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Background: Environmental health research involving community participation has increased substantially since the National Institute of Environmental Health Sciences (NIEHS) environmental justice and community-based participatory research (CBPR) partnerships began in the mid-1990s. The goals of these partnerships are to inform and empower better decisions about exposures, foster trust, and generate scientific knowledge to reduce environmental health disparities in low-income, minority communities. Peer-reviewed publication and clinical health outcomes alone are inadequate criteria to judge the success of projects in meeting these goals; therefore, new strategies for evaluating success are needed. Objectives: We reviewed the methods used to evaluate our project, “Linking Breast Cancer Advocacy and Environmental Justice,” to help identify successful CBPR methods and to assist other teams in documenting effectiveness. Although our project precedes the development of the NIEHS Evaluation Metrics Manual, a schema to evaluate the success of projects funded through the Partnerships in Environmental Public Health (PEPH), our work reported here illustrates the record keeping and self-reflection anticipated in NIEHS’s PEPH. Discussion: Evaluation strategies should assess how CBPR partnerships meet the goals of all partners. Our partnership, which included two strong community-based organizations, produced a team that helped all partners gain organizational capacity. Environmental sampling in homes and reporting the results of that effort had community education and constituency-building benefits. Scientific results contributed to a court decision that required cumulative impact assessment for an oil refinery and to new policies for chemicals used in consumer products. All partners leveraged additional funding to extend their work. Conclusions: An appropriate evaluation strategy can demonstrate how CBPR projects can advance science, support community empowerment, increase environmental health literacy, and generate individual and policy action to protect health.

Background and Aims: Communities of color and low income are affected by multiple environmental hazards that can magnify risks to human health. In earlier research we developed an index of inequali...

Background: Advances in biomonitoring methods have enabled environmental health scientists to measure ever-lower concentrations of environmental contaminants in human blood, urine, breast milk, and...

Background: Studies within the United States and elsewhere have identified a relationship between air pollution, preterm birth, and low birth weight Spatial variation in air pollutant concentration...

Low-income communities and communities of color often suffer from multiple environmental hazards that pose risks to their health. Here we extended a cumulative environmental hazard inequality index (CEHII) – developed to assess inequalities in air pollution hazards – to compare the inequality among three urban counties in California: Alameda, San Diego, and Los Angeles. We included a metric for heat stress to the analysis because exposure to excessively hot weather is increasingly recognized as a threat to human health and well-being. We determined if inequalities from heat stress differed between the three regions and if this added factor modified the metric for inequality from cumulative exposure to air pollution. This analysis indicated that of the three air pollutants considered, diesel particulate matter had the greatest inequality, followed by nitrogen dioxide (NO2) and fine particulate matter (PM2.5). As measured by our index, the inequalities from cumulative exposure to air pollution were greater than those of single pollutants. Inequalities were significantly different among single air pollutant hazards within each region and between regions; however, inequalities from the cumulative burdens did not differ significantly between any two regions. Modeled absolute and relative heat stress inequalities were small except for relative heat stress in San Diego which had the second highest inequality. Our analysis, techniques, and results provide useful insights for policy makers to assess inequalities between regions and address factors that contribute to overall environmental inequality within each region. Keywords: Air pollution, Heat stress, Cumulative impacts, Inequality index, Environmental justice

Lower income communities of color are disproportionately exposed to both environmental and social stressors. Research indicates that the double jeopardy of exposure to environmental hazards combined with place-based stressors is associated with maternal and child health (MCH) disparities. Allostatic load may be a physiological mechanism behind the moderation of the toxic effect of environmental pollutants by social stressors. A conceptual framework is proposed that could instruct future approaches to MCH research that elucidates the interplay of psychosocial stressors and environmental hazards to better explain drivers of MCH disparities.

Over the last decade, a growing number of social scientists have turned their attention to the study of activism around health issues. Health social movements (HSMs) have pressed the institution of medicine to change in dramatic ways, embracing new modes of healthcare delivery and organization. Health activists have also pushed medicine to evolve by connecting their health concerns to other substantive issues such as social and environmental justice, poverty, and occupational or environmentally induced diseases. HSMs therefore serve as an important bridge, connecting the institution of medicine to other social institutions. In similar fashion, the study of HSMs has motivated medical sociology to develop new tools and theoretical perspectives to understand these alterations in the medical landscape. Medical sociologists stand to learn a great deal about the institution of medicine by observing it as it comes into conflict with patients and activists around issues of health care delivery, science and policy, and regulatory action. This broad sweep of interests must be systematized, which is our project here.

There has been a surge of new research highlighting thepotential health consequences of polybrominated diphenylethers (PBDEs), brominated flame retardants which havebeenaddedtoconsumerproductssincethe1970storeduceflammability of electronics and furniture. Due to theirpersistent nature and tendency to bioaccumulate, thesecompoundsareubiquitousandhavebeendetectedinhumantissues, marine mammals, house dust, and virtually anybiologicalorenvironmentalmediatakenfromanywhereonthe planet.Exposure assessment studies have documented bodyburden levels in various populations and investigatedcontributorsofhumanexposure.ThesestudiessuggestthatPBDEexposuresarenothomogeneousacrossdiversegroups.For example, recent studies have shown higher exposuresamong young children compared to adults (

Background We report on the challenges of obtaining Institutional Review Board (IRB) coverage for a community-based participatory research (CBPR) environmental justice project, which involved reporting biomonitoring and household exposure results to participants, and included lay participation in research. Methods We draw on our experiences guiding a multi-partner CBPR project through university and state Institutional Review Board reviews, and other CBPR colleagues' written accounts and conference presentations and discussions. We also interviewed academics involved in CBPR to learn of their challenges with Institutional Review Boards. Results We found that Institutional Review Boards are generally unfamiliar with CBPR, reluctant to oversee community partners, and resistant to ongoing researcher-participant interaction. Institutional Review Boards sometimes unintentionally violate the very principles of beneficence and justice which they are supposed to uphold. For example, some Institutional Review Boards refuse to allow report-back of individual data to participants, which contradicts the CBPR principles that guide a growing number of projects. This causes significant delays and may divert research and dissemination efforts. Our extensive education of our university Institutional Review Board convinced them to provide human subjects protection coverage for two community-based organizations in our partnership. Conclusions IRBs and funders should develop clear, routine review guidelines that respect the unique qualities of CBPR, while researchers and community partners can educate IRB staff and board members about the objectives, ethical frameworks, and research methods of CBPR. These strategies can better protect research participants from the harm of unnecessary delays and exclusion from the research process, while facilitating the ethical communication of study results to participants and communities.

Background Studies have identified relationships between air pollution and birth weight, but have been inconsistent in identifying individual pollutants inversely associated with birth weight or elucidating susceptibility of the fetus by trimester of exposure. We examined effects of prenatal ambient pollution exposure on average birth weight and risk of low birth weight in full-term births. Methods We estimated average ambient air pollutant concentrations throughout pregnancy in the neighborhoods of women who delivered term singleton live births between 1996 and 2006 in California. We adjusted effect estimates of air pollutants on birth weight for infant characteristics, maternal characteristics, neighborhood socioeconomic factors, and year and season of birth. Results 3,545,177 singleton births had monitoring for at least one air pollutant within a 10 km radius of the tract or ZIP Code of the mother's residence. In multivariate models, pollutants were associated with decreased birth weight; -5.4 grams (95% confidence interval -6.8 g, -4.1 g) per ppm carbon monoxide, -9.0 g (-9.6 g, -8.4 g) per pphm nitrogen dioxide, -5.7 g (-6.6 g, -4.9 g) per pphm ozone, -7.7 g (-7.9 g, -6.6 g) per 10 μg/m3 particulate matter under 10 μm, -12.8 g (-14.3 g, -11.3 g) per 10 μg/m3 particulate matter under 2.5 μm, and -9.3 g (-10.7 g, -7.9 g) per 10 μg/m3 of coarse particulate matter. With the exception of carbon monoxide, estimates were largely unchanged after controlling for co-pollutants. Effect estimates for the third trimester largely reflect the results seen from full pregnancy exposure estimates; greater variation in results is seen in effect estimates specific to the first and second trimesters. Conclusions This study indicates that maternal exposure to ambient air pollution results in modestly lower infant birth weight. A small decline in birth weight is unlikely to have clinical relevance for individual infants, and there is debate about whether a small shift in the population distribution of birth weight has broader health implications. However, the ubiquity of air pollution exposures, the responsiveness of pollutant levels to regulation, and the fact that the highest pollution levels in California are lower than those regularly experienced in other countries suggest that precautionary efforts to reduce pollutants may be beneficial for infant health from a population perspective.

Objectives. We compared an urban fence-line community (neighboring an oil refinery) and a nonindustrial community in an exposure study focusing on pollutants of interest with respect to breast cancer and environmental justice. Methods. We analyzed indoor and outdoor air from 40 homes in industrial Richmond, California, and 10 in rural Bolinas, California, for 153 compounds, including particulates and endocrine disruptors. Results. Eighty compounds were detected outdoors in Richmond and 60 in Bolinas; Richmond concentrations were generally higher. Richmond's vanadium and nickel levels indicated effects of heavy oil combustion from oil refining and shipping; these levels were among the state's highest. In nearly half of Richmond homes, PM2.5 exceeded California's annual ambient air quality standard. Paired outdoor–indoor measurements were significantly correlated for industry- and traffic-related PM2.5, polycyclic aromatic hydrocarbons, elemental carbon, metals, and sulfates (r = 0.54–0.92, P < .001). Conclusions. Indoor air quality is an important indicator of the cumulative impact of outdoor emissions in fence-line communities. Policies based on outdoor monitoring alone add to environmental injustice concerns in communities that host polluters. Community-based participatory exposure research can contribute to science and stimulate and inform action on the part of community residents and policymakers.

Background Exposure assessment has shifted from pollutant monitoring in air, soil, and water toward personal exposure measurements and biomonitoring. This trend along with the paucity of health effect data for many of the pollutants studied raise ethical and scientific challenges for reporting results to study participants. Methods We interviewed 26 individuals involved in biomonitoring studies, including academic scientists, scientists from environmental advocacy organizations, IRB officials, and study participants; observed meetings where stakeholders discussed these issues; and reviewed the relevant literature to assess emerging ethical, scientific, and policy debates about personal exposure assessment and biomonitoring, including public demand for information on the human health effects of chemical body burdens. Results We identify three frameworks for report-back in personal exposure studies: clinical ethics; community-based participatory research; and citizen science 'data judo.' The first approach emphasizes reporting results only when the health significance of exposures is known, while the latter two represent new communication strategies where study participants play a role in interpreting, disseminating, and leveraging results to promote community health. We identify five critical areas to consider in planning future biomonitoring studies. Conclusion Public deliberation about communication in personal exposure assessment research suggests that new forms of community-based research ethics and participatory scientific practice are emerging.

We report on interviews conducted with participants in a novel study about environmental chemicals in body fluids and household air and dust. Interviews reveal how personal and collective environmental history influence the interpretation of exposure data, and how participants fashion an emergent understanding of environmental health problems from the articulation of science and experience. To the illness experience literature, we contribute a framework for analyzing a new category of embodied narratives—“exposure experience”—that examines the mediating role of science. We update social scientific knowledge about social responses to toxic chemicals during a period in which science alters public understanding of chemical pollution. This article is among the first published accounts of participants' responses to learning personal exposure data, research identified as critical to environmental science and public health. Our findings raise the importance of reporting even uncertain science and underscore the value of a community-based reporting strategy.

The recent flood of research concerning pollutants in personal environmental and biological samples—blood, urine, breastmilk, household dust and air, umbilical cord blood, and other media—raises questions about whether and how to report results to individual study participants. Clinical medicine provides an expert-driven framework, whereas community-based participatory research emphasizes participants’ right to know and the potential to inform action even when health effects are uncertain. Activist efforts offer other models. We consider ethical issues involved in the decision to report individual results in exposure studies and what information should be included. Our discussion is informed by our experience with 120 women in a study of 89 pollutants in homes and by interviews with other researchers and institutional review board staff.

Background: The field of risk assessment has focused on protecting the health of individual people or populations of wildlife from single risks, mostly from chemical exposure. The U.S. Environmental Protection Agency recently began to address multiple risks to communities in the "Framework for Cumulative Risk Assessment" [EPA/630/P02/001F. Washington DC: Risk Assessment Forum, U.S. Environmental Protection Agency (2003)]. Simultaneously, several reports concluded that some individuals and groups are more vulnerable to environmental risks than the general population. However, vulnerability has received little specific attention in the risk assessment literature. Objective: Our objective is to examine the issue of vulnerability in cumulative risk assessment and present a conceptual framework rather than a comprehensive review of the literature. In this article we consider similarities between ecologic and human communities and the factors that make communities vulnerable to environmental risks. Discussion: The literature provides substantial evidence on single environmental factors and simple conditions that increase vulnerability or reduce resilience for humans and ecologic systems. This observation is especially true for individual people and populations of wildlife. Little research directly addresses the topic of vulnerability in cumulative risk situations, especially at the community level. The community level of organization has not been adequately considered as an end point in either human or ecologic risk assessment. Furthermore, current information on human risk does not completely explain the level of response in cumulative risk conditions. Ecologic risk situations are similarly more complex and unpredictable for cases of cumulative risk. Conclusions: Psychosocial conditions and responses are the principal missing element for humans. We propose a model for including psychologic and social factors as an integral component of cumulative risk assessment.

Nearly 80% of the U.S. population lives in metropolitan areas. With continued growth of urban centers has come increased study of the connection between the built environment, social inequality, and the health and well-being of inhabitants of these large cities. A number of factors related to neighborhood location and other area-level variables such as access to nutritious foods and health care can affect human health. Now a research team points to another health consideration, demonstrating that minority populations living in highly segregated metropolitan areas in the United States have higher estimated lifetime cancer risks from air toxics than whites [EHP 114:386–393; Morello-Frosch et al.]. The team analyzed more than 45,000 census tracts in 309 U.S. metropolitan areas for level of segregation. The metropolitan areas were classified as low-to-moderately segregated, highly segregated, or extremely segregated, based on the proportion of people who would have to move to achieve an even racial balance in every neighborhood of the city. They also used census data to divide racial and ethnic groups into six categories: Hispanics of any race, non-Hispanic whites, non-Hispanic blacks, non-Hispanic Asians and Pacific Islanders, non-Hispanic American Indians and Alaska Natives, and non-Hispanic persons of other race. Then the team used federal air toxics data for 1996 to derive cancer risk estimates. Cancer risks were determined using inhalation unit risk estimates for each known, likely, or potential human carcinogen measured in the tracts’ air. Inhalation unit risk estimates consider the individual lifetime excess risk resulting from chronic lifetime exposure to one unit of pollutant concentration. The researchers found a persistent relationship between increasing levels of racial/ethnic segregation and increased estimated cancer risk associated with ambient air toxics. Hispanics in extremely segregated areas were the most affected, with a 6.4-fold increased lifetime cancer risk compared to Hispanics in low-to-moderately segregated areas. Non-Hispanic American Indians and Alaska Natives in highly segregated areas were the least affected, with a 1.39-fold increased risk over their counterparts in low-to-moderately segregated areas. The influence of racial segregation on cancer risk appeared independent of the effect of poverty across racial categories. The most significant contributors to cancer risk were mobile sources such as on-road vehicles, airplanes, and trains, with diesel emissions an overwhelming source of pollution. The authors note that these results are consistent with findings from a previous national study that analyzed the relationship between black/white residential segregation and ambient air toxic exposure in U.S. metropolitan areas. They believe this study to be the first examination of environmental health disparities to use a generalized multiethnic segregation measure. They assert that future research on this issue that incorporates new and better models of exposure should include segregation as a key factor in analysis.

Environmental health researchers, sociologists, policy-makers, and activists concerned about environmental justice argue that communities of color who are segregated in neighborhoods with high levels of poverty and material deprivation are also disproportionately exposed to physical environments that adversely affect their health and well-being. Examining these issues through the lens of racial residential segregation can offer new insights into the junctures of the political economy of social inequality with discrimination, environmental degradation, and health. More importantly, this line of inquiry may highlight whether observed pollution--health outcome relationships are modified by segregation and whether segregation patterns impact diverse communities differently. This paper examines theoretical and methodological questions related to racial residential segregation and environmental health disparities. We begin with an overview of race-based segregation in the United States and propose a framework for understanding its implications for environmental health disparities. We then discuss applications of segregation measures for assessing disparities in ambient air pollution burdens across racial groups and go on to discuss the applicability of these methods for other environmental exposures and health outcomes. We conclude with a discussion of the research and policy implications of understanding how racial residential segregation impacts environmental health disparities.

Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness; and/or (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality. These movements have challenged a variety of authority structures in society, resulting in massive changes in the health care system. While many other social movements challenge medical authority, a rapidly growing type of health social movement, “embodied health movements” (EHMs), challenge both medical and scientific authority. Embodied health movements do this in three ways: (1) they make the body central to social movements, especially with regard to the embodied experience of people with the disease; (2) they typically include challenges to existing medical/scientific knowledge and practice; and (3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research, and expanded funding. We present a conceptual framework for understanding embodied health movements as simultaneously challenging authority structures and allying with them, and offer the environmental breast cancer movement as an exemplar case.

Environmental justice offers researchers new insights into the juncture of social inequality and public health and provides a framework for policy discussions on the impact of discrimination on the environmental health of diverse communities in the United States. Yet, causally linking the presence of potentially hazardous facilities or environmental pollution with adverse health effects is difficult, particularly in situations in which diverse populations are exposed to complex chemical mixtures. A community-academic research collaborative in southern California sought to address some of these methodological challenges by conducting environmental justice research that makes use of recent advances in air emissions inventories and air exposure modeling data. Results from several of our studies indicate that communities of color bear a disproportionate burden in the location of treatment, storage, and disposal facilities and Toxic Release Inventory facilities. Longitudinal analysis further suggests that facility siting in communities of color, not market-based "minority move-in," accounts for these disparities. The collaborative also investigated the health risk implications of outdoor air toxics exposures from mobile and stationary sources and found that race plays an explanatory role in predicting cancer risk distributions among populations in the region, even after controlling for other socioeconomic and demographic indicators. Although it is unclear whether study results from southern California can be meaningfully generalized to other regions in the United States, they do have implications for approaching future research in the realm of environmental justice. The authors propose a political economy and social inequality framework to guide future research that could better elucidate the origins of environmental inequality and reasons for its persistence.

Of the 188 hazardous air pollutants (HAPs) listed in the Clean Air Act, only a handful have information on human health effects, derived primarily from animal and occupational studies. Lack of consistent monitoring data on ambient air toxics makes it difficult to assess the extent of low-level, chronic, ambient exposures to HAPs that could affect human health, and limits attempts to prioritize and evaluate policy initiatives for emissions reduction. Modeled outdoor HAP concentration estimates from the U.S. Environmental Protection Agency's Cumulative Exposure Project were used to characterize the extent of the air toxics problem in California for the base year of 1990. These air toxics concentration estimates were used with chronic toxicity data to estimate cancer and noncancer hazards for individual HAPs and the risks posed by multiple pollutants. Although hazardous air pollutants are ubiquitous in the environment, potential cancer and noncancer health hazards posed by ambient exposures are geographically concentrated in three urbanized areas and in a few rural counties. This analysis estimated a median excess individual cancer risk of 2.7E−4 for all air toxics concentrations and 8600 excess lifetime cancer cases, 70% of which were attributable to four pollutants: polycyclic organic matter, 1,3 butadiene, formaldehyde, and benzene. For noncancer effects, the analysis estimated a total hazard index representing the combined effect of all HAPs considered. Each pollutant contributes to the index a ratio of estimated concentration to reference concentration. The median value of the index across census tracts was 17, due primarily to acrolein and chromium concentration estimates. On average, HAP concentrations and cancer and noncancer health risks originate mostly from area and mobile source emissions, although there are several locations in the state where point sources account for a large portion of estimated concentrations and health risks. Risk estimates from this study can provide guidance for prioritizing research, monitoring, and regulatory intervention activities to reduce potential hazards to the general population. Improved ambient monitoring efforts can help clarify uncertainties inherent in this analysis.

Over the past two decades, several U.S. companies have sought to bar women from jobs that expose them to potential reproductive hazards, justifying these exclusionary policies by their professed concerns for the well-being of unborn children and potential liability. Although recent court cases have stimulated academic interest in this issue, a historical review of the public health and medical literature reveals that this debate is not new. To understand the logic behind the emergence of “fetal protection” policies, one must examine the scientific history of occupational teratogens and the sociopolitical and economic forces that have driven scientific research in this field. Using lead as an example, the author argues that research on the reproductive hazards of employment has historically emphasized the risks to women and downplayed the risks to men. This results in environmental health policies that do not uphold the ultimate goal of occupational safety for all workers, but rather reinforce the systemic segregation of men and women in the workplace. Although the political struggle over exclusionary policies has a feminist orientation, it also has important class dimensions and ultimately must be viewed within the broader context of American capitalist production.

Background Scientists and regulators have sought to understand whether and how physiologic dysregulation due to chronic stress exposure may enhance vulnerability to the adverse health effects of toxicant exposures. We conducted a cross-sectional study to determine whether allostatic load (AL), a composite measure of physiologic response to chronic exposure to stress, amplifies the effect of lead exposure on blood pressure among middle-aged adults. Methods We analyzed associations between blood lead levels and blood pressure in a nationally representative sample of 8,194 U.S. adults (aged 40-65 years) participating in the National Health and Nutritional Examination Survey, 1999--2008. Outcomes were elevated systolic (≥ 140 mm Hg) and diastolic (≥ 90 mm Hg) blood pressure. AL was defined as the aggregate score of seven components, reflecting dysregulation of the cardiovascular, inflammatory, and endocrine systems. Results Logistic regression models showed a linear dose-response relationship for quintiles of blood lead and elevated systolic blood pressure in the high AL group (p = 0.03) but not the low AL group (p = 0.24). Similarly, the relationship between lead exposure and elevated diastolic blood pressure was stronger among the high AL group than the low AL group. Within the high AL group, the fourth and fifth quintiles had significantly elevated odds of elevated blood pressure compared to lowest quintile [OR = 1.92, (95% CI, 1.07, 3.47) and OR =2.28 (95% CI, 1.33, 3.91), respectively]. In the low AL group, none of the quintile effects were significantly different than the referent group although there was evidence of a linear trend (p =0.03). The lead by AL interaction term was not statistically significant for either systolic or diastolic blood pressure models. Conclusions Results suggest that higher AL may amplify the adverse effects of lead on blood pressure. Future research should assess the implications of cumulative exposures to environmental and social stressors for regulatory decision-making.

Dear Editor: The report of Geraghty et al.1 on a survey of breastfeeding mothers shows the importance of developing and testing methods for reporting biomonitoring results to study participants. They found that 68% of breastfeeding women said they wanted to know about levels of environmental chemicals in their milk, but more than three-fourths speculated that they would discontinue breastfeeding or pump and discard their milk if they learned their milk contained phthalates. Such a decline in breastfeeding as a result of routine breastmilk biomonitoring would be alarming; however, this study does not provide information about how women would respond in a study that used informative and supportive practices for communicating with research participants. Geraghty et al.1 asked women three multiple choice survey questions following a two-sentence statement that told them breastfeeding is recommended by the American Academy of Pediatrics even though breastmilk may contain contaminants and that doctors do not know the potential effects of the contaminants in breastmilk. The researchers apparently did not frame the hypothetical survey questions by providing information about phthalates, the expectation that nearly every mother in the United States carries measurable levels in her body, the opportunities to reduce phthalate exposures, or the environmental contaminants or nutritional deficiencies in infant formula. They apparently provided no opportunity for participants to interact with researchers to gain further information and did not directly state their recommendation for breastfeeding. In our own experience, women who were informed of environmental contaminants in their urine, house dust, and indoor air were able to assimilate this information without undue alarm in a community-based participatory research study in which results were reported along with contextualizing information and opportunities to interact with the researchers.2 The National Academy of Sciences Human Biomonitoring report provides helpful guidance on the issues to be considered in reporting individual results, while calling for additional empirical investigation.3 While Geraghty et al.1 highlight the potential harm from poor reporting methods in breastmilk monitoring, it should not be inferred that similar results would occur in a biomonitoring program with a well-developed communications protocol.

List of Illustrations Acknowledgments List of Abbreviations Part One. Setting the Stage: Introduction, Theory, Methods 1. Introduction: Environmental Justice and Contested Illnesses Rachel Morello-Frosch, Phil Brown, and Stephen Zavestoski 2. Embodied Health Movements Phil Brown, Rachel Morello-Frosch, Stephen Zavestoski, Sabrina McCormick, Brian Mayer, Rebecca Gasior Altman, Crystal Adams, Elizabeth Hoover, and Ruth Simpson 3. Qualitative Approaches in Environmental Health Research Phil Brown 4. Getting into the Field: New Approaches to Research Methods Phil Brown, Rachel Morello-Frosch, and Stephen Zavestoski 5. Environmental Justice and the Precautionary Principle: Air Toxics Exposures and Health Risks among Schoolchildren in Los Angeles Rachel Morello-Frosch, Manuel Pastor, and James Sadd Part Two. Working in the Environmental Health Field: Ethnographic Studies 6. A Narrowing Gulf of Difference? Disputes and Discoveries in the Study of Gulf War--Related Illnesses Phil Brown, Stephen Zavestoski, Alissa Cordner, Sabrina McCormick, Joshua Mandelbaum, Theo Luebke, and Meadow Linder 7. The Health Politics of Asthma: Environmental Justice and Collective Illness Experience Phil Brown, Brian Mayer, Stephen Zavestoski, Theo Luebke, Joshua Mandelbaum, Sabrina McCormick, and Mercedes Lyson 8. Pollution Comes Home and Gets Personal: Women's Experience of Household Chemical Exposure Rebecca Gasior Altman, Rachel Morello-Frosch, Julia Green Brody, Ruthann A. Rudel, Phil Brown, and Mara Averick 9. The Personal Is Scientific, the Scientific Is Political: The Public Paradigm of the Environmental Breast Cancer Movement Sabrina McCormick, Phil Brown, Stephen Zavestoski, and Alissa Cordner 10. School Custodians and Green Cleaners: Labor-Environmental Coalitions and Toxics Reduction Laura Senier, Brian Mayer, Phil Brown, and Rachel Morello-Frosch 11. Labor-Environmental Coalition Formation: Framing and the Right to Know Brian Mayer, Phil Brown, and Rachel Morello-Frosch 12. The Brown Superfund Research Program: A Multistakeholder Partnership Addresses Problems in Contaminated Communities Laura Senier, Benjamin Hudson, Sarah Fort, Elizabeth Hoover, Rebecca Tillson, and Phil Brown Part Three. Ethical Considerations 13. Toxic Ignorance and the Right to Know: Biomonitoring Results Communication A Survey of Scientists and Study Participants Rachel Morello-Frosch, Julia Green Brody, Phil Brown, Rebecca Gasior Altman, Ruthann A. Rudel, Carla Perez, and Alison Cohen 14. IRB Challenges in Community-Based Participatory Research on Human Exposure to Environmental Toxics: A Case Study Phil Brown, Rachel Morello-Frosch, Julia Green Brody, Rebecca Gasior Altman, Ruthann A. Rudel, Laura Senier, Carla Perez, and Ruth Simpson 15. Conclusion Phil Brown, Rachel Morello-Frosch, and Stephen Zavestoski Appendix: Contested Illnesses Research Group's Nuts and Bolts and Lessons Learned Laura Senier, Rebecca Gasior Altman, Rachel Morello-Frosch, and Phil Brown References List of Contributors Index For additional appendixes, see www.ucpress.edu/go/contestedillnesses

Social movements organised around health-related issues have been studied for almost as long as they have existed, yet social movement theory has not yet been applied to these movements. Health social movements (HSMs) are centrally organised around health, and address: (a) access to or provision of health care services; (b) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality; and/or (c) disease, illness experience, disability and contested illness. HSMs can be subdivided into three categories: health access movements seek equitable access to health care and improved provision of health care services; constituency-based health movements address health inequality and health inequity based on race, ethnicity, gender, class and/or sexuality differences; and embodied health movements (EHMs) address disease, disability or illness experience by challenging science on etiology, diagnosis, treatment and prevention. These groups address disproportionate outcomes and oversight by the scientific community and/or weak science. This article focuses on embodied health movements, primarily in the US. These are unique in three ways: 1) they introduce the biological body to social movements, especially with regard to the embodied experience of people with the disease; 2) they typically include challenges to existing medical/scientific knowledge and practice; and 3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research and expanded funding. This article employs various elements of social movement theory to offer an approach to understanding embodied health movements, and provides a capsule example of one such movement, the environmental breast cancer movement.