POPULATIONS AT RISK ACROSS THE LIFESPAN: CASE STUDIES
Environmental Justice and CommunityBased Research in Texas Borderland
Adelita Cantu, PhD, RN,1 Margaret A. Graham, PhD,2 Ann V. Millard, PhD,3 Isidore Flores, PhD,4
Meaghan K. Mugleston, BSN, RN,1 Iris Y. Reyes,2
, and Ester S. Carbajal4
School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas; 2
Anthropology, University of Texas Pan
American, Edinburg, Texas; 3
School of Public Health, Texas A & M Health Science Center, McAllen, Texas; and 4
Health Institute, McAllen, Texas
Adelita Cantu, School of Nursing, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr., Mailcode 7951, San Antonio,
TX 78229. E-mail: [email protected]
ABSTRACT Objective: An innovative academic-community partnership studied daily decisions
in communities of mostly Spanish-speaking, low-income residents of colonias in Hidalgo County,
TX, about risk of exposure to fish contaminated by PCBs at an Environmental Protection Agency
(EPA) Superfund site. Design and Sample: The team used focus group interviews with colonia residents and content analysis to assess knowledge of risk related to the Superfund site, the Donna
Reservoir and Canal System. Results: (1) many lacked knowledge of the Superfund site contamination; (2) a few participants fished at the lake, knew people who did so, and consumed the catch, but
most participants feared going there; (3) some participants remember receiving messages saying not
to fish at the site, although they recalled nothing about contamination, but most participants knew
of no such messages; (4) many use cell phones to get local information through personal networks
and several Spanish-language news sources, but they have no consistent, culturally tailored local
information source. Conclusions: The findings indicate the need for further efforts to design culturally
tailored means of communication and messages to inform local communities widely about the dangers
related to the Superfund site and thus decrease health disparities resulting from consuming fish from
Key words: environmental contamination, Hispanics, PCBs, public health messaging, superfund, US-Mexico Borderlands.
Background and research questions
Polychlorinated biphenyls (PCBs) belong to a family
of organic chemicals known as chlorinated hydrocarbons that present widespread environmental justice concerns. PCB manufacture was banned in
1979 due to toxicity to immune, reproductive, endocrine, and nervous systems of humans and animals
(Abass et al., 2013; Porterfield, 1994; Ropstad
et al., 2006). The more than 200 PCB congener
mixtures vary in toxicity and organ systems
affected, thus carrying different health risks,
complicating environmental health studies. PCBs
were formerly widely used in electrical transformers, pesticides, plastics, and other products (U.S.
Environmental Protection Agency (US EPA,
2014a,b). Found worldwide in surface waters, they
tend to combine with suspended particles, fall to
the bottom, and enter the food chain through small
organisms eaten by fish (Agency for Toxic Substances and Disease Registry, 2011). Eating fish
from contaminated sites exposes people to a wide
variety of health risks.
Public Health Nursing Vol. 33 No. 1, pp. 65â€“72
0737-1209/Â© 2015 Wiley Periodicals, Inc.
Designated by the EPA as â€œprobable human carcinogens,â€ PCBs are associated with non-Hodgkinâ€™s
lymphoma, prostate cancer, and in some cases, possibly breast cancer (US EPA, 2013a,b; see also
Charles et al., 2003; Cohn et al., 2012; Charlier,
Adelin, Liying, Dubois, & Plomteux, 2004; Demers
et al., 2002; Diorio, Dumas, Sandanger, & Ayotte,
2013; Engel et al., 2007; Holford et al., 2000; RecioVega et al., 2011; Stellman et al., 2000). Exposure
prepregnancy and in utero has been associated with
developmental disorders and cognitive deficits in
infants and children (Jacobson & Jacobson, 1996),
and such problems were seen in the region of this
study in the early 1990s (TDSHS, 2010).
PCBs are also implicated in diabetes, which has
an exceptionally high prevalence in the region (Silverstone et al., 2012; Lee et al., 2006; Fisher-Hoch
et al., 2012). â€œSelf-reported diabetesâ€ has been
found to be significantly associated with serum
PCBs including the forms most common in our
study, Aroclors 1240 and 1260 (Philibert, Philibert,
& Schwartz, 2009). A Monsanto plant produced
PCBs in Anniston, Alabama, for decades and those
most affected were working-class African Americans
living near the plant (Spears, 2014). The people in
our study similarly belong to a low-income, ethnic
minority population living near a Superfund site
and also have poor access to health information
and health care services.
This study deals with health disparities related to a
Superfund site, Donna Reservoir and Canal, known
locally as Donna Lake. The site includes a 400-acre
irrigation and drinking water reservoir fed by a
canal from the Rio Grande River in Hidalgo
County, a region with numerous colonias, which
are rural neighborhoods with poor infrastructure
inhabited by the Mexican American working poor.
PCB levels in fish from the lake are at unacceptably
high levels; one fish had an extremely high level of
399 ppm, and a sample of the lakeâ€™s fish had an
average of 1.516 ppm, outstripping the EPA limit of
1.4 ppm (TDSHS, 2004, 2006; 2010).
The EPA listed Donna Lake and canal as a
Superfund site and placed it on the National Priorities List in 2008 (US EPA, 2012, 2014c). A ban on
possession of fish was imposed and continues today
while the EPA searches for the PCB source at the
site. Vigorous campaigns through the mail, door to
door, in fliers and at public meetings warned
against consuming the fish in 2009 and 2011 in the
City of Donna and in 2012 in the City of Alamo,
the two cities closest to Donna Lake and surrounding rural areas (US EPA, 2014c). A number of signs
have been posted by the EPA and the Texas
Department of State Health Services in two waves,
but many were removed immediately and graffiti
defaced many of the others in rapid order.
Even though the campaigns went far beyond
the traditional â€œno fishing advisory,â€ catching and
consuming fish continues. We expect that this
problem contributes to health disparities, leading
us to launch this environmental justice project as a
first step in addressing risks to the colonia population. Our research questions were: (1) What do residents of local colonias know about the risks of
eating Donna Lake fish? (2) Do colonia residents
use Donna Lake for fishing and do they eat or sell
the catch? (3) How do colonia residents get information and alerts about local health problems?
Design and sample
The study held focus groups to gather qualitative
data on colonia residentsâ€™ perceptions of risk associated with Donna Lake. Promotoras de salud
(community health workers) were hired to advise
on and implement the project; the lead promotora
was a longtime colonia resident adept at building
rapport and incorporating the voices of colonia
Nearly all of the research team was bilingual in
Spanish and English. All written materials given to
the participants (consent forms, sociodemographic
survey) were in both languages. A primary
researcher translated materials and several others
edited the work. The bilingual skill of the research
team is one of the strengths of this project, as most
colonia residents prefer to communicate in Spanish.
The promotoras recruited participants through
community word-of-mouth and snowball sampling.
Inclusion criteria were living in a colonia, self-identification as Mexican or Mexican-American, age of
18 years or more, and granting consent for data
collection. IRB approval was obtained from the
University of Texas Health Science Center in San
66 Public Health Nursing Volume 33 Number 1 January/February 2016
Antonio, the University of Texas-Pan American,
and Texas A&M University Health Science Center.
All academics and the lead promotora had certified
CITI training; another promotora received standardized IRB training.
The focus group methodology is an exploratory
means of data collection on a topic that is not wellunderstood (Krippendorf, 2013). Focus groups are
also useful in participatory research to engage with
people to solve a community problem (Krueger &
Casey, 2000). Focus groups provide a method for
eliciting different views from community members
in a socially supportive, nonjudgmental setting
(Fernandez, Gonzales, Tortolero-Luna, Partida, &
Bartholomew, 2006; LeCompte & Schensul, 1999).
This method has the advantage of allowing people
to respond to questions in their own words and
engage in spontaneous discussions with their peers.
Also, the method allows data collection in a relatively short time.
In total, five focus groups were conducted to
reach content saturation (Krueger & Casey, 2000).
Four were at participantsâ€™ homes and one at a local
community center. The groups had between six and
nine participants each. Many group members
already knew each other as neighbors or from community center activities. Participants spoke in their
language of choice, which was Spanish in nearly all
instances, and the promotoras asked questions in
Spanish or both Spanish and English depending on
focus group composition. Focus group meetings
took 60â€“90 minutes. Child care, small gifts of fresh
fruit, bottled water, bilingual childrenâ€™s books, and
hygiene kits were provided to participants.
A nine-question, sociodemographic survey was
completed by each participant at the beginning of
each focus group. The promotoras utilized a script
of 23 questions beginning with broad exploration
of the participantsâ€™ familiarity with Donna Lake
and leading to more specific questions about fish
consumption, PCBs, and health information access.
Each focus group was recorded with multiple
devices and several researchers were present at
each session to record field notes and observations.
The audiorecorded interviews were transcribed verbatim into Spanish or English depending on the
language spoken by the participant. The team
member responsible for the initial transcription
turned over her work to a second team member
who listened to the recordings and made note of
any discrepancies, resolved through discussion.
Additional interviews were conducted with key
agency staff of the EPA and Texas DSHS about
their efforts to educate the public in the surrounding communities. The research team visited Donna
Lake to make unobtrusive observations of people
fishing in the lake and to learn about the work of
the EPA project manager coordinating the Remedial Investigation and Feasibility Study (US EPA,
Sociodemographic data were summarized to see
how well the participants represented the colonia
population. The focus group transcriptions were
discussed among project team members and organized by narrative themes according to the projectâ€™s
specific aims and research questions. As noted by
Krippendorf, â€œa simple descriptive narrative is quite
appropriate and is often all that is necessaryâ€ for
the analysis of focus group data (2013, p. 115). One
researcher wrote the initial data analysis followed
by review and discussion by additional team members, who analyzed focus group transcriptions using
constant comparison and other content analysis.
The analysis also drew on the field observations of
the researchers and promotoras and on the history
of health education efforts by EPA and Texas DSHS
A total of 35 women participated. They were relatively young and most had a low educational level
(Table 1). Nearly all participants began school in
Mexico; this variable indicates immigration status.
Spanish was the language favored for communication at home, and in reading skills, 97.1% reported
ability to read Spanish while only 23.5% noted ability to read English.
On average, they had lived in their colonias for
almost 6 years (5.9 4.5 years with a range from 1
to 20 years). Participants living in the Donna city
region accounted for 82.9% of those in focus groups,
and 17.1% lived around the city of Alamo. In relation
to the public health campaigns on Donna Lake fish
contamination, 85.7% of the participants living near
Donna had resided in their current colonia during
Cantu et al.: Environmental Justice and Community-Based Research in Texas 67
the 2011 campaign and near Alamo, 66.7% had lived
there during the 2012 campaign.
Comparison of participants with those in a
larger, previous study with 208 colonia participants
reveal similar sociodemographic characteristics
(Table 1, column 2). The county as a whole is similar
in that 91% of the county population is Hispanic and
84.5% speak a language other than English at home.
The county poverty rate is 34.3% in a population of
815,996 (U.S. Census Bureau (2013a)). Compared
with focus group members, adult women in the
county population have more education: 23.1% of
adult women had completed high school and 38.3%
had post-secondary education (U.S. Census Bureau,
2013b). A smaller percent of county population had
immigrated from Latin America, 27.62% (ibid.).
Findings related to the research questions
What do residents of local colonias know
about the risks of eating Donna Lake fish?
The majority of the participants knew the location
of Donna Lake, but almost all identified it as an
isolated area that they avoid. Some participants
had never heard of it, even though they lived
fairly close by. Many reported knowing the
reservoir was contaminated but were unable to
identify the source of contamination. A few in
two focus groups attributed the contamination to
people using the reservoir as a dump to discard
many kinds of unwanted items and even dead
animals. Many participants who were aware of
the reservoirâ€™s contamination identified the water,
instead of the fish, as contaminated. Participants
in one focus group reported receiving information
regarding the contamination from school and one
municipal water department suggested they boil
the water before consuming it (such advice would
not clean PCBs from water). None of the participants reported hearing or seeing any information
about Donna Lake from the EPA, and none knew
of it as an EPA hazardous waste site.
A few participants in each of the focus groups
knew of the fishing ban at the lake, but attributed
it primarily to state regulations requiring fishing
licenses. They said residents were afraid of being
fined if they were caught without a license. As one
Rules were given to people who wanted to go fishing. To begin with it was against the law….If we
knew of someone fishing there, we were told to
report them. There was a phone number provided,
where to report it. And [we were told] that the
people who caught fish from there could not eat it
because the fish was contaminated.
Two participants reported fishing regularly in
the past few years, and even though they had seen
the signs banning fishing, they were unable to read
them because of graffiti, poor maintenance, and
unwillingness to read such a long explanation. As
one participant said, â€œIt cannot be read. It is very
ugly because the words are obscured by spray paint
One participant recalled reading â€œsomethingâ€
regarding the contamination on the back of the
water bill a couple of years ago, but since it was in
English, it had to be translated by a relative. She
reported that it concerned small canals, not the reservoir in particular. Participants also reported only
looking at the amount due on their bills and not
reading the special messages on the backs of their
bills as they are in English.
Finally, in another example of different perceptions, one of the participants thought that the fishing restrictions were because Donna Lake was part
of the nearby Lower Rio Grande Valley National
TABLE 1. Sociodemographic Characteristics
Mean SD (range) or percent
Age (years) 33.4 7.1
Education 9.0 5.9
â‰¤Elementary school 27.4 35.6
Completed high school 20.7 17.8
Postsecondary education 6.8 6.2
Where began school
U.S. 5.7 11
Mexico 94.3 89
Language spoken at home
Only Spanish 79.4 81.4
English and Spanish
More English than
Read Spanish 97.1 96.3
Read English 23.5 23.7
68 Public Health Nursing Volume 33 Number 1 January/February 2016
Wildlife Refuge, located nearby. The canal leading
from the Rio Grande River to the lake is also contaminated with PCBs, and participants did not
know of the canal or the layout of the irrigation
Do colonia residents use Donna Lake for
fishing and do they eat or sell the catch? The
focus groups revealed that Donna Lake is used for
recreation and fishing with both commercial and
informal redistribution of fish. Participants said people in the community like to fish for recreational purposes, including fishing for sport (â€œwe like to fish,â€
â€œmy husbandâ€™s family really likes fishing,â€ â€œmany fish
for sportâ€). A few participants also talked about eating fish from Donna Lake that their husbands or
friends had caught and shared with family and
friends. One participant talked about limited access
to a certain type of fish in the local supermarket and
the availability of this particular fish in Donna Lake.
Observations of participants also indicate that for
some time, many have been aware that people fish
for the purpose of selling their catch in the community and at the local markets.
How do colonia residents get information and alerts about local health problems?
The majority of participants had mobile phones,
including basic cell phones and some smartphones
with internet connectivity. Many reported that cell
phone service to their neighborhoods was spotty.
When asked how they got messages, many residents said that they â€œget on the Internetâ€ and also
receive information from â€œneighbors, news broadcasts, Facebook or by textingâ€ and several use
smartphones to stay in touch with relatives living
far away. All participants reported listening to or
watching one of several local Spanish language
news broadcasts (e.g., Noticias 48).
Variability is much greater in direct person-toperson communication within colonias relative to
how messages are received, including health messages. One of the five colonias has a local â€œneighborhood watchâ€ group; one participant said that
residents in her colonia â€œget together on Monday
and we tell each other about what happened over
the weekendâ€ including any health-related messages. However, this mechanism for relating information is not consistent throughout colonias. One
focus group reported being unable to sustain a
neighborhood watch group because some residents
expected to receive incentives for attending meetings. In another case, neighborhood watch
meetings were cancelled after a political scandal at
the sheriffâ€™s office interfered with local law enforcement service. All focus groups reported that colonias can be dangerous, need regular monitoring,
and are only patrolled erratically. Despite living
relatively close to one another, people in colonias
report that they â€œmind their own businessâ€ and do
not interfere with their neighbors as a way to prevent gossip or inadvertent involvement in illegal
Nobody wants to get in trouble for pointing fingers. I do not want to know much about my
neighbor and I donâ€™t want her to know much
about me. If you get too involved with them no,
no, no. It happened to me already and I say, no. A
greeting of â€˜good morningâ€™ is enough.
While cohesive neighborhood networks are
somewhat unusual, people do pass along information and alerts (e.g., Amber Alerts) to others in
their neighborhoods under potentially life-threatening circumstances. When storm and hurricane
warnings are issued, people pass the word to each
other. The exception was one colonia that had no
system of communication about suspicious activity
in their neighborhood. These participants reported
sharing information only when absolutely necessary
and keeping a distance from neighbors as the general rule.
Colonia residents also are aware of written
information on a broad range of topics available
from community centers and clinics, but they
report that they do not often read it. They explain
that some fliers are written in English only and
others may be written in Spanish but at a level difficult to understand. Participants also said that
community centers themselves are not always
accessible; some are located 20-25 minutes away
from their homes by car, limiting the amount and
frequency of information exchanged.
Various kinds of communication are available
to them but in limited ways, and participants report
that they lack access to valuable information. They
said that even upon request, public officials and
safety officers do not give their communities much
attention. One focus group reported that the local
school district was a good source of information
about school-related activities. Participants said
Cantu et al.: Environmental Justice and Community-Based Research in Texas 69
that the fish-ban signs posted along roads and on
the banks of Donna Lake are avoided because they
do not want to stop by the side of the road to read
a sign and thus, draw attention to themselves. They
fear they will be questioned by law enforcement or
spotted by people engaged in illegal activities.
The researchers used methods to examine understandings about PCB exposure risk from fish among
low-income Hispanic colonia residents who live
near Donna Lake, a Superfund site. Focus group
comments show that despite English/Spanish signage that bans fishing at the lake and vigorous public health campaigns by federal and state agencies,
most residents had poor understanding of the exposure risk. The statements of those participants who
knew about the lake reveal an awareness of a problem, but most did not know about PCB contamination of the fish. This supports the findings from
Hewitt, Candek, and Engel (2006); McCurdy et al.
(2004) that there is a paucity of information and
best practices on how to educate about a variety of
environmental exposures on health as well as how
to manage and communicate the risks.
This study finds that major problems come
from community misunderstandings of why the
ban is in place. Community education campaigns in
2009 and 2011â€“2013 did not reach colonia residents effectively despite the use of different lines of
communication and methods. The lack of community awareness may be related to a colonia characteristic of compromised relationships between
service providers and residents with inadequate
translation, lack of trust, mutual suspicion and the
sense that the â€œother side is trying to hide something or pulling something overâ€ (Earle, 1999). This
suspicion and lack of trust is compounded by the
lack of infrastructure support that is characteristic
Limitations of this study include the use of
convenience sampling, meaning that results cannot
be generalized beyond this sample. An attempt was
made to overcome this limitation by having five
focus groups recruited from colonias scattered
through the region of Donna Lake, and the
demographic comparison with a larger study of colonia residents shows that the participants are typical. A second limitation is that the participants in
the focus groups may have had different opinions
from other colonia residents, contributing to potential response bias. Although we found that participants generally enjoyed getting together for a focus
group meeting, we were aware, that individual differences tended to be muted by the focus group
method, as local Mexican American culture emphasizes harmony, politeness, and smooth social relations. The tendency to hide disagreement was
partly counterbalanced by including multiple focus
groups and partly by the atmosphere established by
the promotoras, who encouraged all participants to
speak up freely.
It is clearly evident from this study that there
are some trusted ways and methods that colonia
residents do get information. The focus groups
revealed that the vast majority of participants had
mobile phones, many with internet access. This is
consistent with current trends; according to the
Pew Hispanic Research Center (2013), 86% of Hispanics say they own a cellphone, a share similar to
that of non-Hispanic whites (84%) and blacks
(90%). Among adults, Hispanics are just as likely
as whites or blacks to own a smartphone, 49% versus 46% and 50% respectively. In addition, Hispanic internet users are more likely than white
internet users to say that they go online using a
mobile device, 76% versus 60%.
A study by Anderko, Otter, Chalupka, Anderko,
and Fahey (2013) suggested that web-based media
is a flexible, engaging method to communicate
effectively about environmental health issues to
health professionals. Our study demonstrated that
colonia residents do use their mobile phones in a
variety of ways (calling, texting, searching the internet) to get information. Thus, employment of cellular and smart phone technology is an additional
communication method that needs to be explored
in developing reliable, culturally tailored multimedia strategies within this community.
For public health nurses, this study underscores the importance of community participation
in developing risk messages. This study agrees with
Wardman (2008), which encouraged the risk dialogue approach to motivate â€œparticipation of citizens and other stakeholders in risk-related debate
and decision makingâ€ (p. 1627). This approach calls
for both senders and receivers of critical health
messages to collaborate when developing risk education campaigns while addressing participant
70 Public Health Nursing Volume 33 Number 1 January/February 2016
insights and divergent social realities. Although
reaching community consensus can be costly and
demanding, community-based approaches can lead
to greater adherence to risk messages by the population served (Jardine, 2003). The low literacy of
colonia residents means that handouts and signs
with detailed, technical explanations in either English or Spanish are not good means of communicating health messages. The findings also indicate that
community members cannot rely on each other for
passing on information about health risks.
An additional implication for public health
nurses is the understanding that the key to the success of this project was the Spanish-speaking promotoras who participated in all phases of the
research. It was vital that they could guide the
development of questions in appropriate phrasing,
develop rapport, express themselves in the local
Spanish idioms, and gain enough trust to elicit
valuable information in the focus group meetings.
The success of this method is consistent with other
work by some of the researchers (Millard et al.,
2011) and it will continue to be used in later phases
of this pilot work.
A notable finding of this study is that residents,
while generally being aware that there was a concern about Donna Lake, lacked an understanding of
the PCB exposure risk despite it being present in
signage and other written forms of communication
sent to their homes. This research approach, working with focus groups and promotoras, succeeded
in giving voice to the community and engaging
their attention to a crucial health threat.
The project described was supported by the National Center for
Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 1UL
TR001120. The content is solely the responsibility of the authors
and does not necessarily represent the official views of the NIH.
Abass, K., Huusko, A., Nieminen, P., Myllynen, P., Pelkonen, O.,
Vahakangas, K., et al. (2013). Estimation of health risk by
using toxicokinetic modelling: A case study of polychlorinated biphenyl PCB153. Journal of Hazardous Materials,
Agency for Toxic Substances and Disease Registry. (2011). Toxicological profile forpolychlorinated biphenyls (PCBs).
Retrieved from http://www.atsdr.cdc.gov/ToxProfiles/
Anderko, L., Otter, A., Chalupka, S., Anderko, C., & Fahey, C.
(2013). Web-based environmental health education: Fish
facts. The Journal of Continuing Education in Nursing, 44,
Charles, L. E., Loomis, D., Shy, C. M., Newman, B., Millikan, R.,
Nylander-French, L. A., et al. (2003). Electromagnetic
fields, polychlorinated biphenyls, and prostate cancer mortality in electric utility workers. American Journal of Epidemiology, 157(8), 683â€“691.
Charlier, C. J., Adelin, A. I., Liying, Z., Dubois, N. G., & Plomteux,
G. J. (2004). Polychlorinated byphenyls contamination in
women with breast cancer. Clinica Chimica Acta, 342, 177â€“
Cohn, B., Terry, M. B., Plumb, M., & Cirillo, P. M. (2012). Exposure
to polychlorinated biphenyl (PCB) congeners measured
shortly after giving birth and subsequent risk of maternal
breast cancer before age 50. Breast Cancer Research and
Treatment, 136, 267â€“275.
Demers, A., Ayotte, P., Brisson, J., Jean, R., Dodin, S., & Dewailly,
E. (2002). Plasma concentrations of polychlorinated biphenyls and the risk of breast cancer: A congener-specific
analysis. American Journal of Epidemiology, 155, 629â€“635.
Diorio, C., Dumas, I., Sandanger, T. M., & Ayotte, P. (2013). Levels
of circulating polychlorinated biphenyls and mammographic breast density. Anticancer Research, 33(12), 5483â€“
Earle, D. (1999). The border colonias & the problem of communication: Applying anthropology for outreach. In M. O. Loustaunau, & M. Sanchez-Bane (Eds.), Life, death, & in between
on the U.S.-Mexico Border (pp. 23â€“37). Westport, CT: Bergin & Garvey.
Engel, L. S., Laden, L., Andersen, A., Strickland, P. T., Blair, A.,
Needham, L. L., et al. (2007). Polychlorinated biphenyl levels in peripheral blood and non-hodgkinâ€™s lymphoma: A
report from three cohorts. Cancer Research, 67(11), 5545â€“
Fernandez, M., Gonzales, A., Tortolero-Luna, G., Partida, S., & Bartholomew, L. K. (2006). Cultivando la salud. In L. K. Bartholomew, G. S. Parcel, G. Kok, & N. H. Gottlieb (Eds.),
Planning health promotion programs (2nd edn, pp. 606â€“
645). San Francisco, CA: Jossey-Bass.
Fisher-Hoch, S. P., Vatcheva, K. P., Laing, S. T., Hossain, M. M.,
Rahbar, M. H., Hanis, C. L., et al. (2012). Missed opportunities for diagnosis and treatment of diabetes, hypertension,
and hypercholesterolemia in a Mexican American population, Cameron county Hispanic cohort, 2003-2008. Preventing Chronic Disease, 9, 1â€“11.
Hewitt, J. B., Candek, P. B., & Engel, J. M. (2006). Challenges and
successes of infusing environmental health content in a
nursing program. Public Health Nursing, 23, 453â€“464.
Holford, T. R., Zheng, T., Mayne, S. T., Zahm, S. H., Tessari, J. D.,
& Boyle, P. (2000). Joint effects of nine polychlorinated
biphenyl (PCB) congeners on breast cancer risk. International Journal of Epidemiology, 29, 975â€“982.
Jacobson, J. L., & Jacobson, S. W. (1996). Intellectual impairment
in children exposed to polychlorinated biphenyls in
utero. The New England Journal of Medicine, 335(11),
Jardine, C. (2003). Development of a public participation and communication protocol for establishing fish consumption
advisories. Risk Analysis, 23, 461â€“471.
Krippendorf, K. (2013). Content analysis: An introduction to its
methodology (3rd edn). Thousand Oaks, CA: Sage Publications Inc.
Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical
guide for applied research. Thousand Oaks, CA: Sage Publications Inc.
LeCompte, M. D., & Schensul, J. J. (1999). Designing and conducting ethnographic research. Walnut Creek, CA: Altamira
Cantu et al.: Environmental Justice and Community-Based Research in Texas 71
Lee, D. H., Lee, I. K., Song, K., Steffes, M., Toscano, W., Baker, B. A.,
et al. (2006). A strong dose-response relation between serum
concentrations of persistent organic pollutants and diabetes:
Results from the National Health and [Nutrition] Examination Survey 1999â€“2002. Diabetes Care, 29(7), 1638â€“1644.
McCurdy, L., Roberts, J., Rogers, B., Love, R., Etzel, R., Paulson, J.,
et al. (2004). Incorporating environmental health into pediatric medical and nursing education. Environmental Health
Perspectives, 112, 1755â€“1760.
Millard, A. V., Graham, M. A., Wang, X., Mier, N., Sanchez, E. R.,
Flores, I., et al. (2011). Pilot of a diabetes primary prevention program in a hard-to-reach, low-income immigrant
Hispanic population. Journal of Immigrant and Minority
Health, 13, 1â€“8.
Pew Hispanic Research Center. (2013). Closing the digital divide:
Latinos and technology adoption. Retrieved from http://
Philibert, A., Philibert, H., & Schwartz, D. (2009). An exploratory
study of diabetes in a first nation community with respect
to serum concentrations of p, pâ€™-DDE and PCBs and fish
consumption. International Journal of Environmental
Research and Public Health, 6(12), 3179â€“3189.
Porterfield, S. P. (1994). Vulnerability of the developing brain to thyroid abnormalities: Environmental insults to the thyroid system. Environmental Health Perspectives, 102(2), 125â€“130.
Recio-Vega, R., Velazco-Rodriguez, V., Ocampo-Gomez, G., Hernandez-Gonzalez, S., Ruiz-Flores, P., & Lopez-Marquez, F.
(2011). Serum levels of polychlorinated biphenyls in Mexican women and breast cancer risk. Journal of Applied Toxicology, 31, 270â€“278.
Ropstad, E., Oskam, I. C., Lyche, J. L., Larsen, H. J., Lie, E., Haave,
M., et al. (2006). Endocrine disruption induced by organochlorines (OCs): Field studies and experimental models.
Journal of Toxicology and Environmental Health, Part A,
Silverstone, A. E., Rosenbaum, P. F., Weinstock, R. S., Bartell, S.
M., Foushee, H. R., Shelton, C., et al. (2012). Polychlorinated biphenyl (PCB) exposure and diabetes: Results from
the Anniston community health survey. Environmental
Health Perspectives, 120(5), 727â€“732.
Spears, E. G. (2014). Baptized in PCBs: Race, pollution, and justice
in an all-American town. Chapel Hill, NC: The University of
North Carolina Press.
Stellman, S. D., Djordjevic, M. V., Britton, J. A., Muscat, J. E.,
Citron, M. L., Kemeny, M., et al. (2000). Breast cancer risk
in relation to adipose concentrations of organochlorine pesticides and polychlorinated biphenyls in Long Island, New
York. Cancer Epidemiology Biomarkers & Prevention, 9,
Texas Department of Health. (2004). Seafood safety division. Fish
consumption advisories & bans. Regulatory Action on
Donna Irrigation System (AL-9), Issued February 4, 1994.
Texas Department of State Health Services. (2006). Donna reservoir
and canal system â€œsuperfundâ€ site: Presentation for community groups. Health Assessment and Toxicology Group,
Environmental and Injury Epidemiology and Toxicology
Branch. Austin, TX: TDSHS.
United States Environmental Protection Agency. (2012). Donna
Reservoir and Canal Superfund Site, Donna, Hidalgo
County, Texas: Site Status Summary. Retrieved from
U.S. Census Bureau. (2013a). American fact finder, annual estimates
of the resident population: April 1, 2010 to July 1, 2013;
2013 Population Estimates; PEPANNRES. Retrieved from
U.S. Census Bureau. (2013b). ACS demographic and housing estimates. American Community Survey 1-Year Estimates. DP
05. American Fact Finder. Retrieved from http:/factfinder2.census.gov
U.S. Environmental Protection Agency. (2013a). Public health implications of exposure to polychlorinated biphenyls (PCBs).
Retrieved from http://water.epa.gov/scitech/swguidance/
U.S. Environmental Protection Agency. (2013b). U.S. Environmental Protection Agency â€“ Integrated Risk Information System (IRIS), 2013. Retrieved from http://www.epa.gov/
U.S. Environmental Protection Agency. (2014a). Aroclor and other
PCB mixtures. Retrieved from http://www.epa.gov/
U.S. Environmental Protection Agency. (2014b). Polychlorinated
biphenyl (PCB) Basic information. Retrieved from http://
U.S. Environmental Protection Agency. (2014c). Donna Reservoir
and Canal Superfund Site, Donna, Hidalgo County, Texas:
Site Status Summary. Retrieved from http://www.epa.gov/
Wardman, J. K. (2008). The constitution of risk communication
in advanced liberal societies. Risk Analysis, 28, 1619â€“
72 Public Health Nursing Volume 33 Number 1 January/February 2016
Copyright of Public Health Nursing is the property of Wiley-Blackwell and its content may
not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s
express written permission. However, users may print, download, or email articles for
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