Download PDF Winter Bridge on The Grainger Foundation Frontiers of Engineering December 13, 2024 Volume 54 Issue 4 This issue features articles by The Grainger Foundation US Frontiers of Engineering 2024 symposium participants. The articles examine cutting-edge developments in microbiology and health, artificial intelligence, the gut-brain connection, and digital twins. Achieving Impact through Human Behaviors and Community Engagement in Human Health Risk Assessment Friday, December 13, 2024 Author: Amanda M. Wilson Community engagement will lead to increased capacity for risk assessments to positively impact communities and protect human health. Health risk assessment plays an important role in public and environmental health policy and decision-making. Quantitative health risk assessments, specifically, in which risk assessors estimate the probability of specific adverse health endpoints (i.e., “risks”), are based on evidence and analysis from multiple disciplines, including toxicology, exposure science, environmental engineering, ecology, chemistry, and microbiology. These risk estimates are derived from models that describe how contaminants (such as chemicals or microbes) are transported under specific environmental and social conditions that lead to human exposures and subsequent health risks. There have been increased efforts, especially in microbial risk assessments, to describe multiple exposure pathways and how these pathways may influence each other (e.g., the fact that bioaerosol source control means less opportunity for deposition on surfaces, therefore reducing surface-mediated exposures) (Wilson, Jones, et al. 2021). The development of these models advances current understanding of how contaminants pose human health risks by illuminating knowledge gaps or allowing for experimentation in a simulated environment that would otherwise be impossible in real-world settings due to ethical or feasibility constraints. Risk assessment models may also include the simulated performance of interventions to inform which interventions will reduce risk by the greatest amount. To determine the performance needed for single or bundled interventions, risk assessors may compare estimated risks to thresholds that are deemed acceptable and determine what concentration of a contaminant in a given environment would yield that specific risk threshold. Community Engagement for Reducing Uncertainty in Risk Analysis In building these models, risk assessors sometimes face significant data gaps and inevitably face challenging decisions in designing the models: How much water does someone ingest while snorkeling (Hernández-Zepeda et al. 2024)? How do specific cultural communities use their surface water resources (e.g., bathing, drinking, swimming, watering crops), and what are the health implications during major contamination events (Ornelas Van Horne et al. 2024)? How many times do people touch surfaces in offices, and what is someone’s risk of getting infected during an outbreak (Beamer et al. 2015)? In some risk assessment models, parameters related to human behaviors have some of the strongest relationships with predicted exposures and infection risks (Julian et al. 2009; Wilson, King, et al. 2021). This type of uncertainty is sometimes referred to as “epistemological uncertainty,” or “uncertainty pertaining to knowledge or belief“ (Resnik 2021). There is growing recognition in exposure science and risk assessment communities that community engagement is crucial for reducing epistemological uncertainty. For example, Ornelas Van Horne et al. (2024) demonstrated how engaging the Diné community after the Gold King Mine spill regarding uses of the San Juan River drastically changed the exposure pathways captured through risk assessment relative to the initial assumptions about the water’s use (i.e., nearly exclusively recreational) . Increased community engagement efforts will require highly diverse multidisciplinary teams, including greater inclusion of social scientists among engineering teams. While epistemological uncertainty is often the primary concern and criticism of human health risk assessments, I argue there is another area of uncertainty that is often neglected: “moral uncertainty,” or “uncertainty pertaining to action or conduct” (Resnik 2021). Moral uncertainty in risk assessment, although perhaps less discussed in risk assessment circles than epistemological uncertainty, is also not a new concept. Shrader-Frechette described in multiple works (1985, 1995) the fact that experts bring personal experiences, biases, and judgments to the risk assessment process, and Kahneman et al. (1982) demonstrated that experts may fall victim to the same heuristics and biases that non-scientific experts use in decision-making. Lacking community perspective on these moral judgment calls may translate to lower impact for intervention implementation or criticism of the risk analysis outcomes. For example, the use of acceptable risk thresholds that are not seen as acceptable by those facing the risks in question may impact the trust that communities have in various entities to protect them at acceptable levels. In these situations, “tolerable” risks may be conflated with “acceptable” (Shrader-Frechette 1985). Examples of Community Engagement in Risk Assessment Some of the largest public health challenges of current times will require implementation of new engineering technologies that may not be feasible or impactful without public buy-in. Community engagement is a crucial frontier of engineering that will lead to increased capacity for risk assessments to positively impact communities and protect human health. One example is the increased application of water reuse technologies for addressing water scarcity and, in some areas of the US such as the Southwest, increased population and water demand (Wahl et al. 2022). In a recent study of a large metropolitan area in Arizona, I interviewed water utility customers about their perspectives on what is needed to build or maintain trust with water utilities and risk perceptions related to direct potable reuse. One participant noted that even being asked the question (i.e., an effort to engage communities) helped to build trust (manuscript in preparation). Although this is an anecdote from a single conversation with a community member, it demonstrates the power of community engagement for making the implementation of new technologies a partnership with meaningful dialogue—not just a top-down approach. Risks perceived to be involuntary tend to be seen as riskier than those that are voluntary (Slovic 2000). I hypothesize that increasing ways in which individuals can speak to emerging engineering technologies in their communities could impact risk perceptions by increasing voluntariness of risks, and, therefore, reducing perceived risks and increasing capacity for impactful implementation. Another means by which risk assessors are increasing the capacity to engage non-risk assessors is by creating interactive risk assessment applications, such as freely accessible websites where users without modeling or computational experience can toggle between different scenario settings and compare estimated risks (Gerrity et al. 2019; Harvard T.H. Chan School of Public Health 2021; Heida et al. 2024). This can inform intervention development and implementation, educate people on what factors influence risk the most, and could even be used by some parties to advocate for increased financial resources for engineering interventions that may be more costly but also more effective than other approaches, such as administrative controls or personal protective equipment. For example, in conducting focus groups with school health staff on a risk calculator tool in development for informing interventions to address respiratory viral outbreaks (Wilson et al. 2024), school health staff noted the usefulness of the tool for advocating to upper administration about the need for expensive improvements, like increased ventilation, better air filters, or portable air purifiers in classrooms (Hasan et al., manuscript in preparation). Another effort for increased community engagement in risk assessment includes the translation of methodologies from other disciplines for eliciting the values and perspectives of individuals. For example, we recently used a risk-risk tradeoff (RRTO) approach from behavioral economics in microbial risk assessment to elicit acceptable risk thresholds from nurses regarding competing risks associated with cleaning and disinfection in healthcare environments: increased work-related asthma risk from increased cleaning/disinfection intensity and increased occupational infection risk from contaminated surfaces for decreased cleaning/disinfection intensity (Wilson et al. 2022). Capturing what occupational infection risk one may accept to maintain risk of work-related asthma at a specific level could inform the target performance of cleaning/disinfection interventions that balance competing health outcomes, for example. Conclusion Community engagement can take many different forms in risk assessment, and the examples included here are not an exhaustive list. The benefits may be high, including increased trust with the public, better informed risk thresholds, and more accurate risk assessments (i.e., capturing human behaviors with less uncertainty), leading to greater impact of risk assessment and advancing successful implementation of engineering controls for protecting human health. Increased community engagement efforts will require highly diverse multidisciplinary teams, including greater inclusion of social scientists among engineering teams. Acknowledgments I thank the participants of my research described in this work for their insights and experiences which have helped me grow as a risk assessor and public health researcher. I also thank Drs. David Resnik, Bejamin Wilfond, Paloma Beamer, Kerry Hamilton, and Lynn Gerald who have enlightened and informed my thinking on community engagement strategies and their benefit in risk assessment. Research described in this work includes research funded by the American Lung Association, the U.S. Army Engineer Research and Development Center (ERDC), and National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K01HL168014. AM Wilson was supported by the Southwest Environmental Health Sciences Center (NIEHS P30 ES006694) and by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K01HL168014. The publication’s contents are solely the responsibility of the author and do not necessarily represent the official views of the National Institutes of Health, American Lung Association, or the U.S. Army. References Beamer PI, Plotkin KR, Gerba CP, Sifuentes LY, Koenig DW, Reynolds KA. 2015. 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Respirators, face masks, and their risk reductions via multiple transmission routes for first responders within an ambulance. Journal of Occupational and Environmental Hygiene 18(7):345–60. Wilson AM, Jung Y, Lowe AA, Verhougstraete MP, Seong D, Islam MT, Son Y-J, Gerald LB. 2024. Developing a risk calculator tool to reduce respiratory viral transmission in classrooms. A35. American Journal of Respiratory and Critical Care Medicine 2024 209:A1389. Online at https://doi.org/10.1164/ajrccm-conference.2024.209. 1_MeetingAbstracts.A1389. Wilson AM, King M-F, López-García M, Clifton IJ, Proctor J, Reynolds KA, Noakes CJ. 2021. Effects of patient room layout on viral accruement on healthcare professionals’ hands. Indoor Air 31(5):1657–72. Wilson AM, Mussio I, Chilton S, Gerald LB, Jones RM, Drews FA, LaKind JS, Beamer PI. 2022. A novel application of risk–risk tradeoffs in occupational health: Nurses’ occupational asthma and infection risk perceptions related to cleaning and disinfection during COVID-19. International Journal of Environmental Research and Public Health 19(23):16092. About the Author:Amanda M. Wilson is assistant professor of public health, Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona.