Eskenazi: Working with Stakeholders Adds Challenges, Value to Research

It has been more than six years since COEH faculty member Brenda Eskenazi, researcher Asa-Bradman, and their UC Berkeley colleagues established the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), one of 11 national centers for research into children’s health and the environment. In that time, they have not only conducted pioneering research exploring the health effects of pesticide exposure on the children of farmworkers in California’s Salinas Valley, they have also lived and breathed a commitment to making the community they are studying an active partner in their research.

Everywhere you go in occupational and environmental health, you hear stories about communities that were experimented on and never heard the results,” Eskenazi said. “When we started, we vowed that the community would hear from us in a timely fashion and be included in a respectful way.”

The CHAMACOS team has sought to engage -everyone who has a stake in its research, in many cases bringing together adversaries who do not typically sit down with each other to share perspectives.

“Making that happen has been a challenge,” Eskenazi said, “but I believe that if everybody is at the table and involved, they are more likely to buy into the results, and the research will have a better chance to influence policy changes.”

The researchers work with representatives of the various constituencies to develop their studies. They regularly provide research updates to their community advisory board, and they ask stakeholders for advice at virtually every step of the way. This process takes a great deal of time and effort—and can be frustrating—but Eskenazi wouldn’t have it any other way.

When the Community Says No
Last year, just before her study of the effects of pesticide exposure on fetal growth and premature deliveries was to be published (see sidebar, page 6), Eskenazi began getting calls from reporters about a similar study that was to appear in the same journal. The other researchers had released their results to the press. Her -CHAMACOS team had not.

“As an editor of that journal, I knew that the other researchers had different results,” Eskenazi said. “I was concerned that people might read about those results and confuse them with ours. We hadn’t yet had a meeting to inform our community. If we did a release, people might read about our study in the paper before they’d heard from us.”

Torn, she called her advisory board members, sounded them out about sending out a press release, and found them to be solidly opposed—with one group arguing that the press release would give the findings more attention than they deserved and another arguing that the community needed to hear the results first.

“I reflected on what they had said, and, as much as I wanted to tell our story, I decided that we had to tell the community first,” she said.

As a result of this exchange, CHAMACOS organized town hall meetings that drew people from throughout the valley. “Based on a questionnaire we did after the presentations, we know that people were happy to hear the results from us,” Eskenazi said.

While the reaction of her advisory board had put her in a difficult situation, she did not feel it had compromised her academic freedom. “I weigh what the board has to say, but it is advisory,” she said. “If our research team felt the concerns about a press release were not valid, we would have sent one out. But we needed to honor what was right for them and felt that informing the community first was ethically correct. In the long run, I believe the decision gave CHAMACOS more credibility in the community.”

To avoid similar dilemmas in the future, Eskenazi and her colleagues have since developed a protocol for sharing summaries of new research findings and providing advance notice when they feel that a press release may be in order.

Benefits of Participatory Research
While focusing intensely on interaction with stakeholders may seem to be at odds with research productivity, -Eskenazi points to the benefits derived from this participatory approach.

“One day we were talking to growers about preventing pesticides from coming into the homes of farmworkers,” she said. “We asked them if they could have workers wash their hands in the fields at the end of the day. They said they want their workers to wash their hands, but the workers won’t do it. Then one of our community partners, a doctor who grew up in a farmworker family in the valley and had worked in the fields, told the group that, as a child, he’d been told not to wash with cold water, because cold water would give him arthritis. We could see light bulbs going off all around the table!”

CHAMACOS has since begun work with the community to introduce warm water to the fields, select the best soap for removing pesticide residues, and design clothing that workers can shed before entering their homes. The results of these interventions are not yet available, but Eskenazi argues that involving the community has provided new insights and focused the interventions so that they will be more acceptable and sustainable.

Since community-based research is very costly, she is grateful that the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency, which fund -CHAMACOS, support and advocate community outreach. “This is a growing process,” she said. “It takes years to build trust, rapport, and respect, but I really believe the effort pays off in better research.”

Sidebar:
Children’s Health Study Findings
The Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) conducted research on the effects of pesticide exposure in utero on the growth and gestational development of nearly 500 newborns in California’s agricultural Salinas Valley. The study had two key findings:

• There was no adverse relationship between the mothers’ exposure to organophosphate pesticides (typically used in agricultural settings) during their pregnancy and the growth of their unborn children.
• Exposure to certain pesticides, especially in the latter part of pregnancy, was associated with shorter gestational duration.