Biomonitoring efforts are widely used in environmental exposures assessments beyond
occupational and clinical settings to help identify and assess chemicals observed
in the environment and in humans and to inform public-health decisions and regulations
1]. Due to innovations in technology, increased sensitivity in methods, access to resources,
and institutional support for community-engaged research, there has been a tremendous
increase in the number of human biomonitoring studies 1], 2]. With these types of studies comes an additional level of responsibility to translate
the data and findings and address environmental health literacy (EHL) goals.
Using the University of Arizona’s Metals Exposure Study in Homes (MESH) extensive
report back effort as an example, this commentary highlights how reporting back environmental
exposure data is carving out a new informal education setting (learning outside of
school classrooms) and is stimulating free-choice learning – learning that is occurring
within these settings and that is driven by the needs and interests of the learner
rather than an external authority 3]. By taking an in-depth look at exposure study participants’ understanding of results
and their resulting actions, this commentary contributes to exposure science and expands
the concept of EHL and science education by viewing report back as a free-choice learning
experience. Lastly, it is proposed that such documentation of learning and action
would be an effective method by which to assess report back efforts and, in effect,
evaluate a community’s EHL.
Literacy
Thus far, scholars have defined literacy in terms of science 4], health 5], critical health 6], public health 7], and the environment 8]. Health literacy implies the achievement of a level of knowledge, personal skills
and confidence to take action to improve personal and community health by changing
personal lifestyles and living conditions 5]. Public health literacy is defined as the degree to which individuals and groups
can obtain, process, understand, evaluate, and act on information needed to make public
health decisions that benefit the community 9]. Environmental literacy is the capacity for individuals and groups to make informed
decisions concerning the environment; to be willing to act on these decisions to improve
the well-being of other individuals, societies, and the global environment; and to
participate in civic life 8]. Recently, efforts have sought to merge existing explanations and define EHL. Thus
far, the Society for Public Health Education defines EHL as the ability to “integrate
concepts from both environmental literacy and health literacy to develop the wide
range of skills and competencies in order to seek out, comprehend, evaluate, and use
environmental health information to make informed choices, reduce health risks, improve
quality of life and protect the environment†10].
Literacy as described above, stresses understanding, informed decision-making, and
action. However, health literacy efforts traditionally assess basic literacy skills
such as reading, writing, and arithmetic, and are geared toward compliance with recommended
clinical care. In this context, health literacy is seen as a patient “risk factorâ€
that needs to be managed within the process of providing clinical care 11] and tends to stay within the traditional disciplinary boundaries of medicine and
health promotion 6]. This approach does not view health literacy as an asset or a form of health action
(personal, social, environmental) and does not focus on or assess individual and/or
community efforts regarding knowledge integration, informed choices, actions to improve
personal and community health, and methods to reduce risk. When health literacy is
viewed as an asset, with roots in public health 11], practitioners can then implement and evaluate “health literacy in action.†This
is not only defined by functional literacy, but also communicative/interactive and
critical literacy, which can then assess whether an individual/community is taking
action to improve health, exerting greater control over factors that determine health,
reflecting greater autonomy and empowerment, and engaging in a wider range of health
actions 6], 11]. These actions include personal behaviors to social action to address the social,
economic, and environmental determinants of health. EHL is an evolving concept that
spans and synergistically unites various disciplines such as, but not limited to,
risk communication, social science, public health, health promotion, and communication
12]. Interestingly the field of science education, specifically the subfield of informal
science learning/free-choice learning, has not been part of the dialogue thus far,
and this is a great loss. Efforts to understand how, when and where learning is occurring
are at the forefront of informal science education efforts. Measuring these types
of changes can be challenging and new methods are needed to improve and evaluate literacy
in action, specifically EHL.
Informal science education, defined as science learning opportunities that people
experience across their lifespan outside of school 13], contributes greatly to an adult’s science learning. In fact, over the course of
a lifetime, the average person spends 5 % of their time in school 14] and research suggests that nearly half of the public’s science understanding and
learning derives from free-choice learning 13]. In a study to determine what sources people relied upon for science and technological
information, 74 % of respondents attributed “some or a lot†of their learning to “life
experiences,†followed by “books and magazines –not for school†15]. Data indicates that lifelong learning is intrinsically motivated and largely under
the choice and control of the learner 13], 15], 16]. It seems ideal to harness the power of free-choice learning to improve EHL.
Free-choice learning in environmentally compromised communities
Informal science education methods are particularly valuable when working with communities
impacted by hazardous waste. Communities neighboring contaminated sites are learning
on their own about the contaminants of concern at hazardous waste sites and the associated
health effects, and this type of learning is a multi-faceted phenomenon that is place-based
and socioculturally mediated. As suggested by Falk and Storksdieck (2005), free-choice
learning is a cumulative process involving connections and reinforcement among the
variety of learning experiences people encounter in their lives 17]. In that way, learning is both a process and a product, suggesting a vibrant and
contextual model of learning 17], requiring both creative and innovative evaluation methods 18].