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You have a choice pick one article, either: Gignac et al. C

You have a choice pick one article, either: Gignac et al. C

You have a choice – pick one article, either:

  • Gignac et al. “Co-creating a local environmental epidemiology study: the case of citizen science for investigating air pollution and related health risks in Barcelona, Spain” 
  • Krengel et al. “Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: The Ft. Devens cohort.” 

They are quite different types of articles, so make sure to look at each one before you decide which to choose. Do not worry if you are not completely familiar with the statistical techniques; the results are clearly described in such a way that will not require deep familiarity.

Write approximately 2 to 3 pages double-spaced and make sure to include your name and the title of the article you’re reviewing.  You should cover the elements listed below, and you may decide to add some that I have not listed. Your assignment should be in narrative style, without including a heading for each of the elements listed in the attached instructions.

Reviewing a Scientific Assignment

You have a choice – pick one article, either:

– Gignac et al. “Co-creating a local environmental epidemiology study: the case of citizen science for investigating air pollution and related health risks in Barcelona, Spain”

– Krengel et al. “Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: The Ft. Devens cohort.”

They are quite different types of articles, so make sure to look at each one before you decide which to choose. Do not worry if you are not completely familiar with the statistical techniques; the results are clearly described in such a way that will not require deep familiarity.

Write approximately 2 to 3 pages double-spaced and make sure to include your name and the title of the article you’re reviewing. You should cover the elements listed below, and you may decide to add some that I have not listed. Your asignment should be in narrative style, without including a heading for each of the elements listed below.

Importance and background

– How important does this topic seem to you, and why?

– Do the authors provide sufficient background for you to understand the materials?

Research questions

– Are there clear research questions?

Data and methods

– Does the data source seem appropriate and trustworthy?

– Are the methods described well?

– How was the sample selected? Who was included? Who was excluded?

– Is the sample size large enough?

– How generalizable is this sample to the whole population?

– If there is an exposure, is it measured directly or indirectly?

– Are outcomes clearly defined and measured?

– Is the analytic strategy clearly described and appropriate?

Presentation of results

– Are results presented in an accessible manner?

– Are figures and tables adequate and helpful?

Discussion and Conclusion

– Do the authors provide a useful discussion, conclusion, and ideas for further study?

Overall assessment

– What is your overall impression of this article and your assessment of its contribution?

– Would you make recommendations based on this article?


Gignac et al. Environmental Health (2022) 21:11


Co-creating a local environmental epidemiology study: the case of citizen science for investigating air pollution and related health risks in Barcelona, Spain Florence Gignac1,2,3, Valeria Righi4, Raül Toran1,2,3, Lucía Paz Errandonea4, Rodney Ortiz1,2,3, Mark Nieuwenhuijsen1,2,3, Javier Creus4, Xavier Basagaña1,2,3* and Mara Balestrini4


Background: While the health risks of air pollution attract considerable attention, both scholarly and within the gen- eral population, citizens are rarely involved in environmental health research, beyond participating as data subjects. Co-created citizen science is an approach that fosters collaboration between scientists and lay people to engage the latter in all phases of research. Currently, this approach is rare in environmental epidemiology and when co-creation processes do take place, they are often not documented. This paper describes the first stages of an ongoing co-cre- ated citizen science epidemiological project in Barcelona (Spain), that included identifying topics that citizens wish to investigate as regards air pollution and health, formulating their concerns into research questions and co-designing the study protocol. This paper also reflects key trade-offs between scientific rigor and public engagement and pro- vides suggestions to consider when applying citizen science to environmental health studies.

Methods: Experts created an online survey and analyzed responses with descriptive statistics and qualitative cod- ing. A pop-up intervention was held to discuss with citizens their concerns about air pollution and health. Later on, a community meeting was organized to narrow down the research topics and list potential research questions. In an online survey, citizens were asked to vote for the research question they would like to investigate with the experts. A workshop was held to choose a study design in which citizens would like to partake to answer their preferred research question.

Results: According to 488 respondents from the first survey, cognitive and mental health were the main priorities of investigation. Based on the second survey, with 27% of the votes from 556 citizens, the most popular research ques- tion was, “How does air pollution together with noise and green/blue spaces affect mental health?”. The study design selected was an observational study in which citizens provide daily repeated measures of different cognitive and mental health outcomes and relate them to the air pollution concentrations.

Conclusions: Based on the co-creation activities and the results obtained, we conclude that applying citizen science in an environmental health project is valuable for researchers despite some challenges such as engaging citizens and maximizing representativity.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Open Access

*Correspondence: [email protected] 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Full list of author information is available at the end of the article

Page 2 of 13Gignac et al. Environmental Health (2022) 21:11

Introduction Poor air quality constitutes a serious health burden worldwide [1]. In the last years, there has been an exten- sive body of research documenting established and new health effects associated with air pollution [2]. The pub- lication of new scientific evidence about the health risks of air pollution is contributing to raising public concerns. For environmental health experts, the lay people percep- tion of air pollution as an important public health issue and the civic mobilization are two key factors that are able to move from research to action and influence pol- icy changes [3, 4]. Hence, more researchers have started to incorporate participatory practices in order to bet- ter align the design of their studies on air pollution and health with public concerns, with the hopes that research results can then lead to actions relevant to the local com- munity needs [5, 6].

Participatory practices can take many forms, from the less participatory practices (in which the lay public solely collects data) to the most participatory (in which the lay public gives their input throughout the entire research process). In the field of environmental epidemiology, research approaches engaging the lay public and affected communities are carried out under several banners such as community-based participatory research, community- driven research, participatory action research, popular epidemiology, and more recently, citizen science [5, 6]. The latter broadly refers to the engagement of the general public (non-professional scientists) in scientific research tasks [7]. In particular, citizen science initiatives adopting co-creation methods (i.e. co-created citizen science) aim to give citizens an opportunity to take part in the deci- sion-making process of all aspects of a research project, such as defining the study questions, developing the data collection tools and analyzing the data [7, 8]. A key con- tribution to the application of co-created citizen science in research is the Bristol Approach [9, 10]. The Bristol Approach proposes a model of co-creation that builds on the principles of participatory action research, people- centered innovation and the common goods. In a recent narrative review, we adapted this model from a general perspective and developed a four-phase framework with features that occur in different participatory practices in environmental health research: (1) identification (civic concerns are identified and translated into a research question), (2) design (data collection tools, data govern- ance and other aspects of the study protocol are defined), (3) the deployment (data are collected and analyzed) and

(4) action (results are transformed into practical citizen- produced knowledge to inform public policies) [11]. This framework closely resembles to other participa- tory research frameworks and guidelines that have been already defined by environmental health researchers [5, 12, 13]. In comparison to the other frameworks, this four-phase framework stresses the importance of involv- ing the citizens in each phase of the research process, that is the citizens having an active role in the scientific governance, and calls for an equal involvement between experts and citizens when it comes to decision-making [11].

Over the last few years, although there have been several initiatives claiming to apply a citizen science approach to measure air quality parameters [14, 15], par- ticipatory research projects on air quality are not new and exist since more than two decades [16–18]. While such initiatives are driven by health-related concerns, those research projects for the study of air pollution using citizen science or other participatory approaches do not often focus specifically on assessing the link between air pollution and health [7, 11]. The research study of Wing et  al. [6] is a good example of an environmental epide- miology study in which citizens were involved in almost all the research process and collaborated with research- ers to investigate the relationship between exposure to air pollution from industrial swine production and several health endpoints, including lung function, blood pres- sure, mood and stress level. Community residents were actively involved in identifying research questions, col- lecting data, recruiting study participants, interpreting and disseminating the results.

Along the lines of participatory research like the work of Wing et al. [6], here, we present the initial phases of the Barcelona CitieS-Health project, an ongoing envi- ronmental epidemiology project in which citizens co- design with scientists a study to assess the link between air pollution exposure and health. Following the co- created citizen science framework previously men- tioned, the project aims to involve citizens in all phases of the research, including deciding the research ques- tion, designing the study, collecting and analyzing data, interpreting and disseminating the results and ulti- mately, suggesting policy-related actions. As examples of co-created projects are limited, more so in the field of environmental epidemiology, it is important to docu- ment all the steps taken as this information can contrib- ute to the design of future projects with higher level of

Keywords: Air pollution, Environmental health, Epidemiology, Civic concerns, Citizen science, Participatory research, Online survey, Study design, Co-creation workshop

Page 3 of 13Gignac et al. Environmental Health (2022) 21:11

participation in the field. In this paper, we describe the co-creation activities from the first and second phases of the framework, that is the activities that were con- ducted to collaboratively define the research question and co-design an environmental epidemiological study protocol. Also, we present the main results of each activity and reflect on the added value of civic inputs and the challenges when co-creating an environmen- tal epidemiological study with citizens. Moreover, we provide practical suggestions for environmental health researchers looking to apply co-created citizen science methods to their studies. It is important to note that in this paper, the term “citizen” is used to distinguish the lay public from professional scientific researchers and does not indicate the citizenship status of the people participating in the research project.

Methods Setting The study presented here is part of CitieS-Health, a project funded by the European Commission under the H2020 program, which aims to implement partici- patory research methods through the entire scientific process around the topic of urban environmental pol- lution and health. The project includes five pilot studies in five European cities. Here, we present the pilot study conducted in the city of Barcelona (Spain), which cov- ers the topic of air pollution and health.

Barcelona has pollutant levels above the WHO rec- ommendations [19] and the consequences of air pol- lution exposure on health are one of local citizens’ preoccupations [20, 21]. As a result, different citi- zen platforms advocating for cleaner air and projects engaging citizens in collecting air pollution exposure have been developed in the city [22–25].

Co‑designing the research question The process of co-designing the research question was conducted from August 2019 to January 2020 and included (1) an online survey on knowledge, perceptions and preferences on topics to be investigated around the theme of air pollution and health, (2) a pop-up interven- tion to approach citizens and discuss their interests and concerns, (3) a community meeting with citizens in order to start formulating potential research questions based on the results of the survey, and (4) a second online sur- vey to identify the most preferred research question to be implemented in the epidemiological study. In Table 1, a list of all activities along with their aims and tools used is provided in a chronological order.

The first survey was launched alongside a strategic video campaign entitled “Everything you wanted to know about the air but were too afraid to ask”. The invitation proposed the respondents to partake in the design of a scientific study, the first phase of which consisted on col- lecting citizen concerns and topics of interest regarding research on air pollution and health. To attract a signifi- cant number of respondents, a link to the survey was posted through diverse social media platforms (Twitter, Facebook and LinkedIn). Additionally, to ensure wide- spread dissemination, the link to the survey was sent to key stakeholders including citizen groups concerned about environmental issues, city council representatives, journalists, local governments, and the public transport authority.

The survey was not targeting a specific group of citizens and the questions of the survey were chosen by experts in environmental epidemiology and in civic engagement from the research group. The civic engagement experts were responsible for designing, coordinating and ani- mating activities with the citizens, and had an advanced knowledge in gauging civic concerns, communicating

Table 1 Co-creation activities conducted in the Barcelona pilot along with their aim and tools used

a The templates of the tools can be found in Supplementary Materials. Also, more details on the tools used can be found in the reports available on the website of the CitieS-Health project (https:// citie sheal th. eu/) and also in the CitieS-Health toolkit (https:// citiz ensci encet oolkit. eu/), which includes ideas and concrete examples on how to engage citizens in citizen science projects in environmental health studies

Phase Aim Type of activity Tool a

Co‑design‑ ing the research question

To identify topics citizens are concerned about and would like to investigate in the context of air pollution and health.

Online survey –

To raise awareness about the project across all Barcelona districts and collect further qualitative insights on topics citizens are concerned about and would like to investi- gate in the context of air pollution and health.

Pop-up intervention In-depth discussion canvas

To formulate the concerns into potential research questions. Community meeting Identification Issues canvas

To select the research question to investigate. Online survey –

Co‑ designing the study protocol

To gauge citizens’ preferences in certain aspects of the study design and to be included in the study protocol.

Workshop Experiment Design canvas

Page 4 of 13Gignac et al. Environmental Health (2022) 21:11

scientific concepts to lay public and stimulating the moti- vation of citizens to engage in the project. The survey questionnaire was designed for the purpose of collecting (1) citizens’ perception of air quality, (2) concerns over air pollution health impacts and (3) topics of interest to which they would like to conduct scientific research. The complete survey consisted of a total of nine questions and included 5-point Likert scale and free text questions (Supplementary Table 1). Experts designed a short ques- tionnaire in order to maximize participation, but at the same time to collect enough information to identify key topics of concern and interest. A pilot version of the sur- vey was shared among selected contacts and reviewed to make final adjustments before its final implementation.

An offline pop-up intervention across all the districts of Barcelona was also organized during the Parking Day, an annual initiative in which various organizations and communities temporarily transform public parking spaces by giving them a different use, one that promotes a sustainable urban environment [26]. In collaboration with another national citizen science project called Los Vigilantes del Aire [27], strawberry plants were distrib- uted for citizens to measure air pollution at home. Since particulate matters are iron-rich particles and tend to accumulate on the plant leaves, a proxy for estimating the concentration of ambient particulate matter is by meas- uring the concentration of ferromagnetic particles on the leaves [28]. Plus, this assessment method has been dem- onstrated to be promising for participatory environmen- tal epidemiology research [29]. This pop-up intervention first aimed to raise awareness about the project across all Barcelona districts, which contributed to overcome the limitations of the distribution of the online survey. It helped to gather information about citizens’ concerns on air pollution and health from different socio-economic areas of the city, and at the same time, invite them to par- ticipate in the online survey. More specifically, we had a stand in ten districts of Barcelona and for each stand we used a canvas that we developed for allowing for in- depth discussions. This canvas consisted of a poster with a title “What worries my neighborhood regarding pollu- tion and health?” listing different body parts and health topics. Citizens had to identify the one they would like to know how air pollution affects it using stickers and were asked to explain why. The aim of using this canvas was twofold. It acted as a thematic and social icebreaker. On the one hand, it allowed people to start thinking about the relationship between human health and air pollution, identifying how poor air quality in their neighborhoods was affecting their own body in different ways (causing them to cough, have itchy eyes, be more tired, etc.). On the other hand, because it was a poster, it allowed people to socialize their concerns and find out how others in the

same or different neighborhoods felt about air pollution and health. The template of the canvas can be found in Supplementary Material.

Once the results of the survey were analyzed and topics were identified, we organized a community meeting with public authorities, health bodies, experts and citizens to start co-defining a set of possible questions to investigate building on the findings of the survey and the pop-up intervention. During this event, participants first learned about the survey results and then were divided into work- ing groups for further discussions on potential research questions. A tool developed and used during this activity was the Identification Issues canvas (the template of the canvas can be found in Supplementary Material). Each working group was assigned to a thematic table repre- senting one of the most mentioned health topics in the survey. The number of thematic tables depended on the expected number of participants that registered to the event and the results from the first survey and the pop- up intervention. Using the canvas, participants were asked to define a question based on that topic as well as to identify barriers, and opportunities to investigate such question. Moreover, each participant at the table received an “actor card” which is a card representing a population group, such as asthmatics, athletes, elderly people, and children to enrich the perspective of those affected by the health problem at stake. During the community meet- ing with citizens, the degree of novelty of the different research topics was raised by scientists so that citizens had another piece of information to consider. Moreover, during this meeting, scientists discussed about high-risk hypotheses, i.e., very novel hypotheses that could have a high impact if confirmed but also have a high risk of not being confirmed, which can then reduce the applicability of the results for implementing new policies to reduce air pollution.

Afterwards, scientists and civic engagement special- ists collected all the inputs from the community meeting and assessed the viability and feasibility of the different research questions proposed. Since the general goal of the CitieS-Health project was to explore how pollution in the living environment of a group of citizens is affect- ing their health, questions had to be formulated in a way that the study could assess the relationship of air pollu- tion exposure with a health outcome. The resulting list of questions was shared via a second online survey in which citizens had to vote for their preferred question. The question most voted was selected as the final research question to investigate with scientists.

Co‑designing the study protocol The process of co-designing the study protocol was conducted from February to April 2020. Based on the

Page 5 of 13Gignac et al. Environmental Health (2022) 21:11

research question most voted by the citizens in the sec- ond online survey, a workshop was organized to deter- mine with citizens different elements of the study design and data collection protocol of the research project. A tool that was developed for this event was the Experi- ment Design canvas (the template of the canvas can be found in Supplementary Material). This tool allowed epidemiological researchers to present and discuss with citizens different types of epidemiological studies and gauge their preferences about different aspects of study design. Specifically, the canvas is composed of differ- ent posters, each representing a type of epidemiological studies. Experts presented to citizens three types of epi- demiological study (observational/panel, experimental and cross-sectional) while explaining their strengths and limitations. The description of each study was explained using simple terms and without belaboring all the aspects to consider when designing a research study. The panel study was described as a study that was requiring par- ticipants to collect data (e.g. answering a self-report questionnaire) one or more times per day for one week or more. It was explained that each participant was serv- ing as his or her own control and the aim was to compare the health outcomes between the days more polluted and the days less polluted. It was highlighted that this type of study was effective for studying short-term health effects of air pollutants but could be time-consuming if a daily questionnaire had to be completed. The experi- mental study was described as a study in which partici- pants had to alter their daily routine to follow specific instructions, for example a study in which participants are invited to walk for two hours and the same distance in a street known to be more polluted (e.g. busiest shop- ping street) and, in another day, in a park or area in Bar- celona known to be less polluted (thus modifying their routines). On the one hand, it was explained that this experimental design was requiring a bit more involve- ment from the participants and in the given example, the experimental conditions (busy street vs. park) could not be blind, and consequently, impossible to avoid a placebo effect, an important bias in research. On the other hand, it was suggested that this study could produce results less prone to alternative explanations and could gener- ate a higher exposure contrasts and thus, make it more likely to detect effects. For the cross-sectional analysis, experts proposed to the citizens to use a postal or online questionnaire that could be sent to Barcelona residents to ask about health conditions (e.g., if they have certain dis- ease/symptoms or not) and to assess exposure to air pol- lution using the home address of participants. This was presented as a quick, cheap and easy to conduct study in which multiple outcomes could be measured. Plus, it was presented as a study design that was able to detect some

associations, but for which, in comparison to the other designs, is usually more difficult to see if the associations are causal, or to identify which is the cause and the effect between the exposure and the outcome. The three post- ers for each type of study were displayed on a wall and citizens were first invited to choose individually the type of study they were interested in to partake based on the time and effort they were willing to dedicate. Each poster had three different rows, corresponding to different aspects to be discussed step-by-step with participants. In the first row, participants were invited to select the aspect of the health topic they were most interested in. In the second row, participants had to reflect on the kind of data they were willing to collect and in the third row, they had to choose or propose tools for collecting the data. To vote, citizens used stickers. While the participants were voting, experts initiated more individual conversations with the participants to further discuss their preferences in other elements of the study design, including the par- ticipation duration, indicators of the most popular health topics and the tools to collect health and environmental exposure data. Citizens were invited to write their prefer- ences on the posters. The final study protocol was written by the scientists taking into account all citizens’ inputs, made available online and shared with a selected group of citizens for feedback.

Data analysis For both the first and second online survey, network ID and email addresses were verified to control for dupli- cation. Respondents’ postal codes were matched to the corresponding district. Only Barcelona residents were included in the analysis. Number of respondents and frequencies were reported to describe the results. All analyses were conducted with the STATA 16.0 statisti- cal software package (College Station, TX). The dataset containing anonymized results from questions 1 to 6 of the first survey is available for download and free use through the file repository Zenodo [30].

In the first survey, perception rates were averaged at the district level and plotted on a map, which was compared to a map of NO2 levels. Answers from the two open- ended questions were analyzed using

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