to the location of the residents, the build quality the housing quality together can contribute to environmental health disparities and what can we do as a community to bring forward these recommendations from our reports and kind of get them into action. Again, I'm just going to give you a very brief highlight of the recommendations that we selected from the report for this particular workshop and please join us for the second workshop that Dr. Neon mentioned that will follow up more on the science and research that we need. So one of the recommendations we're focusing on is that researchers and practitioners should include environmental justice communities. The wide range of indoor environments that they study and also engage with these communities and with scientists who work with them in formulating the research priorities and recommendations, hopefully to get towards indoor air quality standards in the future. The important recommendation came about sort of from our discussions that a lot of consumer products and services could be marketed to individuals for the goal of improving indoor air quality but several of them. We know could influence or affect or generate indoor chemistry. The recommendation is that funding agencies should support interdisciplinary research to investigate the impact of these products and services on indoor chemistry and especially under realistic and widely diverse conditions and not sort of, you know, in one let's say socio economic group or where it's convenient, right. So our recommendation will focus on is that, you know, also as you've seen in the pandemic right low cost air sensors are ubiquitous these days and they can really inform consumers of conditions happening indoors in their environment. That may prompt some action like opening your windows to ventilate if levels are high, for example. We still don't quite understand the impact of these products and services and sensor prompted behaviors on indoor chemistry and subsequent sort of reactions or conditions that might take place. So the recommendation here is to also determine or understand better how occupants access to this air quality data could lead to behavior change that could influence indoor chemistry and subsequent exposure and health. And the last conclusion from the report that is also the emphasis of today. Again, coming from sort of the committee's comments that a lot of manufacturers are marketing novel air cleaning products and remediation services that are often of uncertain value or have not been proven to achieve let's say the performances they claim and these could have address indoor air quality and health impact. Some of them could be useful, some of them could be useful, useless, and some of them could be beneficial and some of them could be harmful and really we don't have a lot of information on these. And so that's the conclusion was that we need standardized consensus test methods to enable hopefully potential certification programs for these air cleaning products and services. These test methods could also hopefully help regulators determine whether action is needed on these products and services. So with that I'd like to thank you all for joining us again we have an exciting two days of presentations ahead, and I want to leave you with these links to our report, a summary article that is our viewpoint, and again a reminder to join us on October 18. So with that it is also. Well, I'm happy to take any questions if we have any in the room or online. We don't have any. Okay, thank you so much. And with that, it is also my pleasure to introduce my colleague on the study committee and on the planning committee Dr Gillian middle said who's been working tirelessly with us all to organize this event. Dr middle said is an air quality and environmental professional who leads the tribal healthy homes network and EPA funded program of the Tulalip tribes that addresses indoor air hazards through national tribal training research and design of culturally tailored interventions. Dr middle said also directs the partnership for air matters, providing low cost indoor air to kids to engage and empower environmental justice communities. In her advocacy work, Dr middle said recently co-chaired the EPA screen air act 50th anniversary reports, advise the White House on indoor air quality and infectious disease transmission, and also served on a national academies of science work group on indoor air chemistry, which is our study here. She co chairs the national safe and healthy housing coalition and his past chair of the Washington as my initiative and the Washington leadership council for the American Long Association so please join me in welcoming Dr Gillian who will be moderating our next session. Thank you so much. Right. Good morning. I'm not really sure who I'm speaking to so we'll just go with here. So I'm just going to say a few quick remarks introduce our speakers get us right into the day and we have some very interesting conversation to have today. Just two things that I want to mention and one is that we are talking about environmental justice within the overarching topic of indoor air chemistry. And I just want to caution the caveat that using the term environmental justice is a lovely Western politically progressive term, but that it shouldn't ever replace actually understanding that that is an umbrella itself for all the individual communities who have unique exposures unique risks and unique challenges, and that we should never substitute using that term for actually talking to listening to engaging with those communities right. So that's my first caveat that I want to say the other is that when we talk about the indoor environment that is not a small term it's not a homogenous term. So the indoor environment that I see and that I work in is one where every family has a unique set of exposures based on geography zip code life circumstances economics building standards or lack thereof. And that when in participating in this committee, my strongest observation was that the built environment or residential environment was that the science leads us to study a little bit more of a middle class standardized household that may have an HVAC system right may have been built to code may have been maintained, and that why this I hope to hear today the speakers talk about the communities the households and the families who experience extensive disparate adverse health effects, because their indoor environment does not look like the middle class household. So in order to get the nuance of what the indoor air chemical exposures are, we need to understand what those environments are for those households, and some really interesting things. Okay, I am first going to go ahead and introduce Dr Patricia Fabian, and I apologize I don't have this open yet let's hope it's alphabetical. Okay. Dr Patricia Fabian is an associate professor at the Department of Environmental Health associate director at the Institute for global sustainability at Boston University, and the Boston site PI for the consortium for climate risk in the urban northeast. She co directs a community engaged research study to build resilience to extreme heat in the environmental justice communities of Chelsea and East Boston, and is principal investigator of a system science project linking housing indoor air quality, energy consumption and health and an indoor air quality and sustainability project in Boston. Dr Fabian is an associate professor at the University of Boston, and is principal investigator of a system science project linking indoor air quality and sustainability project in Boston, and is principal investigator of a system science project linking indoor air quality and sustainability project in her research group has published databases of articles in the peer reviewed literature, and she has been quoted in multiple media outlets. Dr Fabian was a steering committee member for the Massachusetts executive office of energy and environmental affairs on the 80 by 50 greenhouse gas reduction study. So with that. Hi, good morning everybody. Nice to see you. Thank you for being here. Thank you for the nice, very long introduction appreciate it. I'm here to talk. My name is Patricia Paviana actually grew up in Mexico also go by Patricia, but just clarifying, and I'm here to talk about moving environmental justice indoors. I'm an engineer and I grew up in Mexico so I feel like I came pretty late to the environmental justice community engaged research conversation, but it's been actually really fun and really rewarding and actually where we should all be I think moving towards engineers or not. So, I think every really nice introduction to what environmental justice I kind of want to start by framing that. This is the definition that the EPA has for environmental justice. It is limited but the reason I put it up here is because a lot of organizations use it and copy it in terms of how they then define environmental justice. Fair treatment and meaningful involvement of all people regardless of race, color, national origin or income with respect to the development implementation and enforcement of environmental laws, regulations and policies. Fair treatment means everybody is exposed to the same hazards or lack of hazards and meaningful involvement meaning means everybody has a seat at the table and making decisions about their healthy spaces where they live, work and play. Historically, I think also as Gillian mentioned, this is really focused on the ambient air. So, citing, for example, communities near industry, near a lot of car traffic, dump waste dumping, whether it was legal or illegal, and things like making decisions around land use. And that really has been where the conversation has has been. Maybe a lot of you have read recent special issue in the American Journal for Public Health that was about frontiers and environmental justice. Talking about how we're missing a lot of populations by kind of these narrow definitions of environmental justice, back to kind of what you were saying as well. So LGBTQ plus community in the conversation, things like consumer beauty products targeted towards people of color, climate change and climate justice populations and sort of that also needs to be integrated. If you haven't read it, it's a really interesting collection of different articles from really great researchers. I looked up green goes. There was a recent review article about environmental justice studies that was published that found around 3200 studies that talked about environmental justice. It was a pretty broad definition this really included things about social vulnerability not all necessarily environmental justice of those 3200 studies. You can see that the majority were about occupational exposures, followed by a good number of ambient air pollution about exposure in indoor air was this really, really tiny fraction of studies. Why do we need to think about this based on all this body of literature actually kind of starting with that first. There has been a lot more funding that has followed which has been really gratifying to see. So probably most of you know about the justice 40 initiative where the government says that 40% at least 40% of investments need to flow to communities that have been disadvantaged marginalized underserved and under burdened by pollution. A good example of where this was applied was the EPA, recent EPA funding for communities to do community air pollution monitoring for there were $50 million for environmental justice initiatives in general. This was a $20 million competition. I think it funded 50 to 70 communities, I believe, to do air pollution monitoring. I looked at the list was actually sort of excited to see whether how many of them were indoor air, and there was actually a really tiny, tiny fraction that were monitoring into air it was all about putting monitors outside. Why because the conversation is dominated by outdoor outdoor air pollution. So we need to change that hopefully this is part of that conversation. Why would we care about indoor air. So this is a study. If you think about environmental justice and just focusing on ambient, that sort of helps you pin down neighborhoods and communities that have high exposure to ambient air pollution. People live in homes, right they spend most of their time indoors, sort of, everybody knows this around 70% of their time in their home. And if your home is leaky, then there's a lot more opportunity for ambient air pollution to enter your house. If your home is closed up less opportunity for ambient air to to come into your house but more opportunity for indoor pollutants to build up. So this project looked was led by Anna was off skills part of our environmental health disparity center, and it was looking at homes using American Community Survey data and what their exposure was to particulate matter so air pollution. And then looking at who lives in leaky homes so homes that have high air exchange rates and lives in areas where there's high ambient air pollution. And so what we found this is for Massachusetts looking at a block group level and then aggregating was that those housing parcels that were in the highest polluted areas and leaky as homes. We're located in neighborhoods that had more Hispanics 20% versus 2% households with low annual income so less than 20,000 and then individuals with less than high school degree. Now, how does that help. Okay, so now if you want to define a vulnerable community just as where the air pollution is high, you can then start narrow down and look at what the housing characteristics are. And we get closer to saying we need to move environmental justice indoors. We wrote a paper on this over 10 years ago now this was led by a Gary Damcox at School of Public Health at Harvard. I'm a co author on this kind of thinking about the framing of why should we think about environmental justice in the context of indoor. Again, this is focused a lot on housing, the framework sets out four different places where we can think about what's contributing to disparities in exposure. We talked already about the outdoor sources so that's the ones we know you know are you close to traffic. Are you close to industrial activity residential activity. The indoor sources are interesting. So if you think about the prevalence of gas stoves and low income housing or in public housing or multi family housing. There's a higher prevalence of gas stoves exhaust fans tend to not work as well. Or they tend to be recirculating exhaust fans instead of exhausting to the outdoors, all of those contribute to higher concentrations. Smoking rates are higher in certain communities. The use of cleaning products will hear more about that later today in the talks, but there's culture aspects about what cleaning products get used. Things like personal care products can we'll talk about that more as well today so certain groups of people use different types of beauty products, and there's marketing that's towards specific groups as well. In the physical structure, this is just plain physics right if you live in a large box then pollutants get diluted if you live in a small box and pollutants get concentrated. If you live in a house in a box that has lots of ventilation where things get removed then you your exposure is lower. If you live in a house that doesn't have ventilation then from indoor sources your exposures are higher. Things like HVAC systems and HVAC systems working so heating ventilation and air conditioning. Heating that has more related more related to thermal comfort and then activity patterns, things like cooking. We did a study in Chinatown once and there were homes that did a lot of cooking for restaurants so all day the stove was on the gas stove was on the exhaust fan didn't work and there were maybe sort of windows cracked open. So we're thinking about patterns of activity that maybe different groups of people have and that we need to think about how to make homes are resilient to that. The other thing I want to mention that there's other things also around the social determinants of health and the one that I'm going to pick is actually being a renter. I want to think about the ability that people have to modify any of these characteristics whether it's living in a larger house, fixing a house, adding exhaust fans etc. The people who can say they do that are the people who have the power over their house right and for renters that's which is 80% of renters sometimes in environmental justice communities that gives them zero part of power to make any modifications either because they don't have the permission to do it themselves because the landlord doesn't do it and there's no sort of power for the tenant to make the landlord do it. And so, keeping in mind that there's so many renters that live in environmental justice communities and frontline communities. And that that really is more about a social determinant of health that has nothing to do with kind of sort of personal individual, both sort of behaviors and abilities to change. This was a table actually from that 10 year old study now kind of thinking about all the different pollutants. And here we go. So here's a list is hopefully out of date we'll hear a lot more about how out of date this is today. But the one thing I did want to point out is that most of these come from indoor sources the physical structure and activity patterns, and very few come from the outdoors. So, again, really, really think need to think differently about environmental justice and shifting the focus away from ambient air. Okay, switching gears a little bit. I wanted to talk about heat and community engagement the importance of community engagement and environmental justice communities. And the context of our sea heat project. This is a partnership with green roots, which is environmental justice organ is community organization that works on the Mystic River in Massachusetts. It's based in Chelsea. And the goal of this project has been to build resilience to extreme heat in these environmental justice communities. And I wanted to just quickly acknowledge, including an advisory board that included people from the city from housing community residents that were part of it. Part of the research team, part of the grant. And the reason this is important is because the solutions have to come from the city the residents and the researchers. Now, a little bit of background on these two communities first. So Chelsea and East Boston East Boston is a neighborhood of Boston Chelsea as a city. They're both around two square miles. They have 50,000 plus residents, majority ethnic minorities in East Boston, it's almost half our Latino, and a high percentage of people live before below the poverty line. During the COVID pandemic, what we now know sort of from national headlines, people who living in Chelsea and East Boston were the most vulnerable with the highest rates of COVID. Lots of essential workers who had to keep working dense housing, all the things that hopefully everybody is now as part of the national conversation played out in Chelsea. Chelsea is a heat island. So that means it's hotter than the neighboring cities. There's also heat islands within Chelsea, meaning that neighborhoods are hotter, even within Chelsea as a whole is hotter maybe we measured around six degrees hotter than what the water station reports. But then within Chelsea, some neighborhoods might be eight to 10 degrees hotter than sort of the neighborhoods that are have more green space. And part of the reason is a legacy of red lining which was historic disinvestment in housing because of lack of home loans in neighborhoods that were deemed high risk. The neighborhoods deemed high risk had a higher percentage of people of color living there. And so if you don't own a home, you can't invest in it. There's implications for wealth over time. And I think it's important in these neighborhoods where the housing quality is poor. The neighborhoods are hot. Chelsea specifically has 80% impervious surface 4% is public green space and it has the lowest amount of tree canopy in the state, only 2%. Moving for the city, if you think of sort of cooling really also kind of stay in the ambient realm, which is why I wanted to kind of talk about this and how community engagement really brings us indoors. This is an example of the cool black project which we collaborated with a lot of other organizations kind of measure the impact of cooling interventions. The cooling interventions, the city had a municipal vulnerabilities planning grant to invest. We had some grants around green space, things like white roofs, green space, reflective pavements, and then redesigning lots like the one that you see here in the, in the corner, and there's a nice little value video about that if anybody wants to watch it later. So those solutions against stay outside in the same way that we think about ambient air pollution is outside. Great. We also engaged residents and asked them about their experience of temperature indoors we gave them sensors personal sensors we put sensors in their homes. And we asked them questions, and through surveys, which I've now become a really great advocate of mixed methods, thanks to Madeline schema, because if you ask questions you only get answers about what you asked. And so you kind of need to be thinking a little bit broader on qualitative methods to get a little more depth. But from what we asked, we figured out that people spent 75% of their time indoors indoors the temperature was on average around three degrees higher than outdoors. The personal monitors were around four degrees higher than the average temperature outdoors. So 87% of the time, this is on a hot week, not all year. The temperature indoors was higher than the ambient temperature with a temperature difference of up to seven degrees Fahrenheit. Everybody had some form of air conditioning, but pretty much everyone also said their home was hot or warm. And 38% of people said they had to make choices about which bills to pay so rent food or cooling, or others. Those strategies were turning on air conditioning for cooling removing clothing and opening windows, and the low less popular options were to leave the homes for a cooler area that speaks to sort of the utility potentially of cooling centers. The use of ceiling fans and window shades mostly because those actually weren't that available in homes. So this again sort of answered questions that said the indoor environment is important. Just looking at outdoor conditions isn't enough environmental justice communities have challenges in terms of what their solutions are. And then we need to ask more questions about what the solutions could be. The project that was part of it was a photo voice that is qualitative research method to empower community voices is one of the goals and it's bringing groups of residents together around the theme that in this case it was extreme heat. They come up with the topics that are important to them. So I'm going to take pictures on what matters to them on different themes that could be around cooling green space and any kind of topic. And here are some examples of the things that came back. I'm focusing on the ones that are about the indoor environment because of this workshop but we have a whole report with really amazing insightful photos and quotes from from community residents that you can look up online. So for example, this one says this is my sweat chair. When it gets crazy hot I piled towels on the couch and sit on them so I don't sweat on to anything. And there's always a towel at hand to wipe yourself down with. This speaks to me about the oppression inescapableness of extreme heat. This was in 2020 2021 we were still during COVID. So there weren't many places for people to go so adding on to sort of where do you go during COVID there even less less places. The second quote, just going to read kind of the bottom part was around housing and how there's houses that have grass trees and central air occupants are well protected from extreme heat, even if there are no trees on the street, but not everyone has access to such a home. We need public community spaces that protect us all. This is one more example of someone saying trying to stay cool with a huge fan. We use this fan all the time during the summer to save on the electricity bill due to the cost of AC. So that's a trade off around affordability. The piece that's missing from this quote was also that we leave it turned on, especially when my mom is cooking all day something like that, which I can relate to having the same type of mom. And then this last one is talking about window air conditioners and how most are old and efficient and noisy in our community there are people that cannot buy new air conditioners, many don't have storage for them so they leave them in the windows during the winter, which then comes with its own challenges around high energy bills during during the winter. So what came from this and this is talking with the residents right this is environmental justice community residents saying this is what's important to me and these are what the calls to action are. So, the four calls to action that came from that were things about where the trees or tree equity, who is vulnerable to heat. Not just vulnerability physiological vulnerability around having comorbidities or sort of an ability to regulate temperature but really more social vulnerabilities. Things about water which I won't talk about here and then how to keep cool creatively. So all of this got elevated we the residents did an exhibit at city hall. We had a presentation we had banners that got moved around kind of the different parks and has been really sort of an amazing way to both elevate community voice and sort of highlight the importance of the solutions are at home indoors. In conjunction with everything else that cities can do outside. One of the key messages from the heat project I would say is that heat is also an indoor environmental justice problem. The solutions are complicated and housing is a key solution to it. And that we need community voices to co design effective interventions. And this is just a time series of photos of park that got redesigned. So, when it was empty was just a parking lot community engaged activities and then what the park looked like in summer of 2022. Last topic I want to talk about our schools so heat was sort of an important thing I wanted to bring up. And the last topic is around schools. So raise of hands if you've ever been more than, you know, a significant amount of time in a school. Okay, good. So by the time you finish high school, you've spent two to three years of your life in school. That's 365 days times two to three years, which maybe doesn't sound like a lot compared to how much time you spend in your house. But consider that in the United States there's 50 million students and elementary schools and 750 million students worldwide. So if you multiply that times person years that is a lot of time that kids spend in schools. So schools sort of fall through the cracks and environmental health research there's been articles about this. There's disparities and exposures to schools this is kind of starting with the ambient exposure this was a paper recently published that showed that for example, students on students on free and for subsidized meals have higher exposure to PM 2.5 into NO2. There's disparities also around racial ethnic character racial racial ethnicity categories. And why do we care about under our quality in schools. So again this group probably already knows but for those that don't. It's six to 10 hours a day of your day teachers not just students but also teachers pollutants can be up to 100 times higher similar to homes similar to has been found in homes. They can impact attendance, memory, health, right things like asthma attacks, both teacher and staff performance, and it accelerates building deterioration so for example things like moisture and mold. And there's a lot of inequities around where schools are cited who goes to public schools, particularly in urban areas. There's solutions. HVAC is sort of the main one. I think we need to be thinking about HVAC as a solution for clean indoor air and the ways that we think of electrification for climate. So every school needs to have an HVAC system. This is a recent recent government report that showed that 41% of schools public schools across the United States have either non existing or not efficient heating. Heating ventilation and air conditioning systems. 41% that means almost half of our public schools don't have a good way to keep clean air and healthy environments and schools. As Gillian mentioned there's all these, no, we must I mentioned there's all these indoor air quality sensor campaigns that have started where we put out low cost sensors this has been in homes. This is because of COVID, but schools in particularly took up that challenge and one school that really admirable led by Catherine Walsh's team. They put out sensors in every single classroom in the school at Boston Public Schools around 4500 sensors. So that would mean PM 2.5 PM 10 carbon dioxide, carbon monoxide temperature and relative humidity. Besides doing that huge campaign the other really brave part of it was to make it public so this is publicly available you can go and look up any school any classroom right now on the website and kind of see what the what the measurements are. measurements are. This has been really useful from an operations perspective to sort of in real time find problems, etc. Where our partnership comes in is that these sensors generate billions of data points every year. And schools are really not equipped to be doing data science data analysis of so much data. There's limitations to low cost sensors, which we all know from the air pollution world, right? They're, they're low cost for a reason, they calibration is variable, they drift, they go offline, etc. So we need to kind of figure out ways to to analyze the data. A little bit about positive public schools, it's the oldest public school system in the United States. It serves 48,000 students from pre kindergarten to 12th grade. And if you look at the student demographics, it is also 43% Latinx 29% African American black, 15% non Hispanic white. 71% low income and almost half the kids their first language is not English. So it's an environmental justice population as well. And it is representative of a lot of old school districts in the Northeast. There's 132 buildings that were all pretty old as well. Two thirds of them don't have HVAC systems. So central HVAC, they do have obviously heat because we live in the North, it's pretty cold. But 70% use steam heat with limited or no ventilation or cooling. So what this partnership is, is to try to leverage all those data by connecting to databases of for example, social determinants of health, things about climate and meteorology, energy consumption, COVID interventions. So things like the portable air cleaners that got installed in the schools, they got installed for COVID, can we figure out what they do for other, for other exposures and other impacts on health, things like HVAC, etc. These are some of the projects that we're working on. So it's linking into air quality to health, comfort and learning, thinking about operations. So a lot of schools are looking at Boston Public Schools to see, well, what are you learning? Do we need to install these many sensors? What do you get from that? Or can you install less? Do you need to collect data every minute? Or can you do it at a lower resolution? Can we calculate air exchange rates in the classrooms? If you know how to calculate our exchange rate, usually companies come and measure in a single point in time. Where else from the time? Climate resilience. We had a heat wave the first week of school and had school closures. Can we make decisions about temperature in classrooms? Which types of classrooms? What kind of modifications can we make? We for the first time had a problem with wildfire smoke, which in the West Coast has obviously been a big issue for a really long time in the Northeast, largely ignored because it hasn't impacted the Northeast. There's electric buses, the whole country is electrifying, but Boston in particular just started with their first 20 this year. What is the impact of that on indoor air quality? So lots of questions to answer, lots of opportunities to partner with schools. And just sort of like one of the questions sort of quick preview, this is the only result slide that I have is a question of like, is HVAC enough? So comparing schools that have HVAC, we looked at the percent amount of time that the classroom is CO2 is above a thousand parts per million or 2000 parts per million. This is just during school hours. And then you can see that there's the light purple would be the time below 1000 parts per million. The light orange is also, but this is for schools with HVAC with central HVAC and without central HVAC. So well, you can see that the HVAC improves indoor air quality by measuring only CO2, acknowledging all the limitations of that is just a ventilation indicator that it's not always enough, right? So we need to be thinking also about connecting to building management systems, what other pollutants standards we don't have standards for schools to follow. And that's the team. The reason I bring up schools is because there's a really unprecedented opportunity in terms of investments. So there's been ESR funds, there's federal funds, there's been local funds. And and the White House issued the cleaner and buildings challenge last fall, which means this is our opportunity to make our buildings safe and clean for kids to learn. So key things that I want you to take away from this is community engagement is essential. This was for environmental justice populations from our heat study and then also for the schools. We need to be thinking about emerging climate related indoor exposures like heat and wildfires. And it relates to indoor chemistry will impact the indoor chemistry. We need to be elevating schools as key indoor environments that we've done a ton of focus on housing, housing still super important, but schools need to also be a focus for us. And that this really is the time to move environmental justice indoors. There's sort of federal will state will certainly in Massachusetts City will to do it. And yeah, so that's it. And I think I'll stop there. Thank you, Dr. Fabian. I'm now going to introduce Dr. Robin Evans Eggnu, who's in our virtual environment today probably coming from us from Tacoma, Washington, and a good long time colleague with our Washington Asthma Initiative work. And hello, Robin. Let me find your out already. Okay, Dr. Robin Evans Eggnu is an associate professor in the vibrant University of Washington Tacomas School of Nursing and Healthcare Leadership. He is focused on upstream actions to transform inequities, especially as they relate to asthma, environmental justice and planetary health. As a community based nurse researcher, he has worked extensively with black indigenous people of color for community transfer transformation and environmental justice, including a nine year community based participatory research partnership with the French major, not Spanish, I will not even attempt that. So, Robin please clarify the group that you work with it. But it was a group of new immigrant mothers of children with asthma. This group has developed and tested tools for environmental assessment of daycares, wood smoke pollution awareness, education of Spanish speaking immigrants on indoor air quality, and assessment of VOC exposures in immigrant homes. He leads a global initiative with Alliance of Nurses for Healthy Environments in developing the first climate justice nursing agenda for research, practice and education. He gained his BSN at John Hopkins University in 1985, completed his master's in nursing at the University of Washington 1998 and his PhD at UW 2011, which was concerned with asthma management inequities in black urban youth from Seattle. And very brief anecdote, Robin was also asthma man. So when he worked with the American Lung Association and we did community outreach events and I was a volunteer, he came in a cape and turned a superhero into asthma man. And I appreciate that he was willing to appear that way because it engaged children. I think you even attempted to fly once at one of the conferences. So with that, I'm going to look forward to hearing your talk. Thank you. Thank you, Gillian. And that's a great, a great introduction. So I truly appreciate it. And it's great to be here today with everybody in this, in this audience. I'm going to turn my slides on and hopefully this will all work out. I'm, I am coming to you from the land of the Puyallup tribe of Indians in the University of Washington Tacoma on the banks of the Puyallup River and the Tacoma tide flats that I spending taking a special interest in now in terms of the effects on indoor air quality from outdoor pollution as well. So this is a, this is an interesting chance to kind of to get to tell you some of the story of my work with the Moreira's Latinas, Apoyanda la Comunidad, which is mums helping the community, basically a group of women that I've worked with for for about nine years, like I said, in the introduction. So I'm going to take you through a couple of things. Today, I'm actually going to take you more into the kind of the methods of how to actually meaningfully engage people in environmental justice research on indoor air quality. And it really is the story of this amazing group of women that I got to meet. It was an asthma support group in a English language learners academy that was set up by the Tacoma school district at the time. This group of women all had children who had asthma. My colleague in the health department, Judy Alson had been working with them to get advice from them in terms of asthma prevention activities in the community. And we started to work with them and over the course of nine years, we did multiple projects together and did some great discovery. So really, I think I'm going to center this kind of on this idea of voice and what voice means in terms of the crisis in indoor air quality. We'll give you a little bit of background to this community based participatory research project and talk specifically about the methods and great to hear previous colleague talk about photo voice and the importance of photo voice. I'll add my spin on photo voice and give you a little bit of how I kind of think of photo voice and the power of photo voice and also citizen science. And we'll talk some of the results we did with an indoor air quality assessment study looking at VOC exposures and really from the voice of the community talk about this kind of call to action where we should go. So just wanted to kind of give you some of the background to this community based participatory research. The photo you see on the right hand side is a presentation. This was this is after about four or five years of working together. We had made some discoveries around indoor air quality. We've done work with daycares, examining and developing a walkthrough assessment for daycares using using cameras. Really talking about exposures and the risks of indoor exposures. And this group of women wanted to develop a health promotion class for other new immigrant women on new immigrant families and parents. And they were able to accomplish this. This is something a class that they designed a class they led a class that they evaluated and then went up and went on and published their results from most of these women have basically a high school education. None of them have gone to university. All of them are new immigrant peoples from Southern New Mexico, Southern Mexico and really an inspiring group of people to work with. They have one of the things that we did to kind of set this project up was to kind of have them be established as a community advisory board. And then when they began to think about this next project, and there's some inspiration behind this next project where Beatrice, one of the women in the group said, you know, Robin, we come from, you know, Mexico, we want to come into, we come into America, we want to be good Americans, right? And we go to the grocery store. And in the villages where we came from, if you go to the store, there's maybe one or two cleaning products on the shelf. But in America, you go to a grocery store and there's an entire aisle dedicated towards cleaning products. And we want our homes to be clean. So we know that this is a big expectation in America is that we have spotless households, and that we can use, we are supposed to be using these products. There is never really any communication with us about the dangers of these products, or the things that we things that we should be paying special care to, because our children have asthma. So that was kind of a call to action. One of the reasons why they did this class that you can see them presenting at this is this is the end of their classroom presentation. And that's, and that's what sort of motivated this future study. I will say that working in a bilingual space takes time. There's a lot of back and forth getting permission with institutional review boards to countless as research, and to value and validate the voice of women is another struggle to engage with, having good partners around like the Puget Sound Asthma Coalition has been great. And this is a list of some of those studies that were in the introduction. And we're going to focus on really their last one of the one of their last latest studies, which is looking at volatile organic chemical exposures indoors. I love that comment at the earlier comments on the description of environmental justice and the definitions. I'll also lift up Robert Bullard's definition of climate justice, which escapes something, misses something in in governmental circles, sometimes because Robert Bullard always said that it's to live, learn, work, learn, play and worship in a clean, sustainable environment. And we often do not think about some of the places where we worship those indoor spaces as well. So that is something to consider really focusing, though, to on this idea of fair treatment and meaningful involvement, really perseverating on the idea of what it means to meaningfully involve people. To me, and the study and hopefully will show you is it's more than just collecting data. It is analyzing data. It is disseminating data. It is taking action steps. That's the the entire arc of community involved research. Got this lovely bottle of Fabuloso on the right hand side. For most people who clean in houses in America, they'll know Fabuloso. The women that I worked with were very familiar with Fabuloso. And had not realized quite the respiratory effects that Fabuloso can have on small children with asthma with small lungs. So my methodology and methods is really to kind of center on Andrew Shercock who comes from Canada talks about eco feminism, this idea that mothers have local knowledge. Mothers understand the urban environments that they're in or their local neighborhoods. They have a historical knowledge of systemic oppression. So they're bringing all of these types of knowledge is in there. So both we collect empirical data, but we also understand the epistemology, but the understanding of how truth is interpreted and the ways of knowing things is multidisciplinary and trans disciplinary, right? So this this space that we go into in terms of involving working with communities, we have to be able to understand and hold up multiple levels, multiple ways of understanding things. Having a better understanding of what those other oppressive conceptual frameworks are forcing on these parents and these people and highlight again, my previous colleagues conversation about working as a working with people who are renting, right, and have less power because of landlord, rent rent dynamics. So here's a little bit about participant design. When we when we got these these the women that we worked with, the children grew up inside the study inside inside our multiple studies. And in this in this in this latest study, a lot of these children were in middle school. And the women said we want our children to be involved in this, we want them to understand this work. We'd also like to partner with the community that's been hosting our our meetings, which have been we've been helping holding our meetings in an Asia Pacific cultural center. And so we reached out to the director of that center and developed a partnership project with both Asia Pacific Islander youth and Latino youth for this particular project. One of the great things about photo voice is that participants can be involved in all parts of the project, all parts of design, data collection, analysis, and then exhibition and planning. The new layer that we added on to this was to have the youth collect air samples inside the home at the same time. And look for the OCS because we know from the research that very few people are looking for volatile organic chemicals inside the home. So this is the other combination. The other frame is to think about this as a citizen science activity, right? Which Bonnie and others when citizen science is sort of like come of age now, right? I went to the first European meeting of citizen science people. We were talking about our project. We have very small scale in terms of citizen science, but this idea of involving the public in the collection and analysis of data addressing issues of concern, including action for policy change. A lot of time inside citizen science, what you see in these big citizen science projects are a lot of data collection, but not a lot of citizens involved or people involved in the actual analysis of data. One of the things you kind of need for interdisciplinary research is to have a science shop. And you'll see here on here on the right hand side, my my colleague Joyce Deglasen-Panelio, who is one of the directors of the Math and Science Institute on campus, and has a lab. And Joyce is an amazing educator, great, great at working with youth and was a great partner with us in this project. So she supplied the bucket elite air samplers. The youth selected their own location, took their own records when they collected the samples inside their own homes. And they participated in sample analysis. They went back to the lab, I'll have another photograph of that when they went back to the lab to conduct the analysis, and then did and organize the dissemination process. Some of the critical kind of questions you need to ask yourself when you're doing citizen sciences. And this is really within citizen science and photo voices. Is the theory understood by the people and based on their interests? Are the research questions relevant for people? And are people emancipated to act in their own interests? So those are questions and challenges for us when we engage in this type of research. Here's an example of where we one of the sample is working in in the homes of one of the youth. And this is an example of their datasheet. You can see that some parts of the data filling out are less accurate than others. But this is really a moment of engagement for the youth and engagement and learning for them in terms of how to collect samples. We then went back to the university lab, and here's Joyce again, demonstrating how to collect a sample out of to reduce the sample to get it ready for putting in the mass spectrometer. We looked for formaldehyde, acetaldehyde, acetone and benzaldehyde as for commonly available tests and ways to look for these chemicals in the air. And then here are some of the results, right? This is Camila's photograph. This is a photograph she took of an indoor environment that actually hasn't been mentioned yet, which is the indoor air inside our cars, right? And and and we had we produced these photographs. We had an exhibit. I'll show you a little bit of the exhibit later on. But we also did English and Spanish language translation with these. So this pertinent question is it good or bad for the air? Here's an air freshener and it's making the air in my car smell good. It affects me by making that my air smell great, but I don't know if it's good or bad for my air. It might get us sick. The situation exists because it makes our car smell good, but we don't know any ingredients and we don't know if it's good or bad for our breathing. We can learn to check the ingredients if we see anything that is horribly bad for our air quality. We're really children beginning to encounter and have discussions with their parents about these differential exposures inside the environment that may be affecting their health. But also there's pregnant understanding that there's not a lot of knowledge about how dangerous some of these chemicals are for long term cumulative exposures, which is nice to see that study quoted. It's looked at how often environmental justice studies looked at cumulative exposures. His Camila's air sample and you can see that she had she's able to kind of look at finding all four chemicals. I got a lot of acetone, acetaldehyde was the least. I think the chemicals came from some of our cleaning supplies. She has a photo, this is a photo of she lined up all of the all of the cleaning supplies that she has in her house. The next time we try to do a place where we can actually smell good smells, right? So this idea that they were beginning to think about where where else could I place the air sample next time to collect another level of data. This is the setup for the exhibition in a local community home. And here this the we did something that was quite unique. What we wanted to be able to do was to begin to show the photographs. You can see there's a one of our youths there showing talking with somebody coming by his booth. He has both his photographs that he's taken and his samples. And he has some assessment charts around the display to give the audience an opportunity to rank the photograph. The audience had sticky sticky dots that they carried around and were able to select their favorite three photographs. They were able to select their most important essay that the children had written next to their next to their photograph and to their air samples to say whether they thought this was important or not and why the audience member thought it was important. Why are we doing this? Well quite a long time ago we thought about using critical knowledge. This idea of using eco feminism is to really kind of plum to begin to situate the knowledge generation within the communities that you're working with. So here we have parents, family members, relations, other people from the community, some community stakeholders coming to this event to see this. This is an opportunity, a real opportunity to have the people in the audience be the people driving the development of knowledge. This comes out of course through an audience discussion at the end and at times in a lot of regular photo voice activities. That's pretty much the action step. Boom, you're done. You do your exhibition and you're done. Maybe you put some things online and you're finished. But we didn't. We worked as researchers and we took some of these data back and had a look at it. Here's a little bit of a more focused look at what some of the things that we were looking at when we were doing this sort of exhibition event. We were doing health risk communication. Here's Stephanie's question. Again, she uses that same question that some of the other kids had been talking about. Should it be good or bad? What is good or bad for our air? Do we know? How do we know? This one's definitely kind of broke the rules and said I want to put two photos together. I don't want to just have one photo. I want to have both of these photos together. Again, kids thinking around developing and taking mastery over the epistemology. Really beginning to derive how knowledge is developed and communicated. She looks at this. She looks at these air freshener and a candle and she also had this picture outside her apartment window looking at mold on the edge of the window. And she says in the first picture it has mold in the window. In the second picture you see two of the things that make your air bad. These things affect indoor air quality because the mold can hurt you by smell and the dust you cannot see. On the other picture they have chemicals in it and that's why asthma is caused. This situation exists because people may be thinking that it helps you clean your air instead of opening a window and letting fresh air inside. And then the other one, people don't clean it and the temperature can cause the mold to come in the window. What can we do about it? Well, you can clean it more often or take more care of things and stop buying these things. One of the interesting challenges that we had in trying to understand and explain the risks of these particular substances to the youth is again there's not much known which is why we're having this conference. Right? So we use the environmental working groups assessment of regular household products from rating things from highest concern to lowest concern. That was the basic, because it's readable, it's understandable, it's explainable, we were able to translate that knowledge for the youth and for the discussions. This is bringing the data back from the audience discussion. We brought the data back and my team of researchers, this is Julie Posmer and other researchers helping the youth begin to assess the little sticky notes that the audience members had left and the rank choice voting on with the sticky dots on the photographs to begin to arrange an album that has some of the most popular photographs more prominent. Right? Why is that good? It's a captive focus group. We're finding photographs that resonate with the rest of the community. If we pick those photographs to attach our message to, we are effectively using you know some marketing research to be able to advance our message and achieve change. We presented, the youth presented their findings back to the advisory board. This was a final discussion section with both the researchers, the community advisory board which is mainly comprised of the mothers of the children in the project with some other stakeholders from both the Latino and API communities and we sat down and we figured out together, all of us, what the action messages that we should be taking forward. So this is the set of five groups that we decided would be the target groups for our action messages and then we determined particular messages and action steps that each one of these groups should do and you'll notice we've got family and friends right but we also have landlords and apartment managers. We found a lot of formaldehyde exposure in some of these houses right which is no doubt linked to particle board and other glued wood products in that in those areas. But also I love the fact that they pick neighborhood store managers. This idea that we walked down an aisle in a grocery store and we think that to be good Americans we need to be using all of these Cleveland products to make our house not only look great but smell great too is one of the major crises that I think we have. We have to consider action at the neighborhood store manager level and also at the healthcare provider level and city and county leaders. The health department took these recommendations and has been working on updating its housing code for for the county based on these particular actions. Just in summary as I'm getting close to the end really I think what this type of research can do is it can help you reach both the national academies of science recommendation around working across disciplines right working with people my colleagues in the math and science department looking at the environment we were able to assay chemicals understand chemical exposures. I'm a social scientist I'm a nurse researcher we can we can work together to do citizen science together to achieve results. And also thinking around it moving beyond interdisciplinary into really what I like to think of is transdisciplinary research working with community members working with new forms of knowledge that emanate from community members and then this idea of citizen science and photo voice being another key place for engaging people in environmental justice communities in their own assessment and their work together. I love this quote that we did that came out of the evaluation at the end when we asked what did you get out of this project at the end and the response was I like working with the team. The idea that this empowers people through working together through people sharing power people understanding university understanding that they don't have all the power in this but they do a lot of the work around the edges such as setting up photographs for displays providing some of the other resources for community members to be able to enact change and work on change together. I think just that's the last slide of my references and I am done. Thank you. Thank you Robin really enjoying the presentation so far and just a reminder to those that are both in the audience as well as those that are participating from their offices or homes as you hear these field projects that are fascinating I'm guessing that you do you may do similar work so please be thinking in our panel discussion of what you want to share because we do need to hear from the broad diversity of communities and regions across the country so we hope you will be including these in whether it's a chat box whatever it is while we get started or we're going to listen to Ashley and then we're going to move to a panel in discussion and we really do want to engage as much as possible to have you participate from virtually so Ashley Schmidt is our third and final speaker in this morning's keynote I'm excited to introduce her as she's a relatively new colleague for me and I'm excited to introduce you to her and the work that she's going to do in future decades. She is currently the lead community health nurse with the Tulalip tribes community health department which is in Tulalip Washington which is about an hour north of Seattle. She leads a team of nurses and community resource coordinators Ashley is a simsian alaska native and Filipino and she has spent her life in the pacific northwest coast salish land to her there is a great intersection between culture and health through this lens she's had the opportunity to work with native communities at the urban Indian Health Institute Seattle Indian Health Board Harborview Medical Center and has been with Tulalip since 2019 her mission as the lead community health nurse is to guide and assist tribal members in achieving their highest goals of wellness through outreach health education and community engagement she is dedicated to breaking silos within tribal government bridging resources and information sharing shareings are driven by an overall goal of building strong tribal health systems that serve with equity and compassion through this work she has developed culturally appropriate health monitoring services such as the elder wellness program and the container for life program Ashley began her work addressing access to culturally relevant health services on a population level while obtaining her undergraduate degree from the University of Washington in medical anthropology and global health in 2011 she went on to pursue her registered nurse license in 2019 2017 and obtained her master's degree in community health nursing in 2018 from Seattle University College of Nursing outside of her work Ashley fills her spirit by spending time with her three sons all under the age five husband family and friends and immersing herself in her urban native culture in the greater Seattle area she is a current member of the Simpsons high you can correct me dance group and evolves herself in all opportunities to serve Indian country in her local area and as with our other two speakers I think you will enjoy and appreciate what Ashley's going to share thank you my name is Ashley Schmidt I am a Tsimshan Alaska native descendant and as Gillian said I was raised and grew up in the Pacific Northwest Coast Salish land my Gigi or grandmother was Noreen Kanto and her mother her mother was Annie Alfred both of the Gishbudwada killer whale clan of the Kit Kalatla House of Shakes from New Malacatla, Alaska I am a nurse by trade and a medical anthropologist by passion and as Gillian mentioned I am a mother of three young boys a devoted wife loving daughter annoying sister you know all the hats I received my undergraduate in medical anthropology and global health from the University of Washington in 2011 fast forward 2017 I received my registered nurse license and shortly thereafter my masters in the science of nursing with a specialty in community health understanding the intersectionality of culture and community with health and resilience have always been the driving force for my work I am still and will probably forever be working to understand this intricate relationship and how to respect it it is my guiding light I am here with you today to take a deeper dive into this relationship one between tribal tribal communities and their environments and I will help you to explore the implications of tribal engagement and research particularly when it applies to their indoor human behaviors and also share with you some important lessons learned from my own experiences in mitigating public health hazards inside and outside tribal homes I am honored to be included at the table here with you today so as I was preparing for this session for you all in the last couple weeks there was something tugging at my heart and I will also preface I don't have a presentation to go along with my session and that was very intentional working with underserved marginalized and particularly tribal communities and as Patricia and Robin have mentioned listening is key so you all get to listen to me for the next 30 minutes but I knew that in order to share all of these lessons and implore you to work with tribal communities I really did have to set a foundation and I had to honor I have to honor all of the lived experiences of real current every day native communities and also by doing this I honor the significance of the stories I will share with you momentarily so simply put what modern medicine science and research has been telling us and is telling us today that higher rates of poor indoor air quality is correlated with household crowding indoor smoke lack of piped water and poverty we also know native communities suffer disparate rates of all four of those risk factors compared to their non-native neighbors we also know based on research that native communities particularly children are at higher risks of developing asthma we also know based on science and data that there are some of the highest rates of cardiovascular disease within native communities and as we all know on this conference that both of those cardiovascular disease and asthma are directly related to poor air quality so native communities have experienced historically heavy disease burdens as a result of pollutions so think of water contamination mining near on tribal lands substandard housing we know now because of data that 40% of on reservation homes are considered substandard compared to 6% in outside non-native communities so I also I really love that Patricia talked about schools because I think that that's a really big implication on that substandard building concept and I would love to and I would urge to find some more research on that so I share those statistics and that foundation with you just so we can know where we came from it's important to know where we came from to know where we're going and to also learn from the past and of course the present so we can do better so let's get to it how do we message the critical nature of chemicals in the indoor environment on human health how do we proactively engage all disciplines increasing access to knowledge on the fundamental aspects in impacts of complex indoor chemistry well let me tell you a little bit about a little bit about what I do how did I get in front of you all here today I'm still asking that question myself but here we are as Gillian mentioned to learn of tribes of reservation sits about an hour north of Seattle or about 30 minutes north of Everett where I live it consists of 22,000 acres of beautiful land and is a beautiful community in a beautiful culture at any given time approximately half of the tribal membership lives within reservation boundaries so that's about 2,500 tribal members within Tulalip Reservation and that makes up a little over 1,750 tribal households this upcoming December will mark my fourth year as a community health nurse for Tulalip tribes and during those past four years I have had the opportunity to implement and partner with some remarkable services and programs so a few months after I started 2019 that date you know in February 2020 we'll live in everyone's memory forever COVID hit and community health was heavily involved with case tracking case outreach we worked to distribute COVID care kits we worked very instrumental on the COVID vaccination dissemination we did a lot of public health campaigns education we also work within the home so elder wellness we do try to prevent isolation we promote health monitoring we empower tribal members and their families to take accountability for their health but also kind of lead them there we work with many many different departments the Tulalip Bay fire department public works senior center pharmacy and I'll discuss that here in just a minute and I would love to share with you some key lessons learned and some of these I'm still learning today and the community teaches me every single day that I work with them one of the most important lessons learned from working within on boots on the ground with community especially a tribal community is spending time is essential consistency is key showing up is pretty much about 50% of the job and if you continue to show up and you continue to do that good work and you hold yourself accountable and your word accountable it will really really go the extra mile I'm going to share three three tools and if you combine all three I really truly believe that your potential for capacity building will be strengthened insurmountably in any community that you work with underserved marginalized or tribal so bridge partnerships I work every day to bridge partnerships both with outside agencies and with inner tribal or inner departmental partners so for example the Tulalip pharmacy I talk to the pharmacist almost daily and that can look like hey Ashley hasn't picked up her medications in about a week can you go knock on her door and make sure everything's okay or Gillian hasn't followed up with her primary care physician and over a year and I can't refill her medications there's some critical ones there can we figure out what's going on why is this person not making it to the to the doctors or maybe they don't even have a primary care physician and how do we bridge that partnership how do we bridge them to their care and then vice versa Tulalip Bay fire department we have an excellent relationship with the community paramedics who are also boots on the ground and they've also worked very hard to build their trust within the within the reservation we are able to call them to homes to evaluate we have a very mutual respect between teams and that has really allowed us to bring a very strong service mindset to the community and really promote that health and wellness and early intervention early diagnosis another key part of this capacity building model is unciling the government you know the tale is oldest time but in tribal government it's very real there should be no reason why the Tulalip Health Clinic and community health department do not work hand in hand open communication about mutual clients there should be no reason why we are not asked to the table to emergency preparedness planning which we are and I'll get to that also further in my session there are strong strong strong opportunities for departments to work towards the same goal and breaking down those barriers within the government itself and within your department however you're looking at that is going to be essential of course last but not least strong rapport and trust with your clients so approaching these underserved marginalized communities and particularly in my experience with tribal communities understanding all of those foundational statistics that I shared with you is essential having that respect and that humbling knowledge to approach these historically traumatized communities with that understanding is important but I will urge all of you here today and the listeners online to shift that framework a little bit switch that narrative from historical trauma to historical resilience what do I mean by that I mean that native communities have been here since time immemorial we all have heard that what does that mean that means that no one here can know any type of history that that includes it is immemorial what that also means is that native peoples have been here through all of the traumas and have survived that makes them resilient and strong and powerful so approaching them and building this report in trust means understanding that and also leaning into that existing strength historical resilience should be seen as a asset historical trauma is not a deficit it is an asset it has strengthened these communities and as long as you understand that and approach them with that respect building that trust will be easy and of course showing up and being there for what you say you're going to be there and delivering that so I do urge anyone working in Indian country to follow that framework to increase your potential for capacity building another very very important key lesson that we work with every day in our department is meeting them where they're at so you'll hear that repeated in our office in our building many many times a day we meet people where they're at but we also don't leave them there so again we look into their existing strengths within the community this person's existing resilience their existing knowledge what is their traditional knowledge and lived experience and we use that when we approach them with any type of behavioral change or lifestyle change or recommendation something that I would really love to bring to the table today are examples of traditional risk mitigation within native communities we're here to talk about looking at human behavior and how do we communicate risk again native communities have been here since time immemorial before we had research before we had data before we had modern science and they yet were still mitigating risk on a very local level and I wanted to share some examples of those so the Colitz tribe the Colitz tribe in Washington that's a little bit southern of Seattle they used a hellebore route that kept fleas and insects off of furs and skins which is really important furs were used in beds during the winter to keep warm and to be able to keep fleas and insects out of their buildings was key Arizona tribes southwestern tribes in that very high hot heat of the desert they built their structures using caliche soil so that's very rich soil it keeps the excessive heat at bay the Coast Salish and Alaska Native tribes that use longhouses for homes had a lot of they up to about 10 to 20 fires in any given long long house that was very large homing housing many many families there was a lot of smoke in those long houses and they would use poles to move cedar planks around the roof to create roof vents or later they also did create a smoke pipes in intervals creating a ventilation system one of my favorite stories of risk mitigation and I will take the time to share that with you today is from the Ho tribe which is down in the key peninsula area of Washington over along the coast I was I'll back up a little bit and let you know I was asked to the table for emergency preparedness planning and a last year for the Cascadia subduction zone rising exercise so if anyone's familiar with the Cascadia subduction zone it's those tectonic plates along the pacific coast and we are very overdue for the quote-unquote big one right it's the big big earthquake it will be very catastrophic for the northwest and we I was actually very impressed with Washington not actually I was impressed with Washington state for inviting the tribes to the table and I was very happy with the Tulalip tribes emergency preparedness team who did accept that invitation and then brought a multidisciplinary team to the table to work the simulation so we're on these conversations talking about mass care how are we going to deal with our infrastructure how will we deal with the buildings etc and I went home one night and I'm thinking well why aren't we looking at the own histories of native people again time in memorial we know I did a little research the last major seismic activity that was documented was around the 1700s we all know native peoples were inhabiting this land at that time so I really wanted to research and see if there was an oral tradition or any type of historical data on how did they respond to that and also prepare for that in the future I'm going to share with you an excerpt from the Thunderbird and the Whale if you do search on YouTube it's very easy to find Ho Indian tribe I think earthquake preparedness is what you search it was a Ho Indian tribal elder being interviewed her name is Viola Reeve excuse me and I am just going to share with you a little excerpt of this story we learned our oral histories from our ancestors the Thunderbird lives in the glacier at the headwaters of the Olympic mountains the whale we all know lives in the Pacific Ocean when the Thunderbird comes out he may not even be looking for a whale or whale hunting but he'll go out to sea usually we can hear him coming with the Thunderbird and the lightning with the thunder and lightning excuse me grandfather used to say he's coming we can hear him he's going a long ways he's not stopping when he gets to the water he'll flap his wings and if he flaps them hard and goes down the water will come up and cause the tsunami and the faster and the harder the Thunderbird comes down and lifts quickly the wave will be bigger but if he's going far away we'll barely hear the thunder and see the lightning these stories we have listened to and believed them when we feel the ground shake we're told to run to high ground or get away from the ocean because it's dangerous why share this story with you today is because native people have a deep knowledge that can help inform science and medicine and oftentimes they have a deeper and more profound relationship with their environment so again going to these communities and understanding that they actually have something to offer you as well they can bring something to the table as well it's extremely important to build that relationship bridge those partnerships and build that trust so how do we message the correlation between poor indoor air quality and asthma how do we message that biomass heating as the main source of heating and cooking is not necessarily great for their health on over a long period of time and biomass heating with wood burning gas stoves or propane used stoves is still the highest or the number one way for most native communities on reservations to be heating their home how do we message that using blankets or sheets over windows actually promotes window condensation which leads to mold sports which then could be released into the air how do we message the correlation between their heart disease their diabetes and air quality you use bite size digestible information at a time baby steps this is a long game this is not a short game I'd say in my fourth year now I feel like I've actually built that trust to impression change I won't even say make change I would start influencing change and that's because this community has seen my face for the last four years I've never gone away I come back every day to work I'm happy to see them I'm happy to work with them and that's important and of course we heavily rely on a harm reduction model so Dr. Middlestead some of her amazing research working with the Tulala preservation has found that human behavior in tribal communities particularly with tribal elders shows that about 63% of elders would prefer to just stay home no matter what and particularly in this case during extreme heat events so they're not going to cooling centers they're not going to stores with AC they're not going to their friends or families home by knowing this and utilizing this research we can use a harm reduction approach and meet them where they're at and get ahead of that so what does that look like we campaign for elders by using this knowledge as a tool we remind neighbors to check on their neighbors or their elders in their neighborhood and we proactively reach out to elders and other at-risk tribal members before the extreme heat event or before the snow storm or before the wind storm which is actually a big one that hits our area quite often we provide risk communication and prevention education in the format most accessible to the community meaning every possible method so we use a reservation-wide text message campaign we have a literal list of every single elder that lives within the reservation boundaries and we split that list up and make phone calls we utilize Facebook websites TV ads I think I even had a vaccine campaign on a billboard on i5 there for a minute we publish articles in newspapers and then we do go door to door we do that hard work of door to door seeing their face handing them information in the health literacy level that they have so I will again reiterate the historical resilience piece of this especially when you're thinking of harm reduction so oftentimes working with underserved populations or ones that have a lot of historical trauma we do experience some pushback some resistance to change so I again urge you not to look at this as something to work against not something that you have to fight or to fix work with it them pushing back and a distrust in western medicine modern medicine or science is quite literally a protective factor that they are caring because of all of the traumas they have experienced let me remind you that Native Americans have been guinea pigs they have been researched and then they've been left behind so again working with that protective factor and honoring it you will find that you're not actually pushing against anything you're working alongside of it we must always remember Native American that Native American and Alaskan Native communities are not secondary to western science and medicine we are and have been here since time immemorial so this is a great time to introduce some specific considerations for engaging tribal communities in research projects and surveys especially regarding indoor air quality and relation to their human behaviors indoors so the national academies in their recommendations does state that the important research should be done in a holistic approach and I agree but what does that look like in relation to engaging and researching tribal communities so I love following Robin's presentation because he mentioned citizen science nothing about me without me again Native people have deep knowledge that can help inform science and medicine but they must be treated as respected partners as equal partners so for example tribes in Alaska and Canada are helping inform and guide climate change right now with knowledge or I'm sorry guide climate change and knowledge by reporting uncommon unusual behavior in sea life when you are approaching these communities to engage them for a research project or for a survey make sure you're stating what that's going to bring them before you even approach them and make sure you also hold yourself accountable to that promise that should also include access to a meaningful dialogue around this actionable change so again going to Robin's point having them be actively engaged in that process have them help you define the survey questions have the communities help you disseminate the surveys have them be equal partners in the work so with that I just again thank everyone for having me at the table today and the last action item I will give you is engage with your tribal communities it's not easy I understand that if you're hitting a barrier or not getting response try a different department again unsilowing that government it should be something where if you are able to find a good contact a good resource within that community use that and then find your way in through that resource and build that trust to bridge those partnerships thank you so much I'm going to have a seat at the table just very briefly again for anyone listening I believe there's a chat box so we are going to be able to in real time have someone read your questions please feel free if you also want to share your case study your research your observation so share participate in this conversation you don't necessarily have to have a question I'm just going to take one minute to briefly summarize a couple of the key things that I heard in I thought they were spectacularly interesting and really excellent work but I heard that some of the major barriers that these particular individuals are observing and I guess I'm assuming many of you are is that we have an aging infrastructure with significant mechanical deficiencies and that by and large communities of color disproportionately inhabit those communities and not coincidentally they are a legacy of historic redlining so as a policy in the United States we have a legacy now and that's a hard thing to under do with science and best practices right so there will need to be systems change so those are some of the barriers that I heard some of the opportunities which was exciting that I heard among the three speakers were an awareness that there are methods like the photo voice and that there are ways bridges to listening engaging and empowering the communities I heard that there's of course record federal investment right now to do some retrofits some upgrades and some research of course I heard a dialogue and reference to the need for standards and that that may be our catapult to more vast improvements to substandard housing and I also heard about of course historical resilience as Ashley just described those are just what I heard and just a brief synopsis but it will so please do me a favor and there are specific prompts that I have now to ask you about but I'm just going to start and begin our conversation by asking the speakers if you want to reflect on what you might have heard or the recommendations and let's just go and hello Robin you're right looking down at you after having heard this and listening to what our conversation is today about the recommendations is there something you would like to add to start with and we'll just go down with I'm happy to go first I think one from both Robin actually and Ashley's conversation is the the amount of time and the meaningful commitment of community engagement I think that everybody is talking about environmental justice engaging with communities good job but I think that the funding has to be there the expectation has to be there and then for researchers as well it's about developing a relationship keeping it long term before and after the funding and before and after the project and I think as sort of federal funding organizations that has to kind of be built in as well so I think both of you alluded to that but I think it's worth elevating but Robin would you like to go next? Sure very impressive presentations and I think Miss Smith's point about listening is really important that the story of the Thunderbird is an important and powerful story and the trouble is that when we tend to listen to stories like that we put on a scientist head and we go this is just a story we don't then listen to the story well enough to understand how this is actually placing people in context and connecting to knowledge that is more ancient and established that there's a real new quality of listening that has to occur with that I think on a practical level what we have with the problem with indoor indoor air chemistry is so much is going on inside indoor environments inside the home that are related to what we want to say is human behavior but there's a Thunderbird outside there are forces that are outside the home that create those situations inside the home so there's a reason why there was the original conversation around Dr. Fabian talked about how homes don't all look the same that we don't really understand what's going inside homes in terms of the number of human beings inside a home and other stuff like that so the chemistry gets very complex very quickly and we need to use ancient wisdom and stories to be able to explain that in a way that helps people understand how they are under threat that the complexity of even thinking about cumulative effects is a complicated a really complicated scientific question and it needs translation in an appropriate way for communities to be able to meaningfully engage with it that's the big challenge I think that this report is beginning to launch so I really appreciated the community engagement approach for both using the photo voice that's actually something that was a tool I utilized in master in my obtaining my master's degree and I'm going to put that back to the work that I do now so I do I appreciate that reminder and there are many many different ways to engage communities but I think making sure that you're collecting their voice right so listening is one step building the relationships and the trust is another but collecting them for useful action is also extremely important so I think both of you for that reminder and I'm excited to bring that back to the work that we do all right so we have some online questions and I'm going to go ahead and read them we can open it up to anybody here who wants to respond if you want to respond to the question as bring your expertise in your online right now feel free to answer that in the chat forum but then also so the first question I am guessing I um okay one of the first questions was are there efforts towards empowering the school managers to collect and analyze their own data for local and immediate actions and then of course are there some lessons learned from the pandemic so I'm just going to direct that at you but feel free others in the audience as well thank you for the question I think some everybody's learning how to do this I will say it's pretty new right putting sense with the schools and sharing data with the school community there's some projects out in the UK in terms of specifically the project where they did a study looking at what happens if teachers can look at the CO2 levels in their classrooms or not and is that modified behavior around things like opening windows or HVAC systems and does it matter that they can see the the actual number on the sensor or not or is it just sort of a reminder like maybe buildings can come remind you and it turns out that if teachers could see the number and know what it meant right to what was a high number that it actually did modify their behavior and then change their CO2 concentrations that's sort of a new project there hasn't been that much I think one of the challenges is that schools can collect data and I don't think we have really great methods for sort of connecting with the community and ways they don't create big problems for the schools and so I think there's a lot of schools that do monitoring that very few schools actually share with the school community but I think it's this nascent field which is why I keep sort of harping on schools and how we should we should be working with schools we should be learning kind of these lessons and figure out how to engage communities either of our other speakers want to address the school question all right one of the next questions is how can these wonderful projects be scaled up across the country I can lead that a little bit I think that it's very doable you know taking these best practices taking what can it be applied to your community or to your work and using that as a framework so I haven't been able to actually put our community health department model into a framework because I do believe it is somewhat new to tribal and Indian country and I'd be happy to discuss that with anyone that's interested but it's applicable anywhere you go if you work in a community whether that's informing the science and the research behind it or your boots on the ground in the field I think that it is applicable you just have to find the niche and the way that you can apply it to your community I actually think a lot about scalability because community engagement really takes to be meaningful right takes a lot of time and if you think about how many people live in communities general population and then how many scientists so to me part of the solution is engagement in a way that's training community scientists right training community researchers the idea is sort of how can you create processes co-create processes and then sort of how do you leave that in the community because otherwise how do you scale actually have an issue with how you can scale meaningful community engagement I think it's sort of I would love to hear other ideas because it's a very good point I try not to sort of overextend on too many communities because that's not meaningful and that's a very good idea Robin's smiling I was having a chuckle too at that comment because with all due respect to the questioner the idea of scaling things is a colonial conception that it is it's about how can we get this widget and replicate it over here in exactly the same way and that will get you the same answers right it's like it's like those standard surveys right we're just talking about if you ask a question you're going to get an answer but if you if you ask a very specific question you will get a specific answer it may not be the answer you need it may just be the answer you want right so so that the challenge is that communities have real contextual knowledge located in their own experiences of oppression so I think rather than scale I would think of this really as being a way to contribute to the policy policies can begin to scale at a higher level when you begin to think about we don't have a way right now of getting every warning label to look the same in the United States we are split we have a federal problem with the way we do warning labels on consumer products right the first time I had a conversation with people in hazardous waste about them partnering with us with our project they were merely concerned with these products ending up in Puget Sound which is an environmental justice issue for sure but they weren't really concerned about exposures inside the home in the same kind of level of safety and awareness right so we have got to really sort of we've got to change some of the ways some of the envelopes that we have around thinking around indoor chemistry as being threats to human health and as being really it's going to be a real struggle with the way we have set up this society to allow people products to be made and tested a little bit for safety maybe sometimes but not really very much and then just hand it out to consumers right so we're kind of working backwards here in terms of that that's the scale bit that I would like to see but at the very local level it's really listening to the local voice for local needs local issues local concerns that are so critically important for for the families that live in that neighborhood and that's what's important Thanks Robin we have a speaker here in the room we have more questions online I'm going to take this question I'm going to add a question back myself though to that because I think it's really important to the concept of scaling up what I think is always missing in that conversation is we think if we have better methods better data a strong ROI the capacity to engage across sectors that all of those ingredients will result in scaling up or or broad adoption when I was a graduate student in upstate New York I worked on the Head Start program and one of the things I observed is that the ROI was significant so you already knew that you would reduce incarceration you would improve you know graduation rates you would improve quality of life for all these underserved inner-city kids fast forward X number of decades we still don't have a significant and adequate investment in Head Start what that has taught me over the years is that institutional racism is something that is underlining everything we do because if we have the ROI and we still do not have adequate federal investment that tells us that something else is going on in a framework that's invisible but is making it difficult so I'm posing that just as a question for us to keep thinking about is in EJ conversations I think that is sort of an elephant in the room sorry for my editorial it was meant to be a question back to think about this so thanks for your patience and you want to introduce yourself too so people can wonderful all the work of and thinking about I'm thinking about how you then what are the systems of place solutions to actually move towards solutions and I've heard a lot about agency so especially you gotta actually render lessons that are going to be agents who will spend their space and people with that activity in schools too right my partners are some of the people and when we had you know some of the workings so we had that Supreme Chief very big school he was one of the internet schools he thought something over 90 years ago that is unacceptable for thinking about the things he's actually learned but he's left competing like who is he's like well I'm told I can't you know turn on and like there's an issue around what there's like he doesn't have any effect between you know the house actually you know all the members are opera companies agree and I worry about you know or I'm not worried I guess there was one day we're putting back actually to think about how we move that towards a community service and how maybe uh to be able to talk to that it's like when you're working with schools like are you how are you dealing with the power system who is in charge actually to save the system and are they at the table to do besides the looking to build the contract to the users of the teachers or of the investors so that's a great a good no excuse me but that's a great question and I think um you know started by saying I'm an engineer I used to do lots of modeling didn't talk to people who's very happy in my last coming back to Korea so as I said I'm sort of late to the game of community engagement and environmental justice thinking about environmental justice as well now I'm trying to do research that is only for solutions because I'm sort of done finding associations between X and Y or finding disparities I still think there's value in that I'm not diminishing the value of it but for myself I think that we have a lot of solutions already I alluded in schools in particular every school should have an HVAC system whether it's for climate resilience for environmental health disparities for like learning ventilation extreme cold right now just extreme heat there's really no other solution right there's band-aids you can put in portable air cleaners you can put in window air conditioners and we probably will need those to get us because HVAC then takes a really long time going through the political processes the procurement processes that schools have to do we have a shortage of like HVAC professionals to install they were the shortage of sheet metal for a while that has nothing to do with you know like we know what the answer is maybe we have the funding there for it and then there's other things to stop that so I think the solution is there how do you empower the people in the classroom to make the change I think is sharing the data knowing like what are the solutions that can happen pushing for budgets that can do the band-aid solutions in extreme cases but schools they just closed right they said we can't keep environments at a decent temperature for students and teachers and they just closed but it's a hard question I love that question and I don't necessarily have as eloquent of a response as Patricia here but I will add just a caveat as well right so a lot of these marginalized populations and our environmental justice communities are served by a greater public school system that was not meant for them so to Gillian's point you know especially and you look at a tribal look at Tleilip tribes for example the Tleilip tribal students go to Marysville school district which is run by a public school district you know out of Washington state and OSPI so in terms of giving them agency my recommendation would be to start local committees and coalitions from a community-based approach to gain and collect those voices to start urging that and give them some autonomy and voice in that and then also go to the top level right if I there have been times and instances where we've had to address and we do the Tleilip tribes has a very amazing youth services department so I won't take any credit for any of this but they go directly to the top to the OSPI and they talk to are to the leaders in Washington state in Olympia to really lobby for that change for tribal students and I have found or I have seen some positive change from that but it's still only scratching the surface so you know I think that's yeah that's hard that's I'm going to end it with that's a hard question we have another speaker in the room and then we'll go back to the questions online thank you I'm Paul Francis then a lot of state in person and I'm interested I just want to put in in my thought a lot of what's been about back here the tale of what's been that's what's been that's what's been that's what's been that's what's been that's what's been that's what's been that's what's been really much on a scale we've got the very very essential that's what's been that's what's been so if you think that the residents that we're talking about they're not calling so they have an issue they call a contract maybe we don't have enough HVAC contractors but they're calling HVAC contractors more than their calling us we need more HVAC contractors and we need to let go it's not going to scale at the science level it's not going to scale at the research level it's going to scale at the practice level if it's going to scale at all so I think we have to recognize that there's there's middle actors between us and the communities and the residents they're the ones that have the chance every single day to make a difference and we have to let go of the science and give it to them in order for it to scale thank you he does a lot of nods in the room and probably virtually as well I'll just do a remark I'm going to go through just some of the comments very briefly under questions with someone that's not being well noticed or notes just to say she's aligned to these patient advocates that specializes in the syndrome of multiple chemical sensitivities she appreciates the work and just wants to connect with any others in particular okay so there's a question probably for Ashley here and since you're rich too what's the best methodology to utilize the indigenous resilience and knowledge within risk management models how can individuals and professionals respectfully engage with the community to make sure that sacred knowledge is protected challenging question but also use it to improve models and policies and are there cultural protocols in place they'll just stop there and say great questions wow that is a very great question and I don't have all the answers and I think that one of those how I closed my session was reaching out to your local tribal communities and that's definitely where it's going to start right you know I can't answer that question across the board for Indian country because it's going to look differently I was very intentional to not so I'm going to back up and I'll be very intentional that I did not do a land acknowledgement in my session which I normally like to do but I was speaking to Gillian before today and I was it was pulling at me but at the same time I didn't have the opportunity to engage with the local tribes here to ask how they would like me to acknowledge their land so that was a choice that I made because I would want the same respect done to me for my tribe and so I think using that framework in your approach with Indian country is you really have to lean into how they would like to see it done now should you use that framework in terms of their oral traditions and respecting their oral traditions the same goes that way right some families have oral traditions that is their oral tradition or their story that you do not have permission to share and so you just really have to walk that that tightrope of respect but also wanting to scale their stories up to a larger audience to be able to make that change and to share their message so I'm not sure if I answered that whole question in the depth that it was asked but I think that we should all be asking those questions of ourselves especially not just Indian country working with all marginalized populations you know the Hispanic communities immigrant communities they have their own stories to tell and they should be the ones telling them as a facilitator I'm a bit stumped we had four or five excellent questions and the robust speakers have already answered many of the questions that we put out so we can I guess I will ask you just to go back as we wrap up we have there's no reason to not end early and have a break I know we all have emails to answer but I am going to pose just a few oh there's a one more question online let me go to that first I have a question okay no okay oh Miriam is our hand raised with slow processing going and Nerhan still probably even see them traveling to the other side of the brain Miriam please go ahead I believe you can unmute yourself yes thank you very much first I'd like to congratulate you on this great workshop and I'm very sorry I'm not there in person I have two comments my first comment for the panelists is about citizen science which I'm working on this in another context in terms of international aid work and it occurred to us that citizen science is a very colonialist construct because and also coming from a Canadian viewpoint where we're working hopefully on reconciliation it's not about citizen engagement it's about the co-production of information of devising the questions and the use of different knowledge systems so I I think there's a very flourishing area of citizen science but I challenge myself to to identify that that is really appropriate and that I'm not contributing to a colonialized construct so I'm going to ask to see if the panelists want to respond and then I have another comment to make well I wrote a paper about this about the place where citizen science kind of connects with action research you know so I do think you make a good point first off the name citizen science is not very open and inviting but I do think that it has kind of a nice broad engagement inside the community so the community what happened with our youth and parents was this engagement with and this empowerment with these are all kids that are almost you know in college age or going to college now right but when we when we did the research with them three or four years ago they were in middle school and so there's a really sort of like okay but we want these kids to kind of understand a college another colonial type of environment a university but come see this open university we're you know we're we're we're grounded in the community at UW Tacoma we bring them into the lab we get them involved and stuff they begin to kind of see that they have a part they have a place here seeing a a person of color as as a professor giving them skills in terms of how to how to essay chemicals and other things like this it begins to stop the chemical elitism that can go on with that so I think citizen science as much as it breaks down elitism and classism in science I think is really really important but you're right it comes with some baggage and perhaps the biggest baggage is that it's extraction focused Miriam so I would I would agree that if it's if you're only interested in gathering all the data give me all the data and then I'll go away and hide in my little box and come up with my great paper that's going to explain the world to everybody who wants to listen to it then you've you've lost the point the point is the engagement throughout but the the challenge often if you do it we've done sort of some analyses of papers I haven't published anything recently in terms of actual how how people actually engaged throughout the entire project right we give up a lot of times when it gets to the analysis it's going to go this is too complicated too difficult for you and so we're going to go into our little black box and figure this out and come back and tell you the answer and that's that's a shame we want the national academies of science to be able to give us good data in terms of exposure risks and all those other kind of stuff we need that but in terms of actually engaging people for change we need we need to break down those barriers so yes there's some problems with the name and some problems with some of the ways it's conducted but I think it can work and I've been seeing some other projects on the side where other people have done this we're using citizen science and working in native community so kind of kind of I think it's I think this is sort of like a sub-variant of citizen science that we've been doing before you ask your second question that if you watch the federal granting process hundreds of millions of dollars from NIH from CDC by and large you have to be a research institution with a PI who's a cre you know has appropriate degrees behind their name and they always say as a criteria should engage environmental justice communities the funding doesn't go to the communities who say then you should engage research institutions so our entire system of where the money goes to build knowledge is right now upside down and it may be I'm not and it shouldn't even be hierarchical frankly which it is but it's certainly upside down right now so just had to add that so you had a second Miriam I believe component to your question or observation yes and Gillian I really appreciate your comment because for the international development field it is it's important for donors to have fiduciary responsibility to go to the international aid industry and not to communities so I appreciate your comment my second comment is more annoying and it really is annoying so low cost sensors are great for empowering the people who use them they are so not great for the people who are supplying the critical minerals that upon which the low cost sensors are based and they are low cost because the materials that go into the sensors are coming from largely exploited communities overseas and then they get the sensors back after they don't work as e-waste this is a very troubling problem where we in the wealthy world benefit from extractive environmentally damaging human health damaging processes we benefit from the data but we need to take a life cycle approach to understand all the implications I don't have an answer for this but it's really a problem excellent sobering observation any I have a comment on that which is sort of it came up in the chat there was a question about indigenous frames or ways of ways of beginning to think around this I think it was it was motivated by the panelists our conversations about all of this but especially Ashley Smith's comments around working with indigenous communities and I would suggest that I think that there is there's new ways of considering there's new theoretical and new new ways of understanding how we participate in planetary health conceptions around this right so trying to broaden our lens if we're going into disciplinary and we're going transdisciplinary and really thinking about planetary health effects we had heat we considered heat as well so just trying to keep the frame a little bit broader would be a good caution for us and certainly I agree that we have to be very careful about these new sensors and the latest technology that's going to fix something that is really burdening the global south etc yeah thank you anyone else in the room anyone else online all right hello everyone my name is Lorelle I am I run a small consultant for focused on around the community health and one I'm very grateful to be in the community guys today so thank you for opening up this this opportunity last week at the you went to the UN science summit at the opening I spoke on a panel with some colleagues from several countries and some of the inclusive science for more achievements is there a development in this climate changing world and it's almost you know the same topics that we raised except for this brother as the speaker who just joined us I'm shared around thinking critically across the just transitions that we're doing right now and ensuring that as we find solutions for for issues that unfortunately you know the chemistry chemistry has created you know maybe a bit you know from from eons ago that we don't impact negatively impact others right and but one of the questions that I'd like to ask more specifically has to do data ownership and data sovereignty and then you know the question was posed around how we you know acknowledge and preserve the knowledge but I would like to to take it a step further and say can we protect it as intellectual property I think when we when we call indigenous knowledge intellectual property it has an economic impact right on the value of that knowledge in this space so I wondered if you guys can talk a little bit about how you ensure not only the availability of the data that you collect but the access to that data so that the community groups that you're working with can then take that data and apply for grants themselves and kind of just bring that bring that circle around and if there's opportunity for intellectual property acknowledgement and the last thing I'll ask because there are lots of academics in the room and perhaps online as you think through the compensation model of engaging with communities do you have any thoughts on how that can change to because as I work with communities I think there's a devaluing of the compensation just you know like the quote unquote Walmart gift card for blood samples or coming into people's sacred spaces so I know that's a lot and and you know I'd be happy to chat but I just wanted to to kind of share that full conversation thank you I'll start just simply because I don't I don't think I have an answer for that I'm not a publisher I'm not on the publishing side in terms of utilizing the data on the grander scheme but I would say that I love that concept of intellectual property and if you don't mind I'm going to borrow that I'm going to bring that back I have a couple of comments and I think you're bringing both of those to the top the way it's really important what is on the funding model I think there's slowly a shift from funding organizations to say we need to be funding communities I think Branson actually say a minimum percentage of the budget should go to community engagement it's still not quite enough but I'm going to say we're fine so long let's just 15% could we dump that up a little bit more but sort of we've gone through it should be more meaningful and either or we need to fund this or we need to acquire science to fund this because I will say that sitting at the table with us is science it's really hard to get community engagement budget it's just really challenging so easy to sort of think of I don't know $100,000 for the equipment not so much to say and then look for the $100,000 into the community based on that it's amazing so that's one of the things sort of the scientists sort of sitting with the groups is advocating for that sitting at the table when there's listening sessions from MSF and NOAA and NIH right and sort of pushing for that to be there as well I don't know what's the right number is either right for that we need to sort of set the communities and say well what is what is suitable compensation is there compensation for someone giving a blood sample and is that different to different communities because it means different things right so I don't have an answer to that other than other than people need to be good at the table to make this a question I think the other point that we made was on data ownership I think again so I've been doing community research for 15 years I did it really poorly it was sort of here's the data I didn't keep it here are the data for what you use but if I share one minute level or 10 second data of PM2.5 values over the last 10 years that means nothing is totally useless for pretty much any other person unless you're a data scientist or a statistician so what I started to come around and working towards is that there's so what you need to do is do collaborating and then be asked and sort of constantly help them the data to use I also think for example you alluded about to grants to grants when community organizations need data for grants is tomorrow when the grant is due not in three years when the paper gets published and maybe what you published were I don't know yearly averages and what you needed was a maximum etc so I must feel like we need two tracks that is sort of the slow research machine that's the publication papers that academics need to you know get promoted and keep the research you know some research going etc and then a different track that is really the collaborative research track that is what do you need what questions do you need answered and let's you know answer them what like co-created knowledge do we need to create etc and just have that sort of side track that happens at the same time I'm finding that I'm not saying I do it 100% right but I'm just finding that that works so much better than a project where it took three years to write a paper and then the community really couldn't use the what we learned we learned together it was you know there were co-authors on the papers etc that's pretty much you know it's good but not necessarily what people may want or need so and from your own personal experience working on the BAM with these communities with that kind of school how did the conversation initially started like who did you go to and what was that conversation like and the way that started really is Boston Public Schools started this censor campaign really was remarkable that they did it it was for a lot of different people so again there's 4,500 censors one-inch classroom also up on the road and heard about it so maybe grab it and let's see bring what this is happening and call up the school and say come help help come help that's really kind of how it started you think I don't know how hopefully it's been tried but again sort of ongoing collaboration not a school community is on board they will come here to the complex in general when we say community is sort of they're just so many lovers and layers and different types of people with all different interests and so we're working really closely with the school the school staff operations and then sort of expanding into teachers students everybody comes with their preconceived ideas of what is important not important but everybody has what they think what they care about but uh so I would say the short answer to your question is that how can you help to initiate conversations and then maybe back over to the direction maybe so far with the school but since then it's happened okay coach thank you I just wanted to add to that I've experienced a high degree of receptivity in working with early childhood education so you have the birth to age five cohort and Irene Gagnia colleague who's I think listening today knows that those teachers see them from infants to toddlers they know every child in that room who has RSV who has bronchiolitis who has then you know recurrent wheezing they see the children playing on the floor they see rashes develop on the skin when different chemical products are used in cleaning and that's a very we found the greatest reception because it's almost like they have a very visceral experience with the students who in those exposure scenarios I don't know once you get to you know kindergarten through grade 12 if then it's your school nurses also who can be a pipeline to observing acute health effects and some of the children right of course we're talking about long-term but I just wanted to add that that's been interesting receptive group to work with um I will also I will also add that I'm sorry finding champions within your community is also key so have you get that initial buy-in you start your work but you know assuming that you've built the trust you've been working with this community you have champions already in your back pocket that you can come to so a lot of the projects that I've kind of spearheaded with Tulalip I will go to my champions and those are tribal members or other heads of other departments and say this is what we're trying to do this is the project we're trying to launch can I have you front facing with the community to speak about it because community members are going to want to listen to other community members they don't necessarily want to listen to you so that that was my add to the piece of how to start that conversation okay welcome back everyone to our indoor chemistry workshop we are now starting the afternoon session we have two more sessions to go with our wonderful speakers thank you so much to our morning speakers for such an amazing session our next session is called putting environmental exposures in context frameworks for research and implementation to holistically address environmental and social exposures and we have two speakers we have Dr. Madeline Scamble who will start she will be virtual and then we have Dr. Michaela Martinez as well so let me start by introducing Dr. Scamble Dr. Madeline Scamble is an associate professor of environmental health at Boston University School of Public Health her expertise is in the area of community driven and community based participatory research and includes the use of qualitative methods in the area of environmental health and epidemiologic studies in 2017 Dr. Scamble was awarded an NIHS Outstanding New Environmental Scientist Award establishing the Mesoamerican Nephropathy sorry Nephropathy Occupational Study which is a longitudinal study of agriculture workers and El Salvador and Nicaragua focused on identifying and preventing exposures associated with the epidemic of chronic kidney disease in Central America she was also awarded a U01 to establish a field epidemiology site as part of the NIDDK NIHS and Fogarty Institute Cure Consortium which is also studying chronic kidney disease of uncertain etiology in agriculture communities in Massachusetts where she is based Dr. Scamble leads the local public health institute with funding from the mass department of public health she co-leads the Chelsea and East Boston Heat Study that you heard about from Dr. Petrushef Abia earlier examining exposures to heat and air quality where we live, work and play Dr. Scamble chairs the board of directors of the science and environmental health network and in 2014 co-edited the toxic school house published by Baywood Press Dr. Scamble are you online? I am can you please get started when you're ready thank you so much thank you so much for that introduction and I'm sorry that I'm not with you in person I'm going to share my screen okay can you see my screen? great thank you okay I am speaking to you from Chelsea, Massachusetts where Petrushef spoke of this morning I really appreciated that talk I've appreciated all of the talks I'm listening um and when I came up with the title for this talk I really wasn't sure what I would talk about except I was really struck by this phrase realistic conditions in the recommendations that funding agencies to support interdisciplinary research under realistic conditions and so I'll talk about those two concepts um today and also I'm sorry to interrupt you if you don't mind could you speak more into the microphone so we could hear you better of course and I will say the same thing to all our speakers please we've noticed in the first session that it's been a little bit hard to hear so everyone please speak more into the microphone thank you and apologies for interrupting you that's okay please interrupt me again if you have to yes okay um so my my goal is to talk about interdisciplinary research under realistic conditions including in environmental justice communities and I'll talk a little bit about access to air quality so um the the title of my talk could alternatively have been two stories the toilet and the outlet and I may have imagined giving a talk at the national academies never about a toilet and before telling you these two stories about the toilet and the outlet I also have to make a confession that I am not a plumber I'm not an electrician I'm not an engineer or a chemist I you know enough about me I'm not any of those things so okay that being said the first story of the toilet has a longer title it's a field study of vapor intrusion in an urban neighborhood and my co-authors of this story are listed below um this is over 10 years old at the time I was the community engagement coordinator for the boston university superfund research program and um heli pennell and eric suber were both engineers with the brown university superfund research program and they have a model of vapor intrusion that they wanted to test with concealed data around at the same time the mass department of environmental protection approached them with a site of contamination that was causing troubles their vapor intrusion analyses were not what they hoped they would be the site was very complicated meanwhile our community engagement partner had also reached out to us because the residents in the site were not happy with the management of the site so to talk a little bit about the classic vapor intrusion model this figure depicts the volatilization of chemicals from the ground and ground water into a building the foundation or the basement exerted because of the pressure exerted by the building on the structure it also is influenced by the temperature of the air of the soil the type of building the ventilation of the building and the ground immediately surrounding the building as it's pavement or a field and the soil type which turned out to be really important in our studies but that's not what I'm going to talk about right now I'm going to tell you the story as I said of the toilet but at the time I will say the State Department of Environmental Protection was looking to present new vapor intrusion regulations this pathway is examined with almost every contaminated site across the country and is essential for human health risk assessment also at that time the U.S. Environmental Protection Agency was planning to issue their final guidance for vapor intrusion so that was the context of our study and this is the site so what you see here is an urban neighborhood near Boston where for nearly 50 years the big warehouse that's shown in red was the transport site for bulk shipments of tetrachloroethylene or PCE from trains to trucks and during that process there was a lot of leaking of that solvent that went into the ground created a groundwater plume of contamination affecting about 70 homes and the school so when this was realized the contractor for the responsible party went door to door to tell every resident in the area about this hazard and that they needed to come in and do some sampling immediately this created quite a bit of an alarm in part due to the fact that the door knocking took place on Christmas Eve and residents responded by saying no company, no contractors, no government are coming into our home we don't care what you say about this chemical it's not that positive there was even a hairdresser who was a vocal opponent of any intervention who said I work with chemicals that are much more hazardous and I'm fine I in my attempt to recruit residents from this area who did not have mitigation systems installed I actually got my hair cut by this person I brought my mother there and despite a lovely hair cut and a lot of conversation I was not successful at recruiting this person to participate in our study we had envisioned recruiting a dozen homeowners we ended up with three three residents who were willing to participate in the study one of them had a sign on his home that said hazardous waste sites and the other had no basement but in every house we were able to measure soil gas outside and through the basement indoor air ambient air groundwater through monitoring wells but this is the story of the single home that already had a mitigation system installed they had a beautiful basement it was overkill according to the engineers they didn't want to include this home in the study because that's not the kind of home they were looking for to test their model but this person wanted to be in the study and had real concerns about the solvents in their home so we all agreed okay we only have three people who are interested will include this household and we monitored in their basement and on the first floor and outside we did everything that we we did for the other two homes what we found as a result of the monitoring was that the PCE concentrations in the basement were lower than on the first floor but still well above the threshold level for action in this situation and the first floor exceeded cancer risk guidelines there were no known sources of PCE anywhere in the house we did a complete inventory of every home so the basement was not the source so students who were working on this project as well as the owners complained about a very strong sewer gas odor so we decided that what we could do is isolate the bathroom from the rest of the first floor and sample in there and we did we found imminent hazard concentrations of PCE in the bathroom coming from a faulty wax ring around the base of the toilet the lesson learned from this experiment where the basement and the remainder of the first floor appeared what we would expect in a situation like this that the engineering solution that everyone thought would be enough for this exposure pathway was not sufficient we had a really unusual pathway here that nobody anticipated not the state not the regulators not the engineers who are experts in vapor intrusion so we published the paper on the toilet with a more attractive title and we developed this conceptual model of how volatile organic compounds enter the sewer through contaminated soil and contaminated brown water that water traps can be effective but not always and that sewer odors can be evidence of vapor intrusion but not always so before this study there was no mention of the sewer pathway in the federal guidelines nor in many state vapor intrusion documents there was one previous report of a sewer to gas indoor air pathway in Denmark since then the US EPA guidance that was eventually issued in 2015 includes this vapor the sewer pathway ATSDR's guidance several states including most recently California is acknowledging with the help not just of our study but several studies and ongoing hazard assessments identifying soil and ground water contaminated with volatile organic is getting into indoor air through this pathway but also there was some a lot to learn from our interdisciplinary collaboration when I was recruiting residents I told them that it would require drilling a two to four inch hole in their yard and in their basement I had no idea that that would require jackhammers and even a pile driver to drill those holes and the engineers couldn't believe that I thought we could drill holes any other way so there's a really big miscommunication you could see the our students got cardboard boxes from Home Depot to try and protect the yard from getting torn up and in the end everybody was okay with the results we did learn that interdisciplinary communication really needs to be painstakingly clear and the lead engineer on this project I'm so proud to say always says when she's talked she would never have had the courage to go down the toilet if she hadn't been working with public health scientists the next story of the outlet is a pilot study of portable air cleaner uses and particulate matter exposure reduction actually in Chelsea, Massachusetts and here are co-authors this is not yet public I will say but as Patricia mentioned this is the city of Chelsea here is shown with all those colors every single census block in the city meets one of the criteria for environmental justice population I could say one or more criteria for environmental justice population as defined in the climate road back bill that was passed in 2020 and which is now threatened by the recent Supreme Court decision about taking into consideration race with any such policies that aside the city of Chelsea was really hard hit with the highest rate of COVID at the height of the pandemic and we also ranked very high for poor air quality as well as third in the state for asthma related hospitalizations and this photo of Mary from a report published by Green Roots talks about the need for more air filters in our neighborhood and what a lot of people have talked about is the need for low cost solutions to poor indoor air quality for tenants of rental housing who are often transient but could bring their solution with them if you will and several of us have portable air cleaners that are like furniture like shelves in our home we don't use them but just giving away air filters was not a solution without also studying usage so in this study conducted in collaboration with the health clinic we recruited residents we gave them temperature sensors HEPA filters which they could keep after the study ended we measured real-time air quality of particulate matter in three sizes and we did weekly surveys with them eight households participated mostly Spanish speakers which reported asthma symptoms that interrupt their sleep approximately four times per week what we learned is that the pack usage really varied by participants so each of these is the eight participants you can see number eight use the filter for the entire study period and number seven used it only at night time there were many reasons for the filter use seeing what it was overall all sizes of particulate matter decreased when the filters were used regardless of day or night time but what I want to talk about here oh sorry and we also have a whole reporting of the results to participants and to the general community about if you have an air cleaner why it's important to use it and that's the level of the filtration matters but here is an implementation challenge for illustrating some of the realistic conditions which we did not anticipate is the loose plug the loose outlet this is fairly common it's not only a fire hazard but it makes it really difficult to plug things in and expect them to run so we hired an electrician to fix and replace the plugs in the home where we couldn't actually plug anything in and have it stay on but then there is also the fact that in some of these homes a lot of devices were being plugged into the same outlet and kids wanting to watch tv would plug out the filter so that they could watch tv for example so we ended up buying strip power strips which we probably should have done from the very beginning and then this is just a side note something that was plugged in in almost every home I entered was an air freshener an air cleaner and that was just a surprise to me because I you know we're thinking about cleaning the air with these filters and meanwhile this is happening and we were not prepared with any educational materials there's definitely a conversation that could happen around this topic and I think we'll talk about today and then I'll just say the issue of the outlet really came up in earlier attempts to weatherize home which we're revisiting in the context of cooling during the summertime that weatherization cannot take place until certain physical requirements are met I'm quoting from a report published by Community Labor United that led a huge effort to weatherize over 450 homes in Massachusetts in the Boston area including prioritizing homes by low income tenants of buildings that they didn't own so by the time this formal evaluation occurred of the 188 households that signed up for weatherization only 27 had completed the process due to the challenges of dealing with structural issues that were unanticipated by the policies and opportunities that are meant to provide weatherization for low income residents so I'll end with one more slide I've I teach the course called Community Engaged Research and I've been reading Bell Hook's book Teaching Community and just love this quote when we teach with love we are better able to respond to the unique concerns of individual students while simultaneously integrating those of the classroom community and I think the same could be said for research when we do research with love responding to the unique concerns of individual study participants we can really inform science and policy as it relates to preventing harmful exposures where we live, work, play, and work with thank you thank you very much Dr. Scamble for that excellent talk please stay with us for our panel afterwards same for our online viewers please stay for the discussion afterwards next it is my pleasure to introduce Dr. Mikayla Martinez who will be our next speaker Dr. well ecologist and justice advocate Dr. Mikayla Martinez is the director of environmental health at We Act for Environmental Justice she is responsible for advancing the organization's efforts to improve environmental health in communities of color and low income communities by promoting public health awareness education coalition building and advocacy she earned her PhD in ecology and evolution and previously served as an assistant professor at Columbia University main man School of Public Health and Emory University her research has focused on infectious disease ecology social justice climate change maternal and infant health and environmental impacts on health Dr. Martinez is currently leading We Act's beauty inside out campaign which seeks to remove toxic chemicals from beauty products particularly products that enforce Eurocentric beauty standards and are marketed towards women of color please join me in welcoming Dr. Martinez thanks so much for being with us wonderful thank you for having me so let's get my slides pulled up so today I've been tasked with ringing the topic of indoor exposures into the broader picture in discussing structural racism and also talk a little bit about cumulative impacts okay great so before we can talk about justice we kind of have to talk about some of the other words that have been quite popular these days equity equality inequality and so I really like this illustration using the example of the children's book the giving tree so when we think about equality this is what we're talking about so we have this tree that's leaning over one child it has more access to the fruit on this tree and more opportunity and then the other child is kind of left behind with less access so that's inequality but then what is equality so if we recognize this unequal access and we said okay let's give these children more access to the tree but let's do it equally then we would give them each a ladder that was the same height and even though we gave them an equivalent resource it still didn't solve this problem we see that now the child that's on the left still has more access to that fruit and the other child is still left behind even though they have that ladder and then when we think about equity then that would be fully acknowledging that one child needs a higher ladder in order to reach that fruit now this has started to solve the problem a little bit in that now each both children have some access but that tree is still leaning over and one child is still getting more and that is where justice comes in so justice is really the full acknowledgement that this is a broken tree we're working in very broken and actually intentionally in just systems and so we need to write those structures and so that's what social justice organizations like we act for environmental justice where I am based that is what we try to do is to acknowledge these broken systems and so in the United States we have many systems of structural racism and I'm going to try to give you a little bit more context and how we frame structural racism so a really useful definition of structural racism is a totality of ways in which societies foster racial discrimination via mutually reinforcing inequitable systems and I underline mutually reinforcing inequitable systems because these systems feed into each other and these include community disinvestment the criminal legal system disparities in our education system housing system and all of these systems work together to reinforce each other and generate cumulative impacts and so we'll get a little bit deeper into that so all of us here care about the environment today we're focused on the indoor environment but environmental racism generally whether it's indoor or outdoor kills particularly in the United States and I just wanted to throw a couple stats up here just so that we're all on the same page in terms of how we think about environmental racism so environmental racism is just one of these systems of structural racism and in the U.S. people of color 61% more likely than white people to live in a county with at least one failing grade for air pollution and a really shocking statistic is that based on data from 2020 black children have an asthma death rate that's 7.6 times higher than white children and oftentimes when you give stats like these people who are skeptical of structural racism will say well isn't it all about income and no it's not there are fairly strong correlations between income and racial and ethnic background in the United States but income is not the sole driver of these disparities because in fact if you control for income black and Latino households in the United States even income matched with white households are still overburdened by environmental pollution and so I work in New York City and in New York City we have quite diverse set of communities going from extremely affluent predominantly white communities to highly underserved communities of color and so here just to give you a hyper local example of New York of how extreme these disparities can be what I plotted here along the x-axis is the percent of the population in each of our community districts which are neighborhoods that is non-white so we have towards the left predominantly white populations and then as you move towards the right these are predominantly communities of color and some neighborhoods in New York City are over 95 percent people of color and what I plotted on the y-axis is the childhood asthma ER visit rate and this is even controlling for the number of children and what you see is that when we move from predominantly white communities to communities of color there's an exponentially higher rate of childhood asthma and so this is all within one jurisdiction we all live in the state of New York we all live under the same laws in the city of New York but you can still see these disparities arise and when it comes to health disparities and structural racism in general they manifest throughout the entire life course all the way from in utero until the day that people die and here what I'm showing is health disparities across the life course with infant mortality as it relates to racial demographics in New York City you can see that strong linear relationship higher childhood obesity in communities of color higher diabetes higher premature mortality rates so these things are manifesting all throughout the life course and in terms of considering these health disparities the way that I like to think of health disparities is they're essentially like an oil rig so you see these massive oil rigs that sit on the top of the ocean and you see this big ugly thing sitting there but what we don't often see is this huge infrastructure that's actually under the water and hidden and this is like a health disparity at the very top we see this like ugly thing that we can see and measure and such but underneath it is that system of environmental and structural racism that's really the root cause and so we act in other justice organizations fully acknowledge that these disparities and these systems are man-made and so therefore they are disruptible and when it comes to these household exposures that we're all interested in here today they fit into this much bigger network and so this image is to try to show you how we can conceptualize structural racism so we have structural racism in the middle and we have this ring of systems of structural racism so that includes the environment the external environment like air pollution urban heat islands we have indoor exposures like household from household exposures food systems the criminal legal system the education system and so all of those systems that have disparities within them they're all interconnected mutually reinforcing each other and then they feed into the disparities that are looped around the outside and those can include things like disparities in cancer rates infant mortality rates diseases that come from endocrine dysfunction social stress financial insecurity etc and the way that the environmental protection agency is starting to frame a lot of this is kind of breaking up these different exposures into chemical and nonchemical exposures and thinking about how these chemical and nonchemical exposures come together to generate cumulative impacts which are those health disparities and so today we're going to talk about those household exposures and so I wanted to give you just two little vignettes of work that we've done at React in terms of indoor exposures so first I'm going to talk about our beauty inside out campaign and then our out of gas in with justice campaign and so the beauty inside out campaign which I lead is really addressing the issue of toxic chemicals in beauty and personal care products so there are two main problems with toxic chemical with beauty and personal care products and their toxicity one is that they cause physical biological harm to our health and two that there is highly racialized marketing and kind of colonial Eurocentric standards that are at the core of marketing beauty products and their particular products that are marketed towards women of color that are highly toxic that are not only causing biological harm but actually psychological and societal harm and so we're trying to address both of these things and the way we're trying to do this is two ways both with top down so like getting at the regulation at the international federal and state level and then bottom up doing grassroots organizing and education so that we can not only address those societal and deep rooted psychological harms but we can also get at the company's regulation and so just to reiterate that cosmetics that are marketed and to women of color and created for women of color are notorious for having some of the most toxic ingredients and so these include things like chemical hair straighteners and skin lighteners so skin lighteners are particularly bad because they oftentimes contain mercury because mercury is a very efficient blocker of melanin production in the skin so from data that we've received from various public health organizations in the United States we see that about a quarter of skin lighteners that have been sampled by the state of California the state of Minnesota and also New York contain mercury in them and so these are very very hazardous because mercury is a neurotoxin and then as many of you have probably seen on the news hair relaxers also known as hair straighteners oftentimes contain very high levels of formaldehyde which is a carcinogen and also for formaldehyde can have other reproductive health impacts and the other thing to know and I will go back to that is both of these products hair straighteners and skin lighteners they are their creation and existence is centered in white beauty standards and racism, shadism and colorism and so that's why they serve as a good example for this kind of dual toxicity and then these products are incredibly prevalent in our community so this picture here is a front window of a beauty supply store that's about three blocks from my apartment in Harlem and as you can see all of the shelves are just full of skin lighteners and then here to the left I'm showing it just like a quick cap of if you do an Amazon search for hair straighteners this is what you're going to get you're going to get products that are all directly marketed to women of color and also products that are marketed to children that actually have young girls of color on their front cover knowing that these are incredibly dangerous products and so a study that we act conducted as part of our beauty inside out campaign was a survey of women and femme identifying individuals that live in upper Manhattan to ask about not only their use of chemical hair straighteners and skin lighteners but also ask about what are some of the societal pressures that drive individuals to use these products and I would say the average person that I've encountered is usually pretty surprised about how widely used skin lighteners are they're incredibly widely used and it is a very rapidly growing international industry and what we ended up finding is that 25% of our survey respondents we had 297 participants enrolled in the survey 25% had used skin lighteners and among Asian respondents it was 57% so this is a large fraction of individuals and then when it came to chemical hair straighteners 44% of respondents had used chemical hair straighteners and when we looked at non-Hispanic Black respondents it was 60% so these are very widely used products even if they're not widely talked about and one of the interesting things that came out of this survey not only in terms of you know getting information about of the prevalence of use was also why people use these products and it wasn't that individuals weren't reporting that they were using chemical hair straighteners and skin lighteners because they thought it made them more beautiful it was that they perceived that others would believe that they were more beautiful, desirable, professional or youthful if they use those products and so what that shows is that the beauty norms that we set and the beauty expectations that we set for those around us really impact our exposures and our product use and I think that this is really important when it comes to why community-based research is so important because we might naively assume that people use these products because it makes them feel better about themselves but that's actually not the case and so this really gives us key insights into why these products are being used in the first place and I just wanted to check on my time can you tell me how many more minutes I have and so we are using this information because being an environmental justice organization we take advocacy very seriously so we are doing advocacy on the international level, the federal level and also at the state level to pass new regulation to improve, to try to achieve beauty justice essentially so at the international level we're supporting the Minamata Convention on Mercury to not only have the ban of import and export of mercury-containing skin lighteners which is currently in place but also to ban the sale, the display of sale and advertising of mercury-containing skin lighteners and then on the federal level we've been working to promote the safer beauty bills package which is a set of four beauty bills one of these bills will increase resources for research into exposures for women of color and then also salon workers and then at the state level we have two new bills one that would do a chemical ban for some of our most harmful chemicals and beauty products and then also require labeling disclosure for menstrual products and then just with my last couple minutes I wanted to talk about our out of gas and in with justice program this was a pilot program and we're hoping to expand this in the near future but the motivation for this study was that it's been long known that the use of gas stoves in homes can produce nitrogen dioxide and carbon monoxide with nitrogen dioxide being harmful to respiratory health and carbon monoxide particularly bad for cardiovascular illness and one of the reasons that we act as interested in this pilot specifically was because of the link between gas stoves and childhood asthma so there have been population level studies that have attributed up to 18.8 percent of childhood asthma in New York state to the presence of gas stoves in homes and based on those data that I had showed you earlier we have such a big problem with childhood asthma disparities that made a study like this desirable to see if we actually got rid of gas stoves in homes would that improve the conditions inside the home and so this was the first study of its kind that did stove swap outs gas for induction in a public housing setting with the actual tenants in place in their homes and I just wanted to show you a couple like snippets of data from this one of the things that we did was to actually do the swap out from the gas to induction stove and then did a controlled cooking experiment where we cooked a standardized meal spaghetti with tomato sauce broccoli and chocolate chip cookies and in each home this cooking was done three times before the gas stove swap out and then three replicated three times after the gas stove swap out to look at the differences and then we here I'm just showing some data for one home what the controlled cooking experiment looked like when the gas was being used to cook so what you have on the x-axis is time after we started the cooking in minutes and then we have the nitrogen dioxide levels on the y-axis so what you could see and also this orange line is showing the unhealthy levels for sensitive groups for nitrogen dioxide levels that's set for EPA based on like outdoor outdoor air but this is indoor and so what we see is within the first 10 minutes of cooking with a gas stove those nitrogen dioxide levels shoot up above those unhealthy levels but if you do the same cooking experiment with an induction stove you don't see that same unhealthy increase and we can we've shown this across multiple homes so we have here these data are showing three homes where we did the stove swap outs and then compared to three homes where we didn't do the swap outs and you could see the background levels of nitrogen dioxide before cooking and then after cooking jumping up with those gas stoves and then kind of staying flat when you're using an induction stove and so what this is really telling us is that having those gas stove in homes can get us to those unhealthy levels for nitrogen dioxide and we really need to do follow-up studies where we can actually measure is the intervention helping to improve health outcomes so that's where we're at with it now and we have an EPA grant in under review now to do a hundred house swap out these were done with 20 homes total but these controlled cooking experiments were only done in six of the apartments but just the last thing that I wanted to say was one reason it was so important to work with the community is you learn a lot so a couple things we learned you have to buy new pots and pans for everybody when you swap out someone's stove you have to be very respectful when you come in and have to do electrical rewiring in people's houses because there's actually a lot of electrical work that needs to be done to do this kind of swap out but also people really love their stoves so we had professional cooks do cooking classes that were culturally appropriate for our participants and they ended up really loving their stoves and I will just leave you with this QR code where you can watch a video of our participants talking about how much they love their stoves and I think you will find it just really lovely seeing how surprising it is that yeah people were very happy with this transition and it is a very big win for us because this was done in public housing and now New York City has committed New York City public housing referred to as NYCHA has committed to doing a 10,000 stove swap out in 10,000 public housing apartments so yep and that's it great sounds good thank you so much Dr. Martinez that was excellent and now I would like to ask thank you Dr. Scam will be online so we just heard excellent talks thank you both so much we have a Q&A session right now so we see Dr. Scam online and Dr. Martinez is right here with us I have plenty of questions that I'd love to pick our speaker's brains on but maybe before we get started if anyone has a question from the audience please step up to the microphone we'll start us off with an online question from Dr. Miriam Chacon and thank you for being with us basically she is hey thanking you Dr. Scam will for your presentation and regards from Stuttgart from Germany her question is if it is known that these beauty products are so dangerous why are they still available in the market and actually I think Dr. Scam will answer that this is really the topic of Dr. Martinez but the sad truth is beauty products are not tested for chemical safety but I would also love to open it up to Dr. Martinez for your personal thoughts on this question and then Dr. Scam will if you want to add anything as well yeah so there's been research from the lake research partners here in the United States that has shown that the majority of Americans believe incorrectly that personal care products are tested for safety before they hit our shelves and that's just not true and the reason for that is because our federal government has just not stood up to regulate the personal care and beauty industry you know we're really behind in this if you look at regulations in the European Union and also Canada they are light years ahead of us so here in the United States we're still fighting for banning you know the dirty dozen chemicals whereas if you look at the EU they have over a thousand chemicals I think they're now over 2,000 chemicals that are banned from beauty and personal care products so it's really in my view a problem of our regulation in federal government Dr. Scam will you want to add anything to this no I think that was very well said and accurate so I would love both our speakers thoughts on this next I'm going to follow Gillian's excellent example and editorialize a little bit I feel like whenever we're talking about environmental health disparities sorry Robin I just noticed you're there we'll go to you next you know we focus a lot rightly so on the sort of uneven burden of exposures and the multitudes very specific types of exposures that these communities are experiencing very high concentrations of right what we don't focus as much on is the double jeopardy I think you noted or the double toxicity which is the vulnerability side of things even if these communities were experiencing the same levels and they're not of course they are still at higher risk of developing adverse health effects from these same exposures because of the multitudes of chronic stressors and lack of resources and issues that are that make them at higher risk what in your sort of personal opinion you know why is this sort of aspect of vulnerability usually ignored in the conversation perhaps or paid less attention to and what do you think is at the heart of strengthening that side of the equation okay I'll start so I think that one of the problems with acknowledging both the social stressors and non-chemical exposures alongside the chemical exposures is science has just been done to siloed you have people in environmental health sciences that are looking at exposures you have epidemiologists that are looking at infectious and chronic diseases you have like you know the reproductive health folks like everybody's working in a silo the social scientists who are doing a great job at looking at social stressors but we've not been intentionally trained to integrate all of those data and all of those different ways of thinking and so it's I think it's a kind of a structural issue of how science has been done Madeline thank you yeah I agree and I would just expand on that by saying I think what we have been trained to do is to believe that we can objectively measure the truth with a quantitative metric that would somehow be representative of the entire population and make decisions based on what is best for the white normal male which is not accurate and so we have to learn how to incorporate all of these different types of information as Dr. Martinez said using new methods and and taking into consideration different ways of knowing about the world than we have historically thank you very much and I see Dr. Dotson has a question for us from the room please go ahead sure well thank you both Madeline and Makilla for these talks both of you touched on something and I'm putting not on my community-based participatory research hat but more from just a research scientist who's trying to get things funded hat you both pointed out implementation challenges and I noted you know Madeline you talked about having to do redo electrical work and things like that in homes and Makilla you also brought up having to like redo electrical work providing pots and pans I'm trying to think as we're developing these intervention strategies where we try to make it palatable to funders and to others who who might support this work to say all you have to do is swap out a stove but then you imagine there's actually these outsized costs on the implementation of it and I'm just wondering how you've worked on trying to make those well first of all have you tried to estimate them or kind of package them as part of the intervention in a way that's palatable for funders or just kind of programmatically yeah so I'll say with our expansion of the out-of-gas project you know I put very clearly like in my EPA budget this is what it's going to cost for me to hire like a culturally appropriate cook I'm going to have cooking classes I need to have like a little test stove there my budgeted I think was like $130 a household for new cookware and I just I mean I'm used to running like a very traditional science lab and I'm used to being like here's what it's going to cost for all of like my pipette tips that all these things like things that are actually necessary to do the science and I see this as the exact same way it's like I know what I need to get this done the right way and I guess maybe a little naively on my side I'm like the funders should understand that because it's just you know that's just what it has to be so yeah I don't know I haven't yet heard back I don't know if I'm going to receive pushback from like being so you know just rank about it but I think that we should probably expect that level of understanding from our granting agencies I would just add to that that well ours was a pilot study and we definitely learned a lot we did not anticipate those challenges which was perhaps naive because then when we went to go look at people's experience with weatherization we learned that these challenges had previously been documented but in a different context but I think definitely those line items would go into a future grant but I also think that like policies like we're sort of at an impasse like right now everybody recognizes that weatherization is really important for homes for heating efficiency and cooling efficiency but people just keep grinding the same tool in terms of saying getting out there and trying to take advantage of the same program that do not allow for these changes or do not provide the funding for or facilitate the changes that require landlord and tenant engagement so I think you know that's I guess we're sort of at the interface of our research with policy and solutions and trying to mutually influence each other you both again have a question online let me try to phrase that first and then I have some thoughts um we've had a couple of questions actually to Dr. Martinez on any research or articles that you could potentially share on the dangers of hair strengtheners and skin lighteners and I'm sure you probably have a long list so if you don't mind maybe sharing with us some resources on where on your website or any other recommendation so you can go to react.org and the beauty inside out website there should be on there a link to our recent publication and I'm sorry that there should be a link on there to our most recent article which covers the hair straighteners and skin lighteners and in those references thanks to other scientific articles on the topic also there was the recent study that was looking at hormone sensitive cancers my mic keeps cutting out and yes also if you just google hair straighteners and cancer you're going to see some very recent articles that have come out so much sorry I couldn't be better from the podium what providing links no it's again will possible yeah I guess we'll we'll just keep running with the mics the Dr. Miriam Diamond who's also participating in our workshop has a comment on hazardous personal care products and if you don't mind unmuting we'd love to hear from you thank you very much Rima thank you very much for both your really informative presentations I was aware of a project done in Toronto in which researchers were looking at personal care products that immigrants often brought with them that could be very hazardous and then completely eluded any regulatory scrutiny because they were brought by community members with for example elevated levels of mercury cadmium and some other very nasty compounds I believe in Canada that at least some personal care products are subject to the cosmetics regulation but it's very challenging for immigrant communities that have cultural norms that include the use of specific products it's not a question just a comment thank you very much yeah and that's a really good point and this is well two things to say toxic beauty products are a global issue so this is not something that is just a U.S. problem we need very coordinated global efforts to address this but also this is a reason why I had mentioned that we're also taking this bottom up approach where which is like a grassroots approach to have conversations with community members about you know why we choose to use certain personal care and beauty products or and thinking about that when it comes to like culture family and California Department of Public Health has done a really great job of addressing the use of skin lighteners among women farm workers in California and you know one of the things that they see there is there are skin lighteners that are sold and like swap meats where they'll have mercury added into them and they believe that this is coming from like the artisanal gold mining mercury that's also used throughout Mexico and Latin America so you have to really address like where this mercury is in the environment the cultural aspects where people are buying them and you have to take a really holistic approach and so yeah that's why this community driven like conversations are really important Thank you very much I also have a chlorinated solvent story to share if if please go ahead I didn't want to leave out Madeleine but Bill Doucet formerly at the University of no Nevada State in Logan, Utah had done some was looking for houses affected by vapor intrusion of TCE as a result of military activity the military base but actually found the smoking gun so to speak with some imported Christmas ornaments that were just loaded with TCE and also when you bring in garments from dry cleaning just degas over time and impossible to keep track of Christmas ornaments and dry clothes dry cleaning clothes and everything Dr. Scamill I think we wanted your thoughts on vapor intrusion perhaps related issues along these lines and examples if you have any of course along the lines of just it's an exposure pathway that we don't often consider or vapor intrusion generally sorry Madeleine I think perhaps it was hard to hear I guess Dr. Diamond was giving more examples of let's say unintentional ways sometimes these chemical products are introduced into the home and trying to give you an example because you talked about TCE so it's fine if you don't have any thoughts to be honest because we could move to Dr. Fabian but I just wanted to make sure we give you the opportunity thank you I think yeah I think there are a lot of products that we bring into our home that's exactly right and dry cleaning clothes and a lot of situations where people living near dry cleaners or near auto body shops are exposed to many of the same chemicals through their their own air building air intake system but also just to consider all of the leaking underground storage tanks in the country wherever there's a gas station and all of the hazardous sites that are managed at the state level and not at the federal level there's a range of approaches to monitoring and assessing health risks that often doesn't include some real now known pathways so I'm just saying I sealed the toilet to my basement and will ever after now with the knowledge that what comes up from the sewer includes many chemicals even if you don't live on a hazardous waste site so much Dr. Petrie Chef Fabian has a question from the audience hi thank you both question for both of you actually around the cost of the implementation of these interventions so portable air cleaners add to the electricity bill swapping out the gas stoves which is the cost from a fuel heating bill to an electricity bill which maybe goes from the landlord to the tenant we talked a bit about this at lunch so can you talk about the challenges with the sustainability of these interventions once we've proven that they work and that this might be a solution somehow how do we then implement them in environmental justice communities where the you know any tweaks to the bells are a big challenge yeah absolutely so you're correct that anytime that we're making modifications to the home we really have to consider the cost to the residents and be particularly sensitive when we're working with lower income communities I will say that this also has to be balanced by the cost of unhealthy homes and so we we need to be able to provide safety nets whether that's through actual like cash incentives or you know reductions to utility bills and such that are sustainable but also recognizing that we need to have a broader conversation about public health and the cost that it's not just costing individuals but like also our infrastructure like our health infrastructure to keep people and so yeah it's a it I think the cost goes beyond like how much does my electric bill or utility bill go up at the end of the month but we really need to kind of factor in like how is this impacting is intervention impacting your chronic diseases and your medical bills etc or even you know your well-being is so important for school attendance and job maintenance etc so that's why I really think we have to take these very very big picture holistic approaches okay great thanks I would just say that for the portable air cleaner study we gave participants money to supplement their utility bill as well far more than the actual cost using the filter as it turned out but I agree that this is really an upstream concern and that we need to make landlords and homeowners responsible for making their home easier to heat and cool without increasing the cost to the tenants who live there and also without resulting in gentrification of an area because their homes have been improved upon and can be rented for more rent and I also wanted to make one other note because this also the cost also comes up with the beauty justice work because transitioning to non-toxic and safer beauty products is also really expensive and so that's something that we're having conversations about as as advocates like how do we make like cleaner beauty more affordable like how do you help like do you need to in help brands to be able to clean beauty brands to be able to scale up so that they can offer non-toxic products for more affordable like it's the cost thing comes into play in multiple arenas much we are at time but Gillian do you do you want to give a quick comment or question just just to the point and thank you remote I'll do this in 90 seconds or less the idea that we we need to incentivize property managers property owners landlords residents I just want to point out that our entire federal tax structure is designed to incentivize home ownership and if you have filed your taxes and you're a homeowner you get to you know tax deduction for every interest every dollar you've paid in your mortgage interest that's just our tax code designed to incentivize the middle class right so changing our tax codes so that we can incentivize property owners to make as I call it Medicaid neutral housing right to do those things we don't think is an insurmountable task I think we just need to start having that conversation so that's my and I'll just say given you know the history of redlining and the home ownership gap it has to be recognize the very intentional blocks that have been put in face in this country to keep people of color from being home owners and therefore being able to benefit from some of those tax incentives you both so much for bringing us back to the sort of systems level thinking and how everything ties into everything I also want to thank Dr. Diamond we don't have time so we're going to go to break in two seconds but I just also want to thank both our speakers for excellent talks but also for bringing in issues around culture and how sort of you know people's behavior or sometimes our products they use or practices they have in their homes are very culturally driven and how you've both given great examples of how to approach that in a very intentional and culturally appropriate way so thank you both so much thanks to our online audience we are out of time we're two minutes over actually we're going to go to break now for eight minutes precisely and if you don't mind please be back at 2.20 p.m. Eastern rest to start back on time and thank you all so much again for your engagement and wonderful talks thank you all right we are going to resume session three and I should have said this before but I also want to thank and introduce Dr. Ellison Carter who was part of the planning team and I'm happy to hear that she can be here with us virtually today she was going to be in person but had jury duty so I'm going to introduce Dr. Carter first and then we'll move right into the speakers in our session so Ellison Carter is an associate professor in the Department of Civil and Environmental Engineering at Colorado State University Dr. Carter has expertise in indoor air quality exposure science and indoor environments as places that support health and well-being she conducts field-based assessments of personal indoor and outdoor air quality and human behaviors and the impacts of intervention in the home and workplace settings her research aims to contribute to the development and implementation of healthy housing and indoor environmental interventions in diverse domestic and international settings she earned her PhD in civil engineering focused on indoor environmental science and engineering from the University of Texas at Austin her work as a JPB foundation and Harvard Environmental Health Fellow broadened her research teaching and professional efforts to further integrate social and environmental factors as they relate to public health pause there before I introduce our first speaker in session and is she going to be visible do we have her coming out of the stratosphere somewhere Ellison I thought she's going to be on camera just when we moderate okay all right so you guys have made it to the third session and we have just fantastic speakers all day so I'm excited for this conversation this particular component is called perspectives on air cleaning products air sensors and the impacts on EJ communities our first speaker for session three is Dr. No yes I'm reading from the wrong agenda apologize or from or I'm just misreading the agenda all right however so session two is just as good this session two is focusing on community engagement approaches for research practice and policy on EJ considerations for indoor air chemistry and our first speaker is Dr. Robin Dodson all good so far okay she is an exposure scientist at silent spring institute and an adjunct assistant professor professor at boston university school of public health her research focuses on three main areas development of novel exposure measurements for epidemiological and community-based studies analysis of environmental exposure data with particular emphasis on semi-volatile organic compounds and interventions aimed at reducing chemical exposures Dr. Dodson investigates environmental exposures of chemicals linked to a range of health outcomes including asthma altered neurological and reproductive development and breast cancer her current research focuses on exposure to consumer product chemicals such as phthalates and flame-retardant chemicals and has been used to identify exposure sources and implement effective exposure reduction strategies in homes Dr. Dodson serves as the chair of the massachusetts toxic use reduction institute science advisory board and is an associate editor of the journal of exposure science and environmental epidemiology Dr. Dodson completed her doctorate environmental health and master's in environmental science and risk management excuse me at harvard th chan school of public health all right so you wonderful well it is my pleasure today to talk to you about some of my research on making homes healthier and particularly doing that within partnership with communities so what I'd like to start off actually is to elevate what Dr. Fabian had already talked about today moving environmental justice indoors and thinking really a lot of my research is kind of in that space around sources and exposures particularly indoor sources and then the activity patterns that can kind of modify some of those sources in particular I'm going to be focusing on consumer product chemicals and what I mean by consumer product chemicals I'm using that term very broadly thinking about things like cleaning products and personal care products I'm thinking about things like furnishings or household goods that we could bring into the home I'm also considering building materials the materials in which we build our homes these include things like phthalates preservatives and antimicrobials UV filters also includes things like flame retardants PFAS or PUR and polyfluoroalka substances and even fragrances these chemicals many of which unfortunately are endocrine active that means that they could affect our endocrine or hormone systems in some way and some have even been linked with cancer many of them are also considered to be semi-volatile organic compounds and this is actually a visual from the report and demonstrating really the complexity of these chemicals they're semi-volatile they love to readily partition between various surfaces they can be found in air they can be found in dust they can be found on us and this complexity is you know kind of makes my job fun but it's difficult it means that we have to develop these models to try to understand their relationship and these models are often based on the physical chemical properties Charlie Westler and Bill Nazaroff have done incredible amount of work in this space trying to characterize this partitioning behavior but the advantage here to this complexity is that it actually gives us different places to actually readily measure exposures and this is important I think the flexibility that those semi-volatiles offer in terms of measurement makes them more flexible and more amenable maybe to community-based work and I'll talk a little bit about what I mean by that so at Sound Spring Institute we've done we've collected hundreds and hundreds of indoor samples largely in homes that work actually started way back with the the Cape Cod household exposure study over two decades ago when Sound Spring was really the first to measure many of these semi-volatile organic compounds in homes in the United States we were the first to measure flame retardants for example this work was community-based the reason we were doing this work was trying to actually identify environmental contributors to elevated rates of breast cancer and Cape Cod and that the attention was called to those issues and by sorry the attention was called to those issues by breast cancer activists living in Massachusetts who actually when traditional risk factors could not explain the elevated rates on Cape Cod they wanted to fund and secure the funds for a research institute to tackle this problem to look for environmental contributors to disease specifically breast cancer so our work started in this community-based way really trying to understand and then respond to community concerns about the environmental links to cancer we then expanded this work into California with our California household exposure study this study was also community based in that it actually came out of concerns about a community that was living in Richmond, California next to the largest oil refinery in the country and residents were very concerned about the impact of the refinery on their exposures inside of their homes so we looked we collected air samples as well as dust samples in California as well we've continued this work in low income housing our subsidized housing in Boston we've looked in college campuses we've done sampling in CDC's green housing study which is subsidized housing with asthmatic children and Boston Cincinnati and New Orleans and have since continued to collect these samples across the country so what are we finding well these consumer product chemicals are readily found in our homes and they love to hang out in dust right they're semi-volatile so house dust is one place they're going to hang out this is actually a summary table from a study that was part of a meta analysis that we did a couple years ago that was looking across United States as household dust studies finding that phthalates in particular were found in every single home that's pretty much ever studied I always find phthalates in homes flame retardants were very abundant and even things like funnels or fragrance chemicals were also found in these homes this is actually plotting the geometric mean from that meta analysis of all the different chemicals the chemicals are listed on the bottom here with the geometric means you can see on the y-axis and what I want to point out here is actually the range across which we see these chemical exposures these are just the geometric medians but I want to point out kind of the orders of magnitude over which we typically see these chemicals and that phthalates typically are found at some of the higher levels and maybe those PFAS tend to be found at the lower levels not saying anything here about risk necessarily or potential health impacts but that you can see this range over which we are observing these chemicals in household dust when the chemicals are in dust they're not alone in fact we find them as chemical mixtures in dust this is data coming from our some of our work on college campuses and this is looking at dust collected from classrooms on colleges and we did a principal component analysis to try to understand how some of these chemicals are highly correlated with each other and then what mixtures might be associated with some of the characteristics of the space so we found a significant association between the presence of wall to wall carpeting in classrooms and elevated or higher levels of a mixture of PFAS chemicals so this is really important we're starting to identify how these could work together to actually to identify associations between building characteristics we found these chemicals in dust we also find them in indoor air this is data coming from our the green housing studies this is a CDC funded study where we added on additional measurements and this is for the triclosan parabens and phthalates these are indoor air concentrations the reason I'm showing this is because I want to demonstrate the variability that we see within each chemical right DEP, diethylphthalate found on the bottom there spans orders of magnitude in terms of the levels that we're seeing this is it's important when we're thinking about what are some of the sources because I see this actually as an opportunity this exposure variability allows us to really kind of target some of those higher levels that we're seeing to try to work back and try to use that like why are they much higher than others to try to understand what are potential sources inside of these spaces this is I want to tell you a little bit about a study that we conducted in Boston, Massachusetts and subsidized housing this is what we call the move-in study so we spent you know 15 years or so characterizing the levels of these chemicals in homes now we want to kind of move towards trying to identify well where are they coming from because that's how we're going to develop interventions so this is what we call the move-in study we collected measurements indoor air measurements inside of homes before people moved in and then after they moved in to subsidize housing units all of these units were renovated to specific certifications and then we went back post-occupancy what we then did was to compare the levels pre and post-occupancy to basically bin these chemicals are they more building related so they were there with once the building was renovated but before the people were there or are they from the occupants are they bringing the chemicals in with them so first let's look at those chemicals that are influenced by the building I'll draw out a few examples here toluene and xylene these are VOCs that are often used in building materials you can see that the levels left is pre the right is post-occupancy and that the levels go down significantly over that time and this is important because we can start thinking about okay well we know these VOCs must be in the building materials we can work with certifiers especially if these are actually attempting to be kind of green building certified this is results for benzo phenone this was actually a surprise benzo phenone is a UV filter typically considered to be in consumer products or personal care products this was surprise I would have beforehand put this in the other the other bin not not building related but I've been related and my I suspect that this is actually coming from paints to make that color last long that they are putting these UV filters in in paints these are flame retardant chemicals these are chlorinated or gano phosphate flame retardants TCIPP and TDCIPP these can be found in building insulation but I want to point out that there's a few points up here where clearly these are being brought in by occupants as well so maybe this is a mixture on kind of on average we would put this in the building material bin although certainly some occupants are bringing this in now why do I care why do I care if these chemicals if I'm slotting these into the building materials spot the reason for that is because it informs our interventions these chemicals that I'm showing are all chemicals that you would then say target for intervention by working directly with building material companies you'd work with construction you'd work with third-party certifications things like that in contrast these are the chemicals that are related to occupancy this is where chemical levels typically went up with occupancy first of all there's chemicals that we didn't even detect before people moved in and then suddenly we're detecting them these include things like methylene chloride which is a highly toxic solvent chloroform and then some of these lower brominated flame-returning chemicals so clearly residents are bringing these chemicals in with them these HTN and HHCB are synthetic fragrances no surprise here not surprised at all that these would be occupancy related they are clearly brought in by participants and look at the levels are spanning quite a range there this is triclosan triclosan can be used in building materials it's an antimicrobial it's a thyroid disruptor at this time of this study it is now it was still being used in toothpaste hand soaps and other other things those have actually been phased those uses have been phased out but can also be found in things like cutting boards scissor handles other places inside the home and here we have BDE-47 this is a flame retardant that was phased out in 2005 these samples were collected about 10 years later so this is a lesson in you phase a chemical out it doesn't magically disappear from the marketplace and in fact what we believe is going on here is that these residents may be bringing an older furniture that still contain these legacy flame retardant flame retardants so these chemicals are in our they're in our spaces they're in our homes they're in our classrooms we always kind of presumed that they must be coming from consumer products but nobody actually did the testing until about 10 years ago we published actually the first product testing paper that looked at over 200 products everything ranging from cleaning products to soaps to cosmetics lotions and even hair products again for a range of endocrine-disrupting chemicals so EDCs and asthma-related chemicals and a couple things to point out here first of all is that these chemicals are found in a wide range of products right and we use a wide range of products okay so we can have chemical exposures could add up in that way you can also see that any kind of any individual kind of product type can contain multiple chemicals and this is important because a lot of these EDCs actually work cumulatively they could kind of matter if you're exposed to multiple at a time because they all have the same kind of outcome and so this is really a demonstration of not only the ubiquity of these chemicals but the potential here for cumulative or aggregate exposure to these chemicals so these chemicals in our homes they're coming from the products and they end up in our bodies this is data from CDC's national biomemetry program the Anne Haynes program what I'm showing here are children less than 12 years old and for their the phenolic suite or what they've now called the personal care product suite in Anne Haynes and these are the percent detected every single American has parabens in their bodies and this is true this is for children but it's also true for adults but we know if we look closely at these data that not everyone is exposed equally to these to these chemicals this is methylparaben again from Anne Haynes for children and you can clearly see that children of color have much higher levels of methylparaben or preservative used in personal care products higher than non-white children and that black children in particular have much higher levels of methylparaben in their bodies why? why are there higher exposures among people of color? consumer product use can be one of those reasons it is important we know potential exposure pathway and this is the particular use patterns may be leading to disparities what I'm putting up here is actually from a really nice commentary a couple years ago that my collaborators Amizota and Bhavna Shamasunder produced are published that they put forth this idea of environmental injustice of beauty Dr. Martinez just talked about this this idea that there may be upstream factors that may be contributing to these exposure disparities and health disparities that are rooted in things like systemic racism things like colorism hair texture preferences and odor discrimination are resulting in exposure and health disparities among people of color this is really kind of the motivation for work that I'm work in California that I'm part of a very highly collaborative community engaged study called the taking stock study this taking stock study is led by researchers at Occidental College Silent Spring and Columbia University as well as community partners Black Women for Wellness and Promotores de Salud living in Los Angeles and what what we're finding is that product use does vary by race and ethnicity in fact we can see that Latinas for example are more likely to use cosmetics Black women are more likely to use certain hair products and intimate care products and this is important because it will help us start to develop interventions in that might be effective depending on the particular product in a more kind of culturally appropriate way so I've spent a lot of time taking measurements exposure measurements and part of doing that within a community partnership approach is sharing those results back with study participants and this is actually work that Silent Spring in particular they spent a lot of time developing the right methods other the best methods for sharing study results and is really key to doing any community-based work so this is actually a just a snippet of a report that we gave to participants in the CDC green housing study that's asthmatic children living in subsidized housing and in Boston, Cincinnati and Orleans and we can see that people are actually using their results that it is affecting personal choices right so people have decided have seen their results and have decided to decrease their use of product products perhaps with fragrances they're bringing their results to their doctor to help them with their asthma management and it's also affecting community and policy change we actually saw this in our California household exposure study where participants were actually going to community meetings and holding up their reports at community meetings and saying these chemicals are in my bodies in my body we need to do something about this and so this is a way of really acknowledging the idea of came up earlier today this idea of co-ownership of data whose data is this it's giving the data back to study participants in a way that they can use so I want to transition now to thinking about solutions where are we with identifying solutions to mitigating or limiting our exposure to these chemicals I think this has to happen at a multiple levels this has to happen all the way from the consumer to the institution maybe working with retailers or manufacturers and of course in the regulatory space as well things like we have an app called detox mean which has evidence based or research based tips for reducing exposure it involves things like engaging with healthcare industry or higher ed or informing restricted substances less that manufacturers might use I want to give a couple examples of solutions and interventions so this is data actually from our crowdsource biomonitoring study where we had over 700 people from across the country mailed us urine samples that we tested for consumer product chemicals and this is actually looking at paraben use paraben products parabens in products this is the increasing product use along the x-axis and increasing paraben concentrations along the y-axis and those people who say that they what we call avoiders that they read the product ingredients list could actually significantly reduce their exposure to parabens this is really great news they could significantly reduce it they could not completely eliminate it that's really important label reading will get you so far but not all the way to the end to reduce your exposures we actually then looked at data from pairs so people who were living in the same household who provided us with biomonitoring samples and we're able to actually figure out or the contributing source is it your personal behaviors that are leading to your biomonitoring levels is it the other person living in your house their behaviors or is it something in the shared household and this is really interesting parabens those are on the top there mostly it's because of what you do is leading to your levels benzophenone 3 which BP3 there other people's behaviors can affect your exposures and then for others like the 2,4 dichlorophenol and 2,5 dichlorophenol that's more likely a shared household exposure things like contaminated water or other sources this is actually from an intervention study that we did that was looking at what we call the couch swap study where people actually swapped out their couches presumably the largest source of flame retardant chemicals in your house either they swap the entire couch or the foam within their couch that's the cheaper option and we could see significant reductions in several flame retardants including that legacy flame retardant VDE-47 and some of the chlorinated organophosphate flame retardants went down significantly by swapping out the couch another intervention that was pretty straightforward is that we actually put the Corsi Rosenthal boxes which gained a lot of popularity during COVID in classrooms on Brown University and so this is work that I did in collaboration with Joe Braun who's at the top of that photo there and we then looked at salate and PFAS levels in indoor air and these filters it's a wonderful co-benefit not only mitigating COVID we know from previous right speakers that we know they also can reduce PM 2.5 or PM levels particulate matter levels but they can also significantly reduce indoor air concentrations of phthalates and PFAS we also know that standards can influence concentrations in this case flammability standards flammability standards like those in TB-133 which is a rather what we call severe flammability standard much more stringent versus TB-117 which is still a flammability standard but you can see the different there are significant differences in flame retardant concentrations in college dorms in different campuses that adhere to the different flammability standards this is really important because it means even those decisions that we're making at the state house can have influence it's even all the way down to what is in the dust in our college dorm rooms and here's actually another study that I want to share is an intervention I'm not sure where it fits on my multi-level because I think it actually in and of itself is multi-level but this is a study that I'm conducting with Katrina Korfmacher University of Rochester where we are looking actually at SVOC concentrations in homes that are going through HUD-funded lead hazard rehabilitation programs so we know lead hazard control programs work to reduce lead in people's homes our hypothesis is that it's probably also having an influence on the other chemicals in the homes things like phthalates pesticides and even flame retardant levels may actually be changing hopefully decreasing over time as these houses are going through a rehabilitation program in addition we're also asking what if we went in and provided folks with a healthy homes kit and education materials and referrals for around their healthy kind of healthy home referrals would they have even further benefits by being engaged in such a program simple thing getting a vacuum cleaner and being told how to clean appropriately in their homes so why community research partnerships right now I am speaking to the researchers in the room online community partnerships improve research you get better questions more relevant questions out of the partnership you get more highly engaged participants we see this in our taking stock study right now we're asking a lot of women they're using an app they're collecting urine samples and all of that and it's because they trust the researchers the research partnerships that we have developed with our community partners it's because they trust the people coming into their homes so taking the time and building that trust means that you'll get better participation it also improves learning there's co-learning when you work in a community partnership so how as a researcher can you be a good partner show up this came up in the earlier session be available to community members meaning answering questions sharing what you know and what you don't know be honest what you know what is expected kind of thing involve communities throughout the entire study all the way from the study conception the study design the actual implementation and then the sharing of the results and the dissemination of the results pay community partners this came up earlier pay community partners who are working with you and listen of course so with that I just want to acknowledge my collaborators draw your attention to some one one way that we communicate some of our science our science translation work here coming from the detox me app with our top 10 tips for a healthy home and look forward to the questions during the QA session thank you very much all right let's digest and thank you Dr. Dodson took pictures of all your slides so we're going I'm now going to introduce our second speaker in the second session Dr. Miriam Diamond and after that for this session we're going to go to Q&A and discussion and we're also going to try to make about six to seven minutes but Miriam we're not going to cut into your time so let me the honor of introducing her she is a professor in the Department of Earth Sciences and School of the Environment at the University of Toronto her research over the past 30 years focuses on understanding and quantifying chemical emissions their transport processes and result in human and ecological exposure her science and policy research has been published in over 200 peer-reviewed articles and chapters in addition to receiving extensive media attention Professor Diamond is an associate editor of the Journal Environmental Science and Technology and sits on the Editorial Review Board of Journal of Exposure Science and Environmental Epidemiology she was the co-chair of the Canadian Chemical Management Plan Science Committee from 2017 to 2021 is the Vice-Chair of the International Panel on Chemical Pollution and is the Chemicals and Waste Expert on the Scientific and Technical Advisory Panel of the Global Environment Facility she's a fellow of the Royal Society of Canada Royal Canadian Geographical Society and the Society of Environmental Toxicology and Chemistry so with that Dr Diamond thank you very much Gillian are we good good okay thank you very much for the invitation to present and I'm sorry that I can't be with you this photo has absolutely nothing to do with the theme of the conference it's just something pleasant and nice to look at okay so the session the workshop started this morning by Patricia Fabian talking about the social determinants of health of which housing, basic amenities and the environment figure importantly a well it's not actually not so recent a review done by Jim Dunn and colleagues Jim as at the McMaster University in Hamilton Ontario Canada looked at a gaps analysis for housing as a socio-economic determinant of health and what he and his colleagues found was that there's a significant dearth of research on housing as a socio-economic determinant of health but enormous potential for conducting high impact longitudinal and quasi-experimental research in the area of particular interest is the impact of housing on the health for vulnerable subgroups for example Aboriginal peoples immigrants children and seniors so as I went to prepare this talk I reached out to my network to try to find work that had been done subsequent to 2006 knowing for example that Indigenous peoples in Canada often experience terrible housing conditions and yet I was unable to find or at least nobody would share any information with me or actually knew of any quantitative information to share so the dearth continues today I want to explain or promote the ideas that exposure to semi-volatiles is inevitable and Robin you thanks that was a great presentation and now I don't have to explain what semi-volatile organic compounds are I want to share with you our experience in trying to understand the inequality of exposure but ultimately these relate back to our inability to sufficiently reduce exposures to protect populations I will comment on two of many reasons for this the first is chemical intensification and the second is indoor chemical dynamics persistence which actually don't explain at all the inequality of exposure but provide some understanding of indoor exposures I'm going to finish by talking about actions and implementation for harm reduction definitely doing a tag team presentation with Robin on this I do want to emphasize the importance of the longevity of decisions that are made regarding housing Robin talked about the importance of building materials and personal products that are brought into houses decisions made on both accounts have long-term implications for exposure Turning first to the inevitability of exposure and following this idea of chemical intensification and indoor chemical dynamics but first I'm going to talk about the inevitability of exposure this is a and Robin mentioned Bill Naseroff who is definitely at the forefront of understanding exposure and I understand now is enjoying retirement well-deserved so what him and Elaine Cohen Hubble from USVPA did a number of years ago this was published actually more than 10 years ago they calculated a chemical production actually intake to chemical production ratio for the US population so it's taking the ratio of intake calculated from NHANES NHANES data to chemical production and they did this there were only a few chemicals mostly this is bisphenol A these are the phthalates that Robin just talked about Robin you also talked about tricklescent and this is methylparabin and surprisingly I find this very surprising this is the intake to production ratio expressed as part per million so if it's a thousand part per million that means a 0.1 it's quite astonishing to me to see these results about 0.1% of total production of these phthalates and higher than that for the more volatile phthalates actually ends up in us as humans what's lower is BPA because it's really quite efficiently locked into the plastic polymer of polycarbonate so there's not a whole lot of BPA that is released it's it's a much lower ratio one per million and then you have at the other end methylparabin which one of the speakers mentioned oh yeah Robin mentioned methylparabin I believe which is in personal care products and has a super high intake to production ratio so this is really quite astonishing more recently Lili John Arnott and others did a very sophisticated model the tracked chemicals from production all the way through their life cycle use stage and so on and lo and behold came up with the same number 0.1% although all of these actually are bio sides like pesticides and and here we have personal care products which are above the 0.1% anyway so take home messages you produce we produce chemicals and they inevitably get into us so it was earlier this morning that Patricia Fabien talked about chemical dynamics and I know that the NAS panel on indoor chemistry talked about this extensively when I first started looking at semi-volatiles it was in lakes and there you've got a lot of opportunity for both advection or in dilution in other words let's just smear the whole world with these chemicals as they move around in air and in water and then eventually some of the chemicals do get buried in the sediments and there's opportunity when the sun shines for the chemicals to break down but when you move indoors you don't have those same opportunities there's limited ventilation instead of the chemicals getting trapped in the sediments they get trapped in carpets which is tantamount to the same thing as the sediment of a lake with a historical accumulation of chemicals but what's important in terms of many of these chemicals is that the main receptor here are my two dogs who are actually no longer with us are in this system the main receptors for these chemicals which have very few opportunities for losses further I talked about chemical intensification which was noted in the Global Chemical Outlook Report in 2013 that we have really chemically intensified our indoor and actually all our environments but indoors we've got like we don't have wood furniture anymore right it's a particle board held together with resins that degasper meldehyde we have lots of electronics that are busy degassing flame retardants that Robin talked about as well as other components so we have all these sources of chemicals indoors as we continue to chemical oh oh I forgot the floor the floor vinyl it's actually mock laminate which has made a vinyl polyvinyl chloride plasticized with phthalates so really intense chemical intensification indoors with limited opportunities for chemical breakdown dilution actually like us soaking up the chemicals so it's pretty amazing to me to see how the longevity of chemicals indoors so this was a great study done by young Mooshin Tom McCown and others Debbie Bennett a number of years ago in which they model the indoor residence time of a bunch of SVOCs and then did a field evaluation so they did it for these three pesticides comparing indoor and outdoor persistence and you can see that indoor persistence well like it's orders of magnitude like thousands like a thousand fold higher indoors than outdoors and then we've done a number of studies this is looking at DDT in homes these are air concentrations these are homes built in 1900 probably before DDT was used all the way to 2000 but the what we found is this significant relationship these are homes in the Czech Republic these are homes in Canada so using DDT like 50 60 70 years ago means that it's going to stick around so that's what I meant by the comment on the longevity of chemicals used indoors both structural structural chemicals and chemicals we bring in so now moving to the inequality of exposure and I'm going to talk about a series of studies done we had our entree to these studies through Jeff Siegel is a building scientist at University of Toronto formerly at Austin, Texas these are social housing units in Toronto so social housing is subsidized housing that is run by the government and in Canada in 2018 630,000 households lived in social housing or about 10% of the population it's a larger number in the U.S. but actually a comparable percentage now in social housing about 25% of the occupants are kids 15% are seniors and 23 almost a quarter of those age 25 to 64 live with a disability so really a highly vulnerable population on many accounts so we looked at these buildings only because and this is good there an energy retrofit was being done on the buildings mostly it was for improving thermal comfort by installing thermometers and improving heating systems so these buildings were built in the 1970s these are results from Jeff Siegel's work and what he found these are concentrations this is the median concentration of 0.5 to 2.5 microns in the air I'm sorry it's a fuzzy picture and this is the in in blue are the measurements made of this particular matter in these social housing units and these are pre the installation of of the thermal retrofits these are for non-smoking versus smoking these two here so let me see I just have to check my numbers yes the smoking units here there were two to three times higher incidence of PM and this is afterwards and there's not a whole lot of difference but what's really in other words the PM levels did not go down substantially after the energy retrofits but what's you know I find very disturbing is that the levels of PM were two were two to three times higher in the social housing units relative to higher socioeconomic status homes so then we did a similar type of study looking at exposures or air levels for a bunch of flame retardants along here and phthalate levels so the blue are the social housing units which were 71 units and the orange are 51 higher socioeconomic status homes and we were really we were absolutely astonished and dismayed to find that the levels were consistently two to 18 times higher in the social housing units for everything for everything for which we don't have a good explanation we found that the SVOC levels in the social housing units were not located to the to the location of the building the type of the building the story in which like the level the apartment level or occupant density there were none of these factors explained the variability that we saw for all these compounds and I should mention that we used exactly the same method to measure these air concentrations and I do want to point out DEHP in particular because Mikaela Martinez showed us very compelling evidence of higher rates of childhood asthma in racialized communities so we published a paper a couple of years ago showing a relationship between levels of DEHP in particularly in the kids bedroom versus asthma so there was a significantly higher odds ratio of developing asthma if the kid had higher levels of DEHP especially in their bedroom and yeah we're finding these higher levels of DEHP in social housing than in non-social housing perhaps related to all to the vinyl flooring and vinyl building materials not sure next we looked at pesticide exposure in these same units but here the pesticides were measured using in air particles using portable air cleaners in the units we found detection frequencies organochlorines organophosphates pyrethroids strobulins these are fungicide and some others like imatocloprid finding detection frequencies they were somewhere very low and they were up to 50% especially for the current use pyrethroids harkening back to my comments about persistence and longevity here we have organochlorine pesticides banned for DDT as far back as 1985 so recall that these buildings were constructed in the 1970s and here you're finding a detection frequency of 30% for DDT and its transformation products which is really really disturbing and then we found some compounds that were not registered for domestic use and probably because they're coming in on building materials here for example the these strobulins and we're also finding some in consumer products but the important thing is that social housing is poor quality housing poor maintenance lots of vermin so it's not surprising to be finding chemicals pesticides used for for example bed bug control cockroaches to have higher to have high levels we can't compare this to non-social housing because we don't have those data but we also found higher levels of these pesticides that are related to tobacco use so we found them at higher levels in units that we found evidence of tobacco use so moving along to actions and implementation for harm reduction so speaking to the Canadian regulatory framework because the Canadian regulatory framework I think works more in a in a communal way in that it's the protection of of all individuals and less sort of no I'm not going to go there anymore anyways the point is it's weak it doesn't matter it's weak it's lousy it's terrible so they're recommended exposure limits or guideline values non non-regulatory values for long term oh my god I mean long term is 8 to 24 hours wow instead of short term which is only one hour for these constituents only non-regulatory guidelines no levels at all for mold benzene and p.m. 2.5 and the mold is such a terrible problem especially amongst many First Nations that and increasing numbers of individuals who are experiencing flooding as a result of climate change and elevated levels of p.m. of course forest fires and then uh there for 25 voCs their indoor reference levels mostly taken from the U.S. thank you very much we appreciate as Canadians I just want to thank you for that and there is one regulation that I found and that's for emissions so formaldehyde has an emission regulation for composite wood products so there's a little bit more but not too much under the Canadian Environmental Protection Act and it was just amended in 2022 a provision was added to a right to a healthy environment unfortunately there are no actual regulatory measures that accompany the statement of the right in other words like if my right is being violated then what do I do like I don't know but this amendment included environmental justice of protecting vulnerable populations here's the definition and also included comments for or noted the importance of intergenerational equity in other words what I do today should not impair the health and safety of future generations now unfortunately I'm really glad this passed but we have hardly any data for vulnerable populations as I mentioned so here are my recommendations Gillian I think you I think it was Gillian mentioned the elephant in the room about about yes it was Gillian who mentioned environmental racism and I and for me the elephant that's an elephant in the room plus the need just to dress poverty it's been said many times just not just but addressing poverty is probably the most potent remedy for improved health outcomes for all the determinants of health including access to housing I know that both of our countries the US and Canada are in the midst of housing crises it's really it's top of the list in Canada right now of having insufficient affordable housing we do and Robin you talked about this the right I think you did about right to know and labeling and you talked about the importance of educational campaigns we don't have this in Canada it's something we need to have but we know that not everybody can read labels and that will continue we do need regulations and not guidelines and we need this for two reasons first of all it provides a remedy for people who experience an environment that's out that is outside of the regulations and secondly it releases money for research I mean probably all of us live in envy of the outdoor air research community that has been swaddled in in so much of funding and attention relative to the indoor environment but we also need non-regulatory levers because regulation moves so slowly so for that I'm just going to comment that I live within an ecosystem my goal in life is to affect change and I do this as an academic by working with all my partners for example non-governmental organizations my government my colleagues in government who are scientists and work and work to develop policy politicians in order to leverage the media in order to in order to affect change thank you I'm done I know I went over time I'm sorry so you actually queued up we have and thank you number one both to you and Dr. Dodson we have five minutes left our goal is to wrap up on time at 4.30 today and we have one more session great speakers we have five minutes for I don't know what's online but I'm going to pose a question related to today's theme to both of our speakers which is if you had two and a half minutes which you actually do you had a regulator in front of you who wants and you want to be able to communicate to them a next step you want to talk about regulating consumer product building product about ventilation and filtration regulating biochemical what would you be able to say to them to further their thinking towards this end point and I'll go ahead and Dr. Diamond I know you can't see Dr. Dodson's here the table first we'll start with her well that's a big question and I would love that opportunity but I do want to say one thing that I think is particularly important is that we we collect a lot of samples and we collect them on and analyze those samples for a lot of different chemicals and something that is extremely clear to me is that we shouldn't be thinking about all of this one chemical at a time that we need to think about this as a class space approach right I think PFAS is an excellent example of that where we can kind of chip away at one or two of them these are highly persistent chemicals that will be in our indoor spaces for decades to come and so we cannot take that one chemical at a time approach so I think thinking of things in a broader context thinking about things from a class perspective is going to be really really important and I also think about doing that in a way that is to increase transparency too I think that's something that is increased transparency and supply chains and the products and the building materials all of that is going to be key as well thank you Dr. Diamond and then we have Dr. Sutter on line oh I'll just I'll add to Robin's great answer just adding some regulatory limits for the indoor environment for indoor environmental quality because without regulatory levers we don't have any remedies and we also don't have the ability to push a research agenda and and ask for funding it's just an important impediment Ellison welcome and hello and would you like to share anything sure thank you Gillian I think the question that came through pertaining this session both speakers which thank you very much for your presentations had to do with what you've observed over time related to detection limits and how our ability to measure in the field has evolved over time so one question that came through was our detection frequencies at the same limits of detection changing over time so detection limits have been going down but I have to tell you that all our results were achieved with low resolution instruments because I don't run a fancy lab so our detection limits are not particularly super low so no from the results that I presented are not a function of detection limits and remember that a lot some of at least my take home messages are a comparison between low and high SES homes and that's not a detection limit issue yeah and I would just add that many of the chemicals that we're looking at are well above and have always been well above the detection limits so I don't think this is suddenly like detection limits are falling and and we're seeing these chemicals phthalates are found 100 times 1,000 times higher than the detection limit and they always have been so it's not like those are suddenly appearing because of the analytical chemistry that we have been there and they will be there thank you for addressing the question Gillian if there's time it looks like we have just like two minutes left and if you'd like to share your own personal experience observations or pose a questions to our presenters oh sure I think it may be difficult to be brief on a question like this but I think both of you did a really nice job of highlighting the complexity of chemistry indoors and when thinking about communicating with people who live in those homes could you comment briefly on the tension between wanting to report things that we know oh really well what their impact is on health and how to take action and that that action is within the agency of the occupant versus things that we know less well and that perhaps the person living in that environment may have less agency can you speak to that tension just a little bit I know we have very limited time Robert did you want to go first that it's an issue and it's something that we have been tackling a lot in our work right you can pretty clear how to report lead levels back we have a we have a regulatory threshold for that we know the health effects there are resources and referrals for lead hazards for things like endocrine disrupting compounds that's a little bit trickier there are no regulatory levels to point to and so we communicate the best way possible we communicate what we know we communicate how we know these chemicals in the laboratory studies in other places are affecting our our health so we communicate that we oftentimes do comparisons against other people in the study against national biomonitoring data to provide people with context but I still think that even with some of the uncertainty around what we do know about either the health effects or the fact that there's no regulatory threshold people want to know and people have a right to know so that they can inform their own actions and so it is you know I believe it's the right thing to do is to share the results and to provide some opportunities or strategies for reducing exposures and folks can make those choices with the as long as they have the information right um oh I'm sorry Dr. Diamond did you have you had a yeah yeah I did a pregnant pause I know because I talked too much so I didn't know if you wanted me to speak but I'll I'll be brief I struggle we struggled with this tremendous amount because from uh for most people there's no choice they don't like in social housing you don't have a choice and you don't know where it's coming from and you don't know what the health effects are and you're already stressed out enough by all sorts of things going on so I actually there was actually um uh considerable there was some disagreement amongst co-authors about how to move forward with this um um so I I struggle a lot with this with that question because it's just I guess another thing to worry about when your life is already full of worries yeah good point to end on so we had some really good questions for those of you online who submitted a question to both our presenters we're going to come in order to give full time to our next speakers because we have we want to hear fully from them we're going to go ahead and if you can we'll answer them offline or we're going to bring your questions back during our final Q&A in just a bit that way we can move right along all right thank you both again thank you very much