S. Katharine Hammond, Michelle Wong, Ilinisa Hendrickson, Ira B. Tager, and Jennifer Mann

Tamaño: px
Comenzar la demostración a partir de la página:

Download "S. Katharine Hammond, Michelle Wong, Ilinisa Hendrickson, Ira B. Tager, and Jennifer Mann"

Transcripción

1 NUMBER 17, VOL. II 2010 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma Report on Communication Activities S. Katharine Hammond, Michelle Wong, Ilinisa Hendrickson, Ira B. Tager, and Jennifer Mann

2 ABOUT THE NUATRC The Mickey Leland National Urban Air Toxics Research Center (NUATRC or the Leland Center) was established in 1991 to develop and support research into potential human health effects of exposure to air toxics in urban communities. Authorized under the Clean Air Act Amendments (CAAA) of 1990, the Center released its first Request for Applications in The aim of the Leland Center since its inception has been to build a research program structured to investigate and assess the risks to public health that may be attributed to air toxics. Projects sponsored by the Leland Center are designed to provide sound scientific data useful for researchers and for those charged with formulating environmental regulations. The Leland Center is a public-private partnership, in that it receives support from government sources and from the private sector. Thus, government funding is leveraged by funds contributed by organizations and businesses, enhancing the effectiveness of the funding from both of these stakeholder groups. The U.S. Environmental Protection Agency (EPA) has provided the major portion of the Center s government funding to date, and a number of corporate sponsors, primarily in the chemical and petrochemical fields, have also supported the program. A nine-member Board of Directors oversees the management and activities of the Leland Center. The Board also appoints the thirteen members of a Scientific Advisory Panel (SAP) who are drawn from the fields of government, academia and industry. These members represent such scientific disciplines as epidemiology, biostatistics, toxicology and medicine. The SAP provides guidance in the formulation of the Center s research program and conducts peer review of research results of the Center s completed projects. The Leland Center is named for the late United States Congressman George Thomas Mickey Leland from Texas who sponsored and supported legislation to reduce the problems of pollution, hunger, and poor housing that unduly affect residents of low-income urban communities. This project has been funded wholly or in part by the United States Environmental Protection Agency under assistance agreement X The contents of this document do not necessarily reflect the views and policies of the Environmental Protection Agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use.

3 PREFACE The Clean Air Act Amendments of 1990 established a control program for sources of 188 hazardous air pollutants, or air toxics that might pose a risk to public health. With the passage of the Amendments, Congress established the Mickey Leland National Urban Air Toxics Research Center (NUATRC) to develop and direct an environmental health research program that would promote a better understanding of the risks posed to human health by the presence of toxic chemicals in urban air. The NUATRC was established as a public/private research organization. Its research program is developed with guidance and direction from scientific experts from academic institutions, industry, and government agencies. Its research results are intended to assist policy makers in reaching sound environmental health decisions. The Center accomplishes its research mission by sponsoring research at universities and research institutions on the human health effects of air toxics and by publishing research findings in its NUATRC Research Reports, thereby contributing meaningful and relevant data to the peer-reviewed literature. In 2005, the Center released RFA , "Proximity to Vehicular Traffic, Exposures to Air Toxics, and Non-Cancer Health Effects." The primary objective of the RFA was to encourage investigators in developing and conducting shortterm research projects dealing with the association between non-cancer health effects and exposure to air toxics resulting from proximity to vehicular traffic. Dr. Katharine Hammond of the University of California at Berkeley School of Public Health was subsequently awarded a contract to conduct the research study "Short- and Long-Term Respiratory Effects of Exposure to PAHs from Traffic in a Cohort of Asthmatic Children." Dr. Hammond's study assesses the relationship between exposure to vehicular polycyclic aromatic hydrocarbons (PAHs) and the short- and long-term respiratory effects on children who have well-characterized asthma. The investigators undertook an intensive assessment of exposure to PAHs to test the hypothesis that acute exposures lead to increased symptoms among children with asthma. The research complements an ongoing study of 302 children with asthma, ages 6 to 11 at intake, in Fresno, California, who had already been recruited and for whom voluminous health and exposure data were available (the Fresno Asthmatic Children's Environment Study [FACES]). FACES has been collecting data for 10 years under the sponsorship of the California Air Resources Board ( ) and the National Institute of Health ( ). The investigators used innovative approaches both to develop exposure metrics and to conduct the epidemiologic analyses. The exposure metric made use of information from both filter samples and an innovative application of pine needles as passive dosimeters in an attempt to capture spatial variability in traffic sources. These data were used in land-use regression analyses to construct spatial-temporal models of PAH concentrations throughout the city. By combining these models with data collected centrally at a U.S. Environmental Protection Agency Superfund site, investigators were able to estimate daily concentrations of PAHs with 4, 5, or 6 rings ( PAH456 ) outside the homes of the children with asthma over the same period as health endpoints were collected in the FACES study. These analyses demonstrated a consistent association between estimated individual-level increased PAH concentrations and daily occurrences of morning wheeze. Analysis of associations between forced expiratory volume in 1 second (FEV 1 ) and measures of exposure including individuallevel and central-site estimates of PAH456 and individual-level estimates of phenanthrene did not provide consistent evidence for such associations. An additional component of the study was the development and implementation of a communications plan. Its goal was to provide useful information to study participants and other study stakeholders about the project, project results, and topics related to the project in a manner that was accessible and understandable, without compromising the study activities. When a NUATRC-funded study is completed, the investigators submit a draft research report. The draft report undergoes an extensive evaluation that assesses the strengths and limitations of the study and comments on the clarity of the presentation, appropriateness of the study design, data quality, data analysis, and interpretation of the findings. The objective of the evaluation is to ensure that the investigators' report is clear, accurate, and complete. The evaluation involves, first, a review of the draft report by a team of three external peer reviewers, including a biostatistician. The draft report and the reviewers' comments are then considered by members of the NUATRC Scientific Advisory Panel (SAP). The comments of the reviewers and SAP members are then provided to the investigator. In its communication with the investigator, the SAP might suggest alternate interpretations of the results and discuss new insights that the study might offer to the scientific literature. The investigator has the opportunity to exchange comments with the SAP and, if necessary, revise the draft report. In accordance with NUATRC policy, the Board of Directors approves the publication of the revised final report after the recommendation of the SAP. NUATRC appreciates comments from readers from academic institutions, industry, and government agencies and from the NUATRC RESEARCH REPORT NO. 17, VOL. II

4 public about the usefulness of the information offered in its reports and about ways that NUATRC can more effectively serve the needs of these groups. NUATRC also wishes to express its sincere appreciation to Dr. Katharine Hammond and her research team, the external peer reviewers, and the SAP, whose expertise, diligence, and patience have facilitated the successful completion of this report. NUATRC RESEARCH REPORT NO. 17, VOL. II

5 Report on Communication Activities The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma Mickey Leland National Urban Air Toxics Research Center S. Katharine Hammond 1, Michelle Wong, Ilinisa Hendrickson, Ira B. Tager 1, and Jennifer Mann 1 University of California at Berkeley September 30, 2009 March 28, 2010 Revision 1 School of Public Health, University of California at Berkeley, CA

6 TABLE OF CONTENTS ABSTRACT INTRODUCTION SUMMARY OF AIMS OBJECTIVE 1. ASSESS COMMUNICATION NEEDS RESULTS OF ASSESSMENT OBJECTIVE 2. ESTABLISH REGULAR COMMUNICATION OBJECTIVE 3. COMMUNICATION OF RESULTS TO PARTICIPANTS OBJECTIVE 4. COMMUNICATION OF RESULTS TO STAKEHOLDERS DISCUSSION IMPLICATIONS PERSONNEL REFERENCES ABBREVIATIONS AND OTHER TERMS APPENDICES 1. NEEDS ASSESSMENT QUESTIONNAIRE 2. NEEDS ASSESSMENT RESULTS SUMMARY 3. STAKEHOLDER SURVEY 4. STAKEHOLDER SURVEY RESULTS SUMMARY 5. QUARTERLY NEWSLETTERS 6. QUARTERLY FACT SHEETS 7. KEY INFORMANT INTERVIEWS SUMMARY 8. STAKEHOLDER MEETING REPORTS 9. STAKEHOLDER MEETING EVALUATIONS 10. FRESNO COUNTY PLANNERS PRESENTATION 11. ASTHMA COALITION PRESENTATION 12. CONTINUING MEDICAL EDUCATION (CME) PRESENTATION 13. COVER LETTER FOR SCHOOL PACKETS NUATRC RESEARCH REPORT NO. 17, VOL. II

7 S. Katharine Hammond et al ABSTRACT The goal of the communications portion of the Fresno Asthmatic Children's Environment Study (FACES) and Mickey Leland National Urban Air Toxics Research Center (MLNUATRC) PAH collaborative project was to provide useful information to study participants and other study stakeholders about the project, project results, and topics related to the project in a manner that was accessible and understandable without compromising the study activities. The principal barriers encountered during the implementation of the communications activities were staff turnover and limited staff time compared with the work at hand. Despite these staffing and time limitations, we achieved the communications goal by completing the following aims: assessment of the communication needs and interests of study participants and other stakeholders, establishment of regular communication with study participants and other stakeholders, communication of aggregate results to study participants, and communication of key study results to the larger stakeholder audience. In response to the staff and time limitations, some changes were made to the originally proposed work-plan activities. However, because the plan was designed to be flexible, almost all of the activities and performance measures were completed. Furthermore, feedback from participants and other stakeholders engaged through this process about the project and the communications activities has been overwhelmingly positive. The work accomplished through this communications plan has served to connect our research team with the participant and stakeholder communities, fostering relationships and collaborations that have facilitated participant and community trust and satisfaction with the study and have increased dissemination of study results. INTRODUCTION Many communities recount their experiences with researchers as less than positive, often because researchers do not return the results to the community or provide assistance with application of the results to help improve the well-being of the community. This might result in a general perception that researchers do not care about participants and hence in an unwillingness to participate in future research studies (Brauer et al., 2004). An effective communication strategy for a research project must communicate information back to participants in a useful, understandable, accurate, and timely manner (Covello 2003) without affecting the outcome of the study. Additionally, when audiences are not aware of or engaged in a process, they are less likely to access, trust, or utilize information that is communicated to them (Brauer et al., 2004). A strong communication plan benefits both researchers and the community in which they are conducting their research. However, communications plans are infrequently required or supported through research funding. The Fresno Asthmatic Children's Environment Study (FACES, which began in 2000 as a 5-year project funded by the California Air Resources Board and is currently being funded by the National Institutes of Health (NIH) until 2011, did not at first have a deliberate communication strategy or plan. The goal of FACES is to examine the health effects of air pollution in children with asthma. The study addresses several research questions. First, it examines the effects of daily air pollution concentrations on short-term asthma exacerbations and might help identify children with asthma who are more sensitive to regional and seasonal pollutants. Second, it examines whether these short-term asthma exacerbations influence the progression of childhood asthma over the course of several years. Third, it examines whether other environmental factors such as tobacco smoke, allergens, or housing characteristics influence children's responses to air pollution. A total of 302 children and their families were recruited from local healthcare organizations and through community advertisements. To be eligible for the study, children were required to have a physician diagnosis of asthma, current asthma symptoms, be 6 to 11 years old upon entry into the study, live in the geographic region for which detailed air pollution monitoring data were available, and speak English. Children with parents who spoke Spanish primarily were also eligible for the study. The full research team includes investigators from numerous academic and healthcare institutions and the private sector. Limited communication activities were initiated as part of the effort to recruit study participants or occurred during routine visits between study participants and field staff. As the long-term study moved into its final stages of data collection and publication of results began, FACES continued to lack the resources to develop and implement a formal dissemination and communication plans for participants and stakeholders. In 2006, the Mickey Leland National Urban Air Toxics Research Center (MLNUATRC) funded Short- and Long- Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma, a FACES substudy that utilized FACES health and air pollution data (while funding NUATRC RESEARCH REPORT NO. 17, VOL. II 7

8 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma additional sample collection, chemical analysis of samples, data collection, analysis, modeling and exposure estimates for PAHs as well as epidemiologic analyses based on the PAH exposures). At that time, the Center requested a plan to incorporate a formal communications component into the newly funded study. In 2007, the Center funded a corresponding plan for communicating results from the substudy and from FACES, the results of which are described in this report. FACES incorporates research funded by the California Air Resources Board, the U.S. Environmental Protection Agency (EPA), NIH, and MLNUATRC; and the communications reported here were funded by NIH and MLNUATRC. In this report, the term FACES results should be understood to include the results of the PAH substudy. The project staff learned the value of flexibility in a communication plan firsthand; communication activities need to happen as a collaborative effort between project staff and the participant and study community and are rarely carried out as originally planned. Our plan encountered a number of challenges along the way, including those of staffing and time limitations. However, project staff was able to change activities as needed and managed nonetheless to complete almost all that was proposed in the original plan, including developing, pilottesting, administering and analyzing a participant survey; developing, distributing, and translating newsletters to all study participants; distributing fact sheets to all study participants; creating a study website; developing, pilottesting, administering, and analyzing a stakeholder survey; and identifying stakeholder meeting co-hosts and holding stakeholder meetings. SUMMARY OF AIMS The communication plan intended to establish positive communication between the researchers and the participant and stakeholder communities. Through our efforts to communicate key results to study participants and engage them in the study process, we aimed to increase participant access, trust, and utilization of study information as well as to increase maintenance of participant contact. Our engagement of nonparticipant stakeholders aimed to increase broader stakeholder awareness of study details and results as well as to increase support for current and future efforts, such as results dissemination or new research studies (Brauer et al., 2004; Parkin 2004). The formulation and execution of our communication plan was guided by the following communication aims: Communicate information that is relevant, significant, and interesting to the audience; Communicate information in a manner that is understandable and useful to the audience and is considerate of their values; Communicate information in a scientifically accurate manner; Communicate results to participants in a timely manner, so that they receive the information before or at the same time as results become public; Communicate information in a manner that does not undermine the study approach; Approach our audiences with honesty and transparency, especially around expectations for when and what information will be communicated. These aims were developed during the formulation of the communication plan as part of a team project-planning session, drawing from the experiences of a health education consultant and the priorities of the project team as well as taking into account considerations for maintaining the scientific integrity of the study. These aims are manifested in the four objectives proposed in the communication plan: 1. Assess the communication needs and interests of study participants and other stakeholders; 2. Establish regular communication with study participants and other stakeholders; 3. Communicate individual and aggregate results to study participants; and 4. Communicate key project results to the larger stakeholder audience. Information gathered for the communication plan, while presented here using the research language of methods and results, is not and was not intended to be research. No health data or other personal data were collected. Instead, the information was used to gain a basic understanding of the possible interests in study results from the two intended audiences (participants and potential local stakeholder organizations). Though we did not collect personal or health data as part of the communication plan, human-subjects approval was received under the FACES institutional review board protocol for a participant-needs assessment before the assessment was deployed. The Office for the Protection of Human Subjects at the University of California, Berkeley determined that no other work included in the communication plan required humansubjects approval. 8 NUATRC RESEARCH REPORT NO. 17, VOL. II

9 S. Katharine Hammond et al Table 1. Activities undertaken to meet each objective OBJECTIVE Activity 1 Activity 2 Activity 3 1. Assess communication needs Conducted participant needs assessment Conducted online stakeholders survey 2. Establish regular communication Mailed newsletters to participants Mailed fact sheets to participants Created and maintained website 3. Communicate individual and aggregate results Communicated aggregate results via newsletter and website Based on feedback, ceased providing individual results Communicated aggregate results via stakeholder meetings 4. Communicate key project results Conducted key informant interviews Conducted three stakeholder meetings Mailed information packets with key project results to schools district stakeholders OBJECTIVE 1. ASSESS COMMUNICATION NEEDS To address our first objective, we completed both a participant-needs assessment and an online stakeholder survey. Participant-needs Assessment (Appendix 1) In order to understand how to better communicate information with the study participants, a participant-needs assessment was recognized to be crucial. Though basic, the needs assessment contributed to our understanding of the participants' reasons for involvement or interests in the study, concerns related to the study topics, other topics of interest, and the most appropriate and desirable forms of communication for study participants and their families. It also helped identify potentially sensitive or controversial topics as well as providing insight into participants' expectations and desires about how the study results might be used to improve health or influence health-related policy or action. We had originally planned to conduct the needs assessment through written surveys administered to participants during office visits. However, with input from the field staff and in consideration of the limited number of office visits planned per participant, we determined that telephone interviews would be a more appropriate and effective option for reaching a larger sample of the participant group. Furthermore, participants were already accustomed to regular communication from study personnel by way of telephone during the duration of the study, and field staff could administer the questionnaire in the course of their regular communications with participants. For the needs assessment, we did the following: Pilot-tested the questionnaire with 17 volunteer participants by way of phone interviews. Volunteer participants were chosen randomly by convenience, because they were already scheduled to be called for a regular phone check-in at the time the questionnaire was ready for testing. Found that no changes were needed based on pilottesting results. Administered the questionnaire to 33 participants by way of phone interviews. Participants were interviewed during regularly scheduled phone check-ins. The 33 participants were chosen as a convenience sample, because they were scheduled to be called at the time we began administering the questionnaire. Generally, the questionnaire took between 5 and 10 minutes to complete, as had previously been confirmed during the pilot-testing phase. Administered a Spanish-language questionnaire to four Spanish-speaking parents by way of phone interviews during the pilot-testing and regular questionnaireadministration processes. Compiled and analyzed the needs assessment. Stakeholder Survey (Appendix 3) The overarching goals of the stakeholder survey were (a) to gain information that would be used to inform implementation of the FACES communication plan and (b) to improve our ability to maximize the use of FACES results for policy and public health action. The specific goals for the stakeholder survey were the following: 1) To learn who (i.e., what types of groups, which groups, and which individuals) the FACES stakeholders were; NUATRC RESEARCH REPORT NO. 17, VOL. II 9

10 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma 2) To learn about the stakeholders' perceptions of FACES; 3) To learn about the asthma- and environment-related interests and information needs of the stakeholders (by type of stakeholder); 4) To learn about the communication needs of the stakeholders (i.e. how they wanted FACES to communicate with them now and in the future); 5) To use the survey as an outreach opportunity to demonstrate that FACES was interested in local concerns and partnership, to reintroduce FACES, to increase interest in FACES; and 6) To learn what stakeholders perceived to be the obligations of FACES scientists to support or promote the use of the FACES results for advocacy or policy change. For the online stakeholder survey, we used a web-based survey service, SurveyMonkey, and solicited responses from 28 stakeholder organizations, ranging from community groups to the Fresno Department of Public Health and the Fresno Unified School District. Some of these organizations were chosen from an existing list of contacts; others were identified by way of an Internet search for Fresno-based organizations or organizations conducting work in Fresno whose activities appeared to be directly or indirectly related to any of the following areas: air quality, asthma, health services, environment, public health, and policy. Some (e.g., the school district) were chosen based on their relationship to topics of interest (e.g., asthma awareness in schools) identified through the participant-needs assessment. In order to generate more responses and reach more organizations, the survey recipients were invited to pass the survey along to others who might be interested in FACES. We tried our best to identify organizations that might be interested in the FACES results but recognized that we would not be able to identify all of them. We felt that the organizations that we did contact could be helpful in identifying others who might also become interested stakeholders. Unlike a research survey with either carefully limited or randomly selected respondents, this survey was intended to capture information from as many respondents as possible. We were not overly concerned about the survey being answered by organizations with absolutely no connection to the topic, as it seemed unlikely that organizations would spend time filling out a survey with no relevance to their work. Instead, we wanted to ensure some opportunity for input from organizations that we might not otherwise have identified as stakeholders but who had a relevant interest in FACES results. We completed the following activities for the online stakeholder survey: Pilot-tested our questionnaire with project staff that were not involved with the development of the questionnaire, including staff at the Fresno office. Because of a shortened timeframe and the loss of key staff at the time, an ideal pilot-testing with representatives of external stakeholder groups was not implemented. Made minor changes to the questionnaire based on pilottesting. (Because we did not have a lead health educator with enough time to review the documents in detail, some mistakes were made in the skip pattern of this survey and were not caught during the numerous other reviews.) Administered the online survey to 23 respondents. Analyzed the survey results, which had been compiled and calculated by SurveyMonkey. The results of the stakeholder survey guided the planning and implementation of the stakeholder meetings. RESULTS OF ASSESSMENT Participant-needs Assessment Fifty participants answered the participant-needs questionnaire administered by way of telephone (the results from the 17 pilot-testing respondents were combined with those from the 33 questionnaire respondents, because the questionnaire had not changed). Among the findings from the assessment were the following: Almost all of the respondents enjoyed their experience as a FACES study participant (94%). Positive relationships with the study staff were a main reason for continuing with the FACES study (96%). Participants had remained in the study because they learned more about asthma (86%), liked the incentives that had been provided over the years for participation in the FACES project during the duration of the study (such as quarterly raffles) (78%), and felt their child's asthma had improved (78%). Most respondents (96%) hoped that the study results would be used to educate people about the dangers of air pollution for people with asthma and how to protect their children from harm when air pollution is at unhealthy levels. Numerous respondents noted a desire for results and information to be shared with schools. Most respondents (96%) hoped to encourage support for air quality improvement in Fresno and (92%) hoped that the results would be used to force air quality 10 NUATRC RESEARCH REPORT NO. 17, VOL. II

11 S. Katharine Hammond et al improvements in Fresno. (Note: Although the sentiment of wishing to force air quality improvements was not unusual in Fresno - to judge from our interactions with residents and community-based organizations around their frustrations about air quality regulations and policymaking - it might be the case that the survey question could have been better worded as, for example, provide evidence that leads to air quality improvements. Our intention was to assess the participants' desire for or expectation that the study results lead to significant action, regardless of actual feasibility.) A response that was added many times as a write-in was the hope that the results and information would be shared with schools. When respondents were asked how they thought the results from FACES would actually be used, most (96%) said they thought that the results will help people learn more about how air pollution is harmful to children with asthma. However, a majority of respondents (64%) did not believe that people would pay attention to the results. A total of 60% of respondents were not sure how the results would be used. When asked whose opinions about health information they trusted: 89% of respondents said they trusted information from the FACES staff, 89% said they trusted information from their doctor, and 94% said they trusted the information in newsletters from their healthcare provider. With regard to communication from FACES: 90% of respondents said that they actually read their individual EZ1 reports, 78% said they thought the EZ1 reports helped to improve their child's asthma, and 100% said they felt the communication from FACES has been just right. When the data collection phase was over: 94% of respondents said they would be interested in hearing the study results, and 90% said they would like to learn about related scientific topics. For future communications, respondents answered a series of questions related to what would make them more likely to read mail from FACES: 100% of respondents said they would be more likely to read mail if the information were interesting, current, and contained tips on improving health, and 97% said they wanted the information to be easy to understand. The topics that respondents were interested in hearing more about included: Caring for their child's asthma (82%), Why air pollution is bad for people's health (80%), and How to get involved with local groups that are interested in asthma and reducing air pollution in Fresno (72%). Not all percentages for the questions added up to 100%, as multiple choices were allowed in some questions, and a number or respondents skipped questions. A detailed summary of the results is given in Appendix 2. When developing the needs assessment, we recognized that because of limited staff resources and a shortened timeline the amount of information we would be able to gather would be limited. We also knew we would not be able to distinguish specific needs among segments of the participant group, nor could we realistically assess participants' prior knowledge or understanding. Given the scope of the project, we felt that information about perceptions would still be useful. To avoid creating false expectations among the participants, we attempted to limit our questions to communication issues that we felt the study team could realistically address within the FACES timeframe. Finally, our desire to gather information about the participants needed to be balanced with consideration to participant burden and responsiveness and with the aforementioned staff and time limitations. Even within the limited scope of the needs assessment and after pilot-testing the questionnaire, the questionnaire had areas for improvement. These were related to the flow of the questions (e.g., indicating when questions could be skipped), the choices of answers provided (e.g., not assessing participant's trust in family or religious leaders as sources of environmental or health information), or interpretation of wording (e.g., asking about information details could be interpreted as amount of information or variety of information), leading in some cases to apparently contradictory results. In spite of these few potentially problematic areas, we found the information gained through the assessment to be useful. The needs assessment, though basic, did enable us to gather information that suggested that our proposed plan to use newsletters and fact sheets with the participants was appropriate. It also indicated that participants generally felt positive about FACES even after years of participation and that FACES was generally a trusted source of information - another affirmation of the value of our communication NUATRC RESEARCH REPORT NO. 17, VOL. II 11

12 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma plans (i.e., if FACES had not been trusted, we would have had to reconsider our entire communication strategy). Furthermore, the results of the participant-needs assessment (in particular Question 12), which were useful in guiding the selection of newsletter and fact sheet topics. The responses about desired actions from study results and about trusted information sources also informed our efforts in identifying participants for the stakeholder survey. Results from the needs assessment might also provide useful information for future studies in Fresno. Online Stakeholder Survey The invitation to participate in the online survey was ed to 28 organizations. Participants were permitted to complete the survey anonymously but were asked to identify the type of organization they represented. Twentythree stakeholders from various community, nongovernmental, and governmental organizations completed the survey. Of the 23 respondents, 13 representing 10 distinct organizations chose to supply contact information so that they could be notified of future FACES developments. Although we chose to allow participants to submit the survey anonymously in hopes of increasing the response rate, in retrospect requiring identification might have provided more useful information. Conducting the survey online, rather than in person or by way of telephone, was an efficient way to collect information. invitations were sent to the following organizations: 1. American Lung Association in California - Fresno 2. California State University at Fresno 3. Center on Race, Poverty, and the Environment 4. Central California Center for Health and Human Services at California State University at Fresno 5. Central Valley Air Quality Coalition 6. Coalition for Clean Air 7. Community Medical Center Fresno 8. Dolores Huerta Foundation 9. El Comité Para Bienestar de Earlimart 10. Fresno Asthma Coalition 11. Fresno Bee 12. Fresno City Council 13. Fresno City Mayor's Office 14. Fresno Council of Governments 15. Fresno County Bicycle Coalition 16. Fresno County Department of Community Health 17. Fresno-Madera Medical Society 18. Fresno Metro Ministry 19. Fresno Native American Health Center 20. Fresno Unified School District 21. Hmong American Community 22. Latino Issues Forum 23. League of Women Voters - Fresno 24. Lideres Campesinas 25. San Joaquin Valley Health Consortium 26. San Joaquin Valley Unified Air Pollution Control 27. Sierra Club - Tehipite Chapter (Fresno) 28. University of California at San Francisco - Fresno campus Respondents from the following organizations opted to leave their contact information: 1. American Lung Association in California - Fresno 2. The Bakersfield Californian 3. Californians for Pesticide Reform 4. Central California Regional Obesity Prevention Program 5. Central Valley Air Quality Coalition 6. Coalition for Clean Air 7. Fresno County Department of Health 8. Fresno-Madera Medical Society 9. Fresno Unified School District 10. San Joaquin Valley Health Consortium We were able to follow up with all respondents who indicated that they would be interested in a stakeholder meeting and collaborated with a number of them for a series of such meetings. The survey results are shown in Appendix 4. Among the findings from the stakeholders survey were the following: The respondents were from diverse stakeholder groups: The majority of respondents identified themselves as a nongovernmental or nonprofit organization or a community-based/grassroots organization (56%), Another 26% identified themselves as a local government agency, and The remaining respondents included one media representative, one academic, one nonprofit advocacy organization and one membership organization for physicians. The primary focus of these organizations was: Public health (39%), Environment (17%), or 12 NUATRC RESEARCH REPORT NO. 17, VOL. II

13 S. Katharine Hammond et al Education (8.7%) Almost half of the respondents were familiar with FACES (41%); nearly a quarter had never heard of it (24%). In response to the questions about the usefulness of FACES data, an overwhelming majority of respondents said that they would be interested in the results and would use the data either directly or indirectly in their work. The first choice for keeping updated on FACES information was an e-newsletter (73%). The first choice for learning about the release of FACES results was notification with link to website (41%). More than one-third of respondents stated that they were interested in working with or contributing to FACES (35%), and 26% said they would be interested in participating in a presentation or meeting. Most respondents said that they would be interested in learning when FACES datasets were ready for public use (71%). The results of the stakeholder survey reinforced our belief that the FACES results were of interest to a broad stakeholder community in Fresno and that efforts to communicate study information and results would be welcomed. OBJECTIVE 2. ESTABLISH REGULAR COMMUNICATION To address our second objective, we developed and mailed newsletters to study participants. The newsletters were accompanied by fact sheets related to information in the newsletters. We also established a project website, an unplanned activity that was initiated in response to the stakeholder survey. Newsletters (Appendix 5) We completed and mailed three newsletters. All newsletters were translated into Spanish, as many of the participants' families were monolingual Spanish speakers. Two of the newsletters were created after the participantneeds assessment, which allowed us to use the responses from the assessment to develop newsletters that reflected the stated needs of the participants. Fewer newsletters were developed than originally proposed, because of challenges in staff recruitment and retention (see Discussion). Furthermore, because of these limitations in staffing and time as well as the challenges of communicating scientific information in lay language, we were not able ensure that the newsletters were written at an appropriate reading level (we did not assess each participant's reading ability), though a sixth- to eighth-grade reading level would have been desired. It was an even greater challenge to ensure that Spanish translations were made using simple Spanish, because there were no fluent speakers on the study team to review such documents and because of limited resources for testing. None of the newsletters were pre-tested. Revisions by investigators and staff took several weeks, as did the Spanish translation after finalization of the newsletter. Pre-testing was not a possibility, given our limited timeframe and staffing resources. However, newsletter topics were based on the information participants had indicated that they would like to receive. The first newsletter was mailed in summer It included information about newly published results from FACES data, which reported that decreased lung function in children is related to exposure to traffic pollution during the mother's pregnancy. It also included information about the use of pine needles to measure concentrations of PAHs in different parts of Fresno and how this information would contribute to the FACES researchers' understanding of the effects of traffic pollution on asthma in children. Finally, the newsletter included information about California wildfires, their impact on health, and how to reduce wildfire exposure. The second newsletter was mailed in fall In response to the participant survey, and having learned about interest by participants in having more information on air quality and asthma groups, the newsletter highlighted various government agencies and their work on these topics. It also included information about the health effects of wood smoke and ways to minimize exposure to it. The third newsletter was mailed in spring It contained information about the California Air Resources Board's new diesel regulations and a summary of their benefits. The newsletter also continued the list of organizations working on asthma and air quality, this time focusing on various nongovernmental and grassroots organizations in the Central Valley, with opportunities to get involved in their work. A fourth newsletter had been scheduled to be sent out in October 2009; however, because of staff limitations, it was not possible to complete this newsletter. It was intended to include information about the causes and effects of coarse particulate matter as well as a summary of a recent FACES publication entitled Altered Pulmonary Function in Children with Asthma Associated with Highway Traffic. Work from the fourth newsletter, in addition to several recently published articles by study investigators, can be NUATRC RESEARCH REPORT NO. 17, VOL. II 13

14 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma incorporated into the community outreach activities of the Berkeley/Stanford Children's Environmental Health Pre- Center (an extension of the work done by FACES), currently pending funding from the National Institute of Environmental Health Sciences and the U.S. EPA. Fact Sheets (Appendix 6) Included with each newsletter was a fact sheet containing information related to the issues included in that quarter's newsletter. The fact sheets were created in place of those proposed for the communication of individual results (Objective 3). Originally we had planned to create our own fact sheets, but this was not necessary given the excellent fact sheets available already. We chose fact sheets from the Centers for Disease Control (for use with the summer 2008 newsletter), San Joaquin Valley Air Pollution Control District (for fall 2008), and the California Air Resources Board (for spring 2009) because these agencies would be well recognized by participants and because they had already created fact sheets that were relevant to our newsletter topics. Furthermore, these were trusted agencies whose recommendations are supported by welldocumented data. We also covered the San Joaquin Valley Air Pollution Control District and the California Air Resources Board in our Getting Involved segment in the fall 2008 newsletter. As the study developed, field staff and investigators realized that participants were far less interested in individual results than they were in aggregate results and general information related to asthma and air quality, as shown in the needs-assessment summary. Only half (55%) of the respondents in the needs assessment said they had found the earlier individual EZ1 reports useful, but 94% said they would be interested to learn about results of the study (Appendix 2). The fact sheets mailed (or planned to be mailed ) with each newsletter were: Summer Fire Safety: Wildfire (from the Centers for Disease Control) Fall Check Before You Burn (San Joaquin Valley Air Pollution Control District) Fall Fresno County Asthma Profile (from the California Breathing state health department initiative) Spring Truck and Bus Regulation Emissions Reductions and Health Benefits (from the California Air Resources Board) Fall a fact sheet on particulate pollution (from the U.S. EPA) [note: this newsletter and associated fact sheet were not mailed] Website We developed a website for FACES in response to the stakeholder survey results and in an effort to communicate results and updates effectively and conveniently to both participants and stakeholders. This activity was not included in the original proposal, but the interest expressed in the surveys and the advantages of an immediately accessible resource were deemed to be responsive to participant and community needs and thus justified the effort. The website consisted of a Welcome homepage with a brief summary of FACES and the latest news from the study, including publications, the latest newsletter, or links to surveys. The website also included an About the Study page with a more detailed history of FACES as well as a subpage dedicated to the MLNUATRC study. The website also contained a page dedicated to the study personnel and a page of photos and a Contact Us page with the mailing address, phone number, and fax number for our field office as well as a study address. Finally, there was a Publications page where visitors could access all of the newsletters and fact sheets in PDF format. The page also contained links to PubMed summaries of the FACES publications and a list of noteworthy presentations given about the study. The website still exists and is located at facesproject.berkeley.edu. It is updated on a regular basis by study personnel. A key advantage to communication through the website is that, now that the site has been developed, maintenance is not resource-intensive and the website can be minimally maintained regardless of the future of the larger communication effort. It is one way in which long-term communication has been established for FACES through this communication effort. We have recently updated the site to include a feedback function. We were unable to do this previously because sites created with the open-source blog publishing application WordPress, like ours, are particularly prone to spammers, and we did not at the time have a dedicated study address. Without a dedicated address, feedback -along with a great deal of spam - would have gone directly to individual project team members' accounts, which was not safe or preferable. We recently created a dedicated address, and posted it to the website so that questions or comments can be received indirectly by study staff. The study administrator and field office coordinator 14 NUATRC RESEARCH REPORT NO. 17, VOL. II

15 S. Katharine Hammond et al currently have access to this account and can direct feedback to the appropriate person(s) for response. In our stakeholders' meetings and information packets for the schools, we shared the project website URL with the participants as a way for them to keep abreast of new project results and publications. OBJECTIVE 3. COMMUNICATE RESULTS TO PARTICIPANTS To address this objective, we used the study newsletters to provide aggregate data results to participants. Aggregate results In the summer 2008 newsletter (Appendix 5), we shared study results on prenatal and lifetime exposure to air pollutants and pulmonary function in children. We will also include aggregate study results on traffic proximity and asthma in our final newsletter, which will be mailed to participants in fall In addition to the newsletter, the FACES website links directly to published study results. In the stakeholder survey, the respondents' first preference for staying updated on FACES general information was an enewsletter (73%); the stakeholders also identified notification with link to website (41%) as their preference for reporting the release of FACES results in publications. Having established both a website and a newsletter that will be sent to stakeholders electronically, we have been able to disseminate aggregate results successfully in accordance with stakeholder preferences. Individual Results As noted in the section on Objective 2, on establishing regular communication, both investigators and field staff personnel (who had been interacting with participants for more than 8 years) suspected that participants were less interested in receiving individual reports, which were likely of limited utility to them, than they were in receiving aggregate study results and health information related to asthma and air quality in the Central Valley. This was confirmed in the needs-assessment results. Only half (55%) of the respondents in the needs assessment found the earlier individual EZ1 reports useful, while 94% of respondents stated they would be interested in learning about results of the study, 87% wanted updates on study activities, and 97% wanted information about current events related to asthma and air quality. We therefore determined that the results would best be communicated in the newsletters. Stakeholder Meetings Additionally, all participants and their families were invited to a stakeholder meeting held in conjunction with the Fresno Asthma Coalition on August 14, The participants were mailed invitations to the meeting. Because the meeting was held in conjunction with a regularly scheduled Asthma Coalition meeting, it was held during work hours. It is likely that the timing of the meeting made it difficult for participants to attend. However, two families did attend, including one participant child that had been with FACES since the beginning of data collection. Meetings of this kind might not be the best venue for communicating with participants. This is congruent with the previous experience of FACES staff, who had organized participant parties and picnics in the past with limited attendance. OBJECTIVE 4. COMMUNICATE RESULTS TO STAKEHOLDERS To address this objective, we first conducted a series of key informant interviews. These interviews served to collect information from people who had a wide range of knowledge about the Fresno environmental health community. The informants were helpful in providing insight into the community and helping our communication consultant get a better picture of the way the community operates (The Access Project, 1999). Ultimately, we used the information we gathered to identify co-hosts and plan stakeholder meetings. We have held three stakeholder meetings. The meetings represented an opportunity for the project team to learn about and to establish relationships with stakeholders who are likely to play a role in using project results to advance public health action and policy. For the attendees, the meetings were an opportunity to learn about the project results, provide input to the project team, and network and share ideas with other stakeholders. Key Informant Interviews (Appendix 7) The key informant interviews conducted for FACES proved to be an invaluable asset to stakeholder communications. Because the communication consultant who replaced our graduate-student researcher (see Discussion) began her work in June with fewer than 3 months to complete the stakeholder meetings, it was imperative to have a quick yet thorough introduction to the environmental health community in Fresno. The consultant NUATRC RESEARCH REPORT NO. 17, VOL. II 15

16 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma solicited nine informants by way of phone and . The individuals solicited were chosen to represent a broad range of interests in the environmental health community, ranging from medical and public-health interests to cityplanning and community-advocacy interests. All of the individuals were required to have above-average knowledge of the environmental health community in Fresno. The consultant succeeded in conducting key informant interviews with five individuals, three of whom had responded to the FACES online stakeholder survey. The interviews were each no more than a half hour long and were conducted by way of telephone. Even with such short interviews, they served to create a good rapport between the communication consultant and the informants, which greatly aided the consultant in establishing ties in the community. The informants represented the following organizations: The Fresno-Madera Medical Society; The Fresno Department of Public Health, Office of Policy, Planning and Communication; The American Lung Association - Fresno; The Fresno Asthma Coalition; and The Central Valley Air Quality Coalition Two informants were health educators, one was an air quality director, one was a programs director, and one was in charge of community outreach. All worked on asthma issues, with activities ranging from coordinating the Fresno Asthma Coalition and middle-school asthma prevention programs to administering a grant from the Centers for Disease Control to help planners incorporate health data into their work. All five key informants offered to co-host a meeting with FACES. These connections were vital, and all three of the meetings for stakeholders had informants as co-hosts. The interviews were also important for the recruitment of stakeholder attendees. The consultant sent invitations to all key informants for the community stakeholder meeting, who then forwarded the invitation to their environmental health contacts. These connections greatly aided in recruiting a diverse group of attendees. Stakeholder Meetings (Appendix 8) We had originally intended to host three meetings over a long period of time, with the same group of stakeholders providing input to the project and feedback about the results. However, because of staffing limitations, we were not able to start organizing these meetings until summer A year before, we had hired a graduate-student researcher to lead the communications activities. However, she left the position to focus on her schoolwork, leaving a gap in staff resources that we were able to fill by hiring an experienced communications consultant. The consultant's expertise in health education and stakeholder involvement enabled us to organize the meetings with strong co-hosts and with the potential for many attendees. The cost of this expertise, however, was great and would not have been sustainable under our original plan. As a result, we were able to employ her only on a temporary, part-time basis. Given the time and staff limitations, and with the benefit of the stakeholder survey, we decided to hold three separate meetings for distinct stakeholder audiences. An unexpected benefit of the delayed timeline was that several study results had been completed, and we were able to present them to stakeholders at the meetings. We completed the following activities to meet this objective: Identified a co-host for each of the three stakeholder meetings; Held all three meetings; Wrote and distributed meeting notes (Appendix 8); and Assembled and analyzed meeting evaluations for each meeting (Appendix 9). The first stakeholder meeting was with Fresno city and county planners and Clovis city planners who were working with the Fresno Department of Public Health to create a toolkit that focused on design aspects of cities, and the prevention of asthma (for the presentation, see Appendix 10). We held this meeting on August 5, 2009, in Fresno with 13 participants and two FACES staff members in attendance. The planners are hoping to incorporate FACES data into their policy plans. Evaluations of the meeting were completed by 12 of the 13 participants and were overwhelmingly positive (Appendix 9). When asked about what FACES data most interested them, the planners gave a variety of answers, including maps of air pollution in Fresno, the number of people with asthma, and information about the health effects of traffic pollution. The planners also entered into a discussion about how FACES data could translate into policy. Some of the points made in the discussion included the following: FACES data could be used for the Fresno County General Plan; FACES data could be used for mitigation measures, 16 NUATRC RESEARCH REPORT NO. 17, VOL. II

17 S. Katharine Hammond et al such as pedestrial and bicycle trails to reduce air pollution from vehicular traffic, because local data give the measures more legitimacy; The region's transportation process, blueprint process, and congestion-management process could use FACES data; and Recommendations for land use policies could be affected by FACES data. Most of the planners said that they would prefer to be updated on FACES results via , although a number of them also said that they would visit the FACES website. The meeting served as an excellent first introduction to a group of people who were active in the Fresno area and excited to incorporate FACES data into their work. The second stakeholder meeting was with community groups that worked on asthma and air quality issues as well as with study participants and their families. The meeting was co-hosted by the Fresno County Asthma Coalition and was held August 14, 2009, with 21 participants and five FACES staff members in attendance (for the presentation, see Appendix 11). Evaluations of the meeting were completed by 17 of the participants and were overwhelmingly positive (Appendix 9). When asked about their interest in FACES results, participants gave a wide array of responses, including the following: Specific FACES data could be used for community advocacy and to support advocacy efforts; FACES health data and results are important for advocating for clean air; FACES results could be used for policy advocacy, future project development, and funding opportunities; and Local data that are published and available are very valuable to the community. A few of the participants entered into a discussion about the importance of local data, and a number of people commented that it would be helpful to begin published articles with an introduction that included basic statements about all that has been proven about the relationship between asthma and air pollution. A number of participants asked about the availability of FACES datasets and remarked on how they were looking forward to using them in their work. The majority of participants said they wanted to be notified via , although a number also said they would check the FACES website. The meeting had representatives from most of the environmental health, air quality, and asthma groups in Fresno in attendance. Most people commented on how eager they were for FACES results and wanted to make sure they were notified as soon as results became available and were published. The third meeting was co-hosted by the Fresno-Madera Medical Society and offered Continuing Medical Education credits to medical providers who were interested in learning about air quality and asthma in Fresno. The meeting was held at the Fresno-Madera Medical Society in Fresno on October 29, 2009, and had 19 participants, two co-presenters, and three FACES staff members. In the first half of the program, Dr. Katharine Hammond and Dr. John Balmes of FACES shared FACES results and discussed the studies in progress (for the presentation, see Appendix 12). Dr. Jose Joseph and Dr. Maries Joseph, physicians at the Fresno campus of the University of California at San Francisco, presented current asthma-education information in the second half of the program. During the presentation by Dr. Hammond and Dr. Balmes, participants asked a number of questions, ranging from the differences among PAHs to the effects of agricultural burning on air quality and asthma as well as the effects of pesticides and spraying on asthma. Unfortunately, most of the participants left the program during the second half of the program (during the co-presenters' presentation) and therefore did not fill out the evaluation forms that were distributed at the end. From the six evaluations we did receive, most respondents noted that the presentation was presented in a way that was understandable to them. Additionally, the majority of respondents indicated that they would be very much interested in following all six FACES future results about which we asked (for evaluation results, see Appendix 9). We had hoped to hold a fourth meeting for the Fresno Unified School District and participant families in order to share results from the school monitoring and the FACES results in general. However, this proved to be difficult because of the timing of summer break and the beginning of the school year. The communication consultant therefore prepared and mailed information packets on the FACES study to all 13 principals and vice principals at the schools that had had monitoring trailers on the premises (i.e., five in the Fresno Unified School District and one in the Clovis Unified School District) and to school nurses. The packets were sent to the following people: Schools with monitoring trailers Forkner: Principal Kay Davies, Vice Principal Gay Ockey Bullard Talent: Principal Sue Fuentes, Vice Principal Terry Marinaro Copper Hills: Principal Christine Archer NUATRC RESEARCH REPORT NO. 17, VOL. II 17

18 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma Burroughs: Principal Misty Her, Vice Principals Carlos Castillo and Paul Griffin Fremont: Principal Deborah Schlueter, Vice Principal Diane Steele Viking: Principal Ron Bohigian, Vice Principal Christie Yang Fresno Unified School District, Office of the Superintendent Superintendent Michael Hanson Assistant Superintendents of Elementary Education Rosario Sanchez, Holland Locker, and Dr. Sue Smits Clovis Unified School District, Office of the Superintendent Superintendent David Cash Nursing and health education staff Glena Walke, nurse at the Fresno Unified School District and coordinator of a Division of Adolescent and School Health grant from the Centers for Disease Control Jeanne Prandini, director of nursing at the Clovis Unified School District The packets also included a cover letter from Dr. Katharine Hammond (Appendix 13), abstracts of all published journal articles about the research, FACES newsletters and fact sheets, contact information for FACES staff, and information on how to stay updated on FACES study results and publications. Despite the challenges in initiating and implementing the stakeholder meetings, the three completed stakeholder meetings were deemed to be successful in helping to accomplish the following: Establishing contacts and initiating relationships with stakeholders, Sharing information about FACES and study results, Learning which results interested stakeholders and how results might be used, and Discovering the best methods for continuing contact and future communications. As stated earlier, it was not ideal to have started the process of stakeholder engagement so late in the project. Although the late start enabled us to share study results with stakeholders at the meetings, we missed out on many months of dialogue with the stakeholder community and the opportunity for stakeholders to provide the study team with input while data were still being collected. DISCUSSION The communication plan and activities were intended to help establish positive communication between the researchers and the participant and stakeholder communities. Through our efforts to communicate key results to study participants and engage them in the study process, we aimed to increase participant access, trust, and utilization of study information as well as to increase maintenance of participant contact. Our engagement of nonparticipant stakeholders aimed to increase broader stakeholder awareness of study details and results as well as to increase support for current and future efforts, such as results dissemination or new research studies (Brauer et al., 2004; Parkin 2004). Although this plan was not implemented exactly as originally proposed, we have accomplished the overall objectives of communicating with both the participants and the stakeholders. We have also learned much from each activity, even in the modified forms. Principal challenges Several factors contributed to challenges in implementing the communications plan, often resulting in delays in conducting proposed activities or implementing activities as originally proposed. First, the lack of experience of the principal investigator in conducting a formal communication component as part of a field scientific study was a challenge, because communications activities require specialized management and supervision skills just as much as research activities do. Good communication components are rare in research studies, and MLNUATRC is to be commended for requesting a communications plan and funding it. The investigators were able to hire a communications consultant to develop the communication plan after the original grant was funded, which set the framework for a feasible and effective plan. However, because funding for the communication plan was not received until the second year of the study and there had been miscommunication about the costs of a graduate-student researcher, the project began behind schedule and was somewhat underfunded. The main challenge in implementing the plan was the delay in hiring and subsequent loss of the graduate-student researcher. Because the funding available was not sufficient to sustain a professional health educator, the investigators had planned to hire an experienced graduate-student researcher. In the event, we were able to hire a graduatestudent researcher with some experience in health education and extensive experience in Fresno and in air 18 NUATRC RESEARCH REPORT NO. 17, VOL. II

19 S. Katharine Hammond et al quality issues. However, at 0.5 full-time equivalent (FTE), the time commitment needed for the project was too much for the graduate-student researcher, and she was unable to complete the work while completing her schoolwork, ultimately deciding to leave the position after a semester. In retrospect, the work was probably too complex and timeintensive to be accomplished by most graduate students and should ideally have been undertaken by a health education professional. The communications were successful because we had the ongoing participation of the communications consultant who wrote the original plan to provide guidance throughout the project and particularly because we were able to hire another highly experienced health educator at 0.5 FTE for the final 3 months of the project. Finally, we were fortunate to have talented project staff members who were able to assist in communications activities beyond their normal duties. Lessons learned First, although both the participant-needs assessment and the online stakeholder survey were delayed and limited, we gained useful information from each. Both of these instruments (as well as the stakeholder meetings) helped us learn more about which study information might be relevant, significant, and interesting to our audiences. The needs assessment provided us with very positive feedback about communications between participants and the FACES project members, with 100% of participants stating that the communications they had received from FACES had been just right. The participants also had many good suggestions about results dissemination, focusing especially on the schools, although we had not included them as part of the questionnaire. This has led us to plan for communications with the Fresno and Clovis unified school districts order to share study results and reestablish lines of communication. The high percentage of participants who said they wanted to learn about getting involved with local groups interested in asthma and reducing air pollution led us to include in our newsletters information about such groups in the Central Valley as well as about volunteer opportunities. The online stakeholder survey also provided invaluable information, especially concerning stakeholders who wanted to be involved in our community meetings. The stakeholder survey led to a series of key informant interviews, which helped us connect with co-hosts and participants for our stakeholder meetings. Second, we learned that the communication of individual results that we were able to provide was not something our participants were particularly interested in or found useful but that communication of aggregate results (by including them in the newsletters) worked well. And although we didn't send out the first newsletter until summer 2008, the delay enabled us to tailor the content of all the newsletters more toward what was wanted by the participants, based on results from the participant-needs assessment. We also included information about asthma, air quality groups, and related scientific topics. Finally, from the delays in our stakeholder meetings, we learned a major lesson about conveying results in a timely manner. If the meetings had been held as originally planned, we would have been able to engage stakeholder earlier and receive their input about communications processes and project activities, but we would not have had much data to present. A communication plan needs to be flexible, especially around the release of data. Holding these meetings as near to the end of the study as possible has enabled us to share many more results than we otherwise would have been able. Additionally, we developed the plan of group-specific meetings, which had its own advantages. Under this arrangement, we have been able to reach broader audiences - including policy makers, doctors, community advocates, and school officials - and to tailor our information to these audiences. We see these meetings as excellent opportunities for audiences to learn about the study results, provide input to the study team, and network and share ideas with other audience members. The co-hosts for each meeting were quite enthusiastic and have done a very thorough job of recruiting and reaching a diverse group of stakeholders. Their participation in these meetings has led them to be more engaged with the study; there has been a lot excitement among them about disseminating study results to their colleagues and communities and using them in their own work. The lessons learned from the communication plan have affected not only this study but have also been incorporated into the Berkeley/Stanford Children's Environment Health Pre-Center grant. The Pre-Center will continue the work of FACES for another 3 years and includes a large community outreach component designed to help involve the community in the study. The MLNUATRC communication plan served as the template for this community outreach component, which adopted the following objectives that reflect the successes and lessons learned by the current investigators: 1. Establish and build relationships with a diverse network of stakeholders with an interest in environmental health outcomes for the San Joaquin Valley. NUATRC RESEARCH REPORT NO. 17, VOL. II 19

20 The Short- and Long-Term Respiratory Effects of Exposure to Traffic PAHs in a Cohort of Children with Asthma 2. Obtain guidance and feedback from the stakeholder network on communication and information needs, Center aims, and project activities. 3. Communicate Center updates, activities, and research findings to the stakeholder network and study participants in an accessible, clear, timely, and respectful manner. 4. Communicate individual and aggregate study results to study participants in an accessible, clear, timely, and respectful manner. These objectives will be accomplished through the following specific aims: 1. Reach out to potential stakeholders using existing relationships with local asthma coalitions, environmental health advocacy groups, local researchers, and others. 2. Assess information and communication needs and interests of Center study participants and other stakeholders through surveys and other needsassessment methods. 3. Establish regular communication with stakeholders and study participants to update them on Center activities and research progress through quarterly newsletters and other means. 4. Communicate individual and aggregate study results to study participants by developing culturally and linguistically appropriate fact sheets. 5. Obtain guidance on project activities and communicate project results by convening stakeholder meetings. We believe that the success of this outreach component will greatly reflect the work completed for the MLNUATRC communication plan and the relationships forged with stakeholders in the Central Valley. IMPLICATIONS We have learned many lessons from the communication plan. The difficulty of incorporating participant and stakeholder communication into research is widely acknowledged, and we encountered many obstacles along the way. However, researchers have a responsibility to communicate with the community in which they conduct their research, and our communication plan attempted to address this responsibility. The most significant challenge we faced was not having the communication plan or communication staff as part of the original FACES study when it was launched, in It came into place much later, and then only thanks to MLNUATRC, with the result that we missed many years of opportunities to communicate and collaborate with participants and stakeholders. Furthermore, our funds were limited and, we discovered, insufficient to realistically complete the communication plan as originally envisioned, because we had no full-time health education staff and the skills needed for community communication are outside the scope of most research scientists. This proved to be a major challenge for the study staff, because many of the activities outlined in the communications plan required intimate knowledge of risk communication, stakeholder involvement, and survey design. However, the cost of a fulltime health education staff person, given the cost of living and related salaries in the Bay Area, would not have been affordable on the planned budget. We also learned very quickly the importance of being flexible with timetables when working with a study community. Overall, we did glean a number of broad insights from our communication results. First, the communication needs or interests of the participants are sometimes outside the scope or expertise of the study staff. Second, it is very important to establish whether or not the audience is going to trust and listen to you before embarking on a communication plan; in highly politicized settings a different communication plan may be more effective than in one where there is a basic level of trust. Third, the information and communication needs of stakeholders and participants can be different, meaning that the investigators should plan for multiple communication pathways and be prepared to prioritize. Fourth, it is important to communicate to the entire community of participants and stakeholders, not just the participants. There are differences in the communications required to report results for information only versus communication to report results for action purposes). And finally, researchers should no longer suppose that publishing their results in a peer-reviewed journal is the only communication they need to do, because the ability of the community to use their research and for it to be relevant to to the community to which it applies depends in part on whether the people of the community know about and understand the study results. On a more detailed level, we found that despite all the challenges, the activities carried out in the communication plan have led to positive communication with the participant and stakeholder communities. These activities have also contributed to increased data dissemination, because stakeholders involved with the study through the survey and meetings have proved to be excited to promote 20 NUATRC RESEARCH REPORT NO. 17, VOL. II

Descripción de contenidos del E-FORM Capítulo Proyectos de cooperación europea

Descripción de contenidos del E-FORM Capítulo Proyectos de cooperación europea Descripción de contenidos del E-FORM Capítulo Proyectos de cooperación europea DOCUMENTO NO VÁLIDO PARA PRESENTAR LA SOLICITUD* *Documento-resumen del formulario online (eform) de la 2ª convocatoria de

Más detalles

GUIDE FOR PARENT TEACHER CONFERENCES

GUIDE FOR PARENT TEACHER CONFERENCES GUIDE FOR PARENT TEACHER CONFERENCES A parent-teacher conference is a chance for you and your child s teacher to talk. You can talk about how your child is learning at home and at school. This list will

Más detalles

Dear Parents and Patrons,

Dear Parents and Patrons, Dear Parents and Patrons, The purpose of this letter is to inform you that according to the 2013-14 state student assessment results NeSA reading, Gibbon Elementary School is considered a Title 1 School

Más detalles

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR Subject: Important Updates Needed for Your FAFSA Dear [Applicant], When you completed your 2012-2013 Free Application for Federal Student Aid

Más detalles

Karina Ocaña Izquierdo

Karina Ocaña Izquierdo Estudié Ingeniería en Sistemas Computacionales (1997) y una Maestría en Ingeniería de Cómputo con especialidad en Sistemas Digitales (2000), ambas en el Instituto Politécnico Nacional (México). En el 2003,

Más detalles

Final Project (academic investigation)

Final Project (academic investigation) Final Project (academic investigation) MÁSTER UNIVERSITARIO EN BANCA Y FINANZAS (Finance & Banking) Universidad de Alcalá Curso Académico 2015/16 GUÍA DOCENTE Nombre de la asignatura: Final Project (academic

Más detalles

The Home Language Survey (HLS) and Identification of Students

The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) is the document used to determine a student that speaks a language other than English. Identification of a language

Más detalles

Escuela Olympic Program Titulo 1

Escuela Olympic Program Titulo 1 Escuela Olympic Program Titulo 1 Misión: Creemos que toda la comunidad de alumnos de Olympic van aprender Creemos que el habiente de posibilidad da lugar para la capacidad Nosotros esfuerzos nos ha logrado

Más detalles

Screener for Peer Supporters

Screener for Peer Supporters Screener for Peer Supporters Primary Recruiter: Secondary Recruiter: Potential Peer Supporter Name: Phone #1: Home/Cell Phone #2: Home/Cell Address: City: Zip: Contact 1: Date: / / Contact 2: Date: / /

Más detalles

PROYECTO INFORMÁTICO PARA LA CREACIÓN DE UN GESTOR DOCUMENTAL PARA LA ONG ENTRECULTURAS

PROYECTO INFORMÁTICO PARA LA CREACIÓN DE UN GESTOR DOCUMENTAL PARA LA ONG ENTRECULTURAS PROYECTO INFORMÁTICO PARA LA CREACIÓN DE UN GESTOR DOCUMENTAL PARA LA ONG ENTRECULTURAS Autor: García Lodares, Victor. Director: Castejón Silvo, Pedro. Entidad Colaboradora: Entreculturas. Resumen del

Más detalles

THE BILINGUAL CLASSROOM: CONTENT AND LANGUAGE INTEGRATED LEARNING

THE BILINGUAL CLASSROOM: CONTENT AND LANGUAGE INTEGRATED LEARNING THE BILINGUAL CLASSROOM: CONTENT AND LANGUAGE INTEGRATED LEARNING Curso de: Carolina Fernández del Pino Vidal Nº Horas 110 h. /11 créditos (0,5000 puntos) Matricula AFILIADOS A ANPE Y U.P. COMILLAS NO

Más detalles

Chapter Six. Sanitary and Phytosanitary Measures

Chapter Six. Sanitary and Phytosanitary Measures Chapter Six Sanitary and Phytosanitary Measures Objectives The objectives of this Chapter are to protect human, animal, or plant life or health in the Parties territories, enhance the Parties implementation

Más detalles

RDA in BNE. Mar Hernández Agustí Technical Process Department Manager Biblioteca Nacional de España

RDA in BNE. Mar Hernández Agustí Technical Process Department Manager Biblioteca Nacional de España RDA in BNE Mar Hernández Agustí Technical Process Department Manager Biblioteca Nacional de España RDA at the National Library of Spain: BNE preparation for new Cataloguing Rules Since 2007 BNE has been

Más detalles

Thank you. US English US Spanish. Australia-English Canada-English Ireland-English New Zealand-English Taiwan-English United Kingdom-English

Thank you. US English US Spanish. Australia-English Canada-English Ireland-English New Zealand-English Taiwan-English United Kingdom-English Dear Healthcare Provider, Included in this PDF are recruitment brochures in several languages to be used in MM Bone study (Protocol No.: 20090482). Kindly note these brochures have been updated according

Más detalles

Organized in collaboration with the Central Bank, Ministry of Environment and the National Statistic Institute of Dominican republic

Organized in collaboration with the Central Bank, Ministry of Environment and the National Statistic Institute of Dominican republic DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS STATISTICS DIVISION UNITED NATIONS DEPARTAMENTO DE ASUNTOS ECONÓMICOS Y SOCIALES DIVISION DE ESTADISTICAS NACIONES UNIDAS Seminario Regional sobre Contabilidad

Más detalles

Edgar Quiñones. HHRR: Common Sense Does Not Mean Business. Objective

Edgar Quiñones. HHRR: Common Sense Does Not Mean Business. Objective Edgar Quiñones HHRR: Common Sense Does Not Mean Business Objective Share experiences & insight gained in the last two decades in the management consulting business regarding why Common Sense Does Not Mean

Más detalles

RED IT4ALL PLAN DE ACTIVIDADES PARA 2009-2010 IT4ALL NETWORK PLAN OF ACTIVITIES FOR 2009-2010

RED IT4ALL PLAN DE ACTIVIDADES PARA 2009-2010 IT4ALL NETWORK PLAN OF ACTIVITIES FOR 2009-2010 RED IT4ALL PLAN DE ACTIVIDADES PARA 2009-2010 IT4ALL NETWORK PLAN OF ACTIVITIES FOR 2009-2010 SEPTEMBER- 2008 1. PLAN DE ACTIVIDADES 2009-2010 A continuación se desglosan el plan de actividades que la

Más detalles

GENERAL INFORMATION Project Description

GENERAL INFORMATION Project Description RESULTADOS! GENERAL INFORMATION Project Description The campaign "Adopt a car " had as its main objective to position Autoplaza, the main automotive selling point of Chile, as a new car sales location

Más detalles

How to stay involved Como permanece participando

How to stay involved Como permanece participando How to stay involved Como permanece participando Numerous opportunities exist to stay informed and involved in the I-70 East Corridor EIS. These include various written information in mailings, flyers,

Más detalles

CETaqua, a model of collaborative R&D, an example of corporate innovation evolution

CETaqua, a model of collaborative R&D, an example of corporate innovation evolution CETaqua, a model of collaborative R&D, an example of corporate innovation evolution CETaqua: manage projects, create value Tomas Michel General Manager, CETaqua September 2011 1. AGBAR: R&D indicators

Más detalles

Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094

Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094 Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094 www.health.ri.gov Date: December 30, 2009 To: Parents and guardians of school-aged children in Rhode Island From: Director

Más detalles

http://mvision.madrid.org

http://mvision.madrid.org Apoyando el desarrollo de carrera de investigadores en imagen biomédica Supporting career development of researchers in biomedical imaging QUÉ ES M+VISION? WHAT IS M+VISION? M+VISION es un programa creado

Más detalles

Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course.

Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Bienvenidos a la lección dos. The first part of this lesson consists in this audio lesson, and then we have some grammar for you

Más detalles

LA FIRMA THE FIRM QUIENES SOMOS ABOUT US

LA FIRMA THE FIRM QUIENES SOMOS ABOUT US LA FIRMA THE FIRM QUIENES SOMOS Somos una firma de abogados especialistas en derecho laboral, comercial y administrativo que entrega a sus clientes su conocimiento y experiencia de manera eficiente, oportuna

Más detalles

SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA

SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA ELABORAR LA POLITICA AMBIENTAL PDF File: Siguiendo

Más detalles

UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS UNIDAD DE POSTGRADO DE INGENIERÍA DE SISTEMAS E INFORMATICA

UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS UNIDAD DE POSTGRADO DE INGENIERÍA DE SISTEMAS E INFORMATICA UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS UNIDAD DE POSTGRADO DE INGENIERÍA DE SISTEMAS E INFORMATICA DISEÑO E IMPLEMENTACIÓN DE UNA OFICINA DE GESTION DE PROYECTOS PARA LA POSITIVA SEGUROS Informe Profesional

Más detalles

Guide to Health Insurance Part II: How to access your benefits and services.

Guide to Health Insurance Part II: How to access your benefits and services. Guide to Health Insurance Part II: How to access your benefits and services. 1. I applied for health insurance, now what? Medi-Cal Applicants If you applied for Medi-Cal it will take up to 45 days to find

Más detalles

Daly Elementary. Family Back to School Questionnaire

Daly Elementary. Family Back to School Questionnaire Daly Elementary Family Back to School Questionnaire Dear Parent(s)/Guardian(s), As I stated in the welcome letter you received before the beginning of the school year, I would be sending a questionnaire

Más detalles

\RESOURCE\ELECTION.S\PROXY.CSP

\RESOURCE\ELECTION.S\PROXY.CSP The following is an explanation of the procedures for calling a special meeting of the shareholders. Enclosed are copies of documents, which you can use for your meeting. If you have any questions about

Más detalles

ADAPTACIÓN DE REAL TIME WORKSHOP AL SISTEMA OPERATIVO LINUX

ADAPTACIÓN DE REAL TIME WORKSHOP AL SISTEMA OPERATIVO LINUX ADAPTACIÓN DE REAL TIME WORKSHOP AL SISTEMA OPERATIVO LINUX Autor: Tomás Murillo, Fernando. Director: Muñoz Frías, José Daniel. Coordinador: Contreras Bárcena, David Entidad Colaboradora: ICAI Universidad

Más detalles

Espectro de partcipacion publica

Espectro de partcipacion publica Espectro de partcipacion publica Meta de participación publica Espectro de la participación pública Informar Consultar Involucrar Colaborar Empoderar Proporcionar al público información equilibrada y Trabajar

Más detalles

Spanish 3V: Winter 2014

Spanish 3V: Winter 2014 Spanish 3V: Winter 2014 Elementary Spanish 3 in online format: https://login.uconline.edu/ Robert Blake, rjblake@ucdavis.edu; Rebecca Conley, mconley@ucdavis.edu Description: Spanish 3V is the second of

Más detalles

Certified translation Traducción certificada. Qué es una Declaración de Impacto de la Víctima?

Certified translation Traducción certificada. Qué es una Declaración de Impacto de la Víctima? Translated from English to Spanish Traducido del inglés al español Certified translation Traducción certificada Victim Impact Statements "Declaraciones de Impacto de la Víctima" June 2014 Junio 2014 Qué

Más detalles

manual de servicio nissan murano z51

manual de servicio nissan murano z51 manual de servicio nissan murano z51 Reference Manual To understand featuring to use and how to totally exploit manual de servicio nissan murano z51 to your great advantage, there are several sources of

Más detalles

Learning Masters. Early: Force and Motion

Learning Masters. Early: Force and Motion Learning Masters Early: Force and Motion WhatILearned What important things did you learn in this theme? I learned that I learned that I learned that 22 Force and Motion Learning Masters How I Learned

Más detalles

Disfruten su verano! Hola estudiantes,

Disfruten su verano! Hola estudiantes, Hola estudiantes, We hope that your experience during Spanish 1 was enjoyable and that you are looking forward to improving your ability to communicate in Spanish. As we all know, it is very difficult

Más detalles

DISEÑO DE UN CRONOTERMOSTATO PARA CALEFACCIÓN SOBRE TELÉFONOS MÓVILES. Entidad Colaboradora: ICAI Universidad Pontificia Comillas.

DISEÑO DE UN CRONOTERMOSTATO PARA CALEFACCIÓN SOBRE TELÉFONOS MÓVILES. Entidad Colaboradora: ICAI Universidad Pontificia Comillas. DISEÑO DE UN CRONOTERMOSTATO PARA CALEFACCIÓN SOBRE TELÉFONOS MÓVILES Autor: Sánchez Gómez, Estefanía Dolores. Directores: Pilo de la Fuente, Eduardo. Egido Cortés, Ignacio. Entidad Colaboradora: ICAI

Más detalles

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Headaches, Working with your Doctor to Avoid the Emergency Room Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Conozca a su equipo de cuidados para los dolores

Más detalles

Regional Action Plan for the Conservation of Mangroves in the Southeast Pacific

Regional Action Plan for the Conservation of Mangroves in the Southeast Pacific Regional Action Plan for the Conservation of Mangroves in the Southeast Pacific Fernando Félix Comisión Permanente del Pacífico Sur CPPS www.cpps-int.org Permanent Commission for the South Pacific - CPPS

Más detalles

COMMUNICATIONS AT THE ZARAGOZA CONFERENCE AND OTHER WAYS TO GET INVOLVED/

COMMUNICATIONS AT THE ZARAGOZA CONFERENCE AND OTHER WAYS TO GET INVOLVED/ COMMUNICATIONS AT THE ZARAGOZA CONFERENCE AND OTHER WAYS TO GET INVOLVED/ WEBCAST The sessions will be webcast through the Conference website to ensure the Conference is accessible to a wider audience.

Más detalles

Comité de usuarios de la RES

Comité de usuarios de la RES Comité de usuarios de la RES Jordi Torra CURES Comité de usuarios de la RES (CURES) - Las grandes infraestructuras nacionales e internacionales tienen Comité de Usuarios - Es una obligación para las ICTS

Más detalles

Entrevista: el medio ambiente. A la caza de vocabulario: come se dice en español?

Entrevista: el medio ambiente. A la caza de vocabulario: come se dice en español? A la caza de vocabulario: come se dice en español? Entrevista: el medio ambiente 1. There are a lot of factories 2. The destruction of the ozone layer 3. In our city there is a lot of rubbish 4. Endangered

Más detalles

Resumen de Entrevista: Asociación Mexicana de Agentes de Carga

Resumen de Entrevista: Asociación Mexicana de Agentes de Carga Resumen de Entrevista: Asociación Mexicana de Agentes de Carga 1. In regard to the hiring and payment of international freight services, can you tell me in what percentage of total export transactions

Más detalles

iclef-2002 at Universities of Alicante and Jaen University of Alicante (Spain)

iclef-2002 at Universities of Alicante and Jaen University of Alicante (Spain) iclef-2002 at Universities of Alicante and Jaen University of Alicante (Spain) ! Introduction! Passage Retrieval Systems! IR-n system! IR-n system at iclef-2002! Conclusions and Future works ! Introduction!

Más detalles

CO148SPA.1206 PAGE 1 OF 3

CO148SPA.1206 PAGE 1 OF 3 Assurance of Support Algunos inmigrantes necesitan obtener una Assurance of Support (AoS) (Garantía de mantenimiento) antes de que se les pueda conceder su visado para vivir en Australia. El Department

Más detalles

DUAL IMMERSION PROGRAM INFORMATION PRESCHOOL PRESENTATION SEPTEMBER 10, 2014 6:30 P.M.

DUAL IMMERSION PROGRAM INFORMATION PRESCHOOL PRESENTATION SEPTEMBER 10, 2014 6:30 P.M. DUAL IMMERSION PROGRAM INFORMATION PRESCHOOL PRESENTATION SEPTEMBER 10, 2014 6:30 P.M. Presented by Dr. Norma R. Delgado, Director of Curriculum & Instruction 1 The United States Government has identified

Más detalles

From e-pedagogies to activity planners. How can it help a teacher?

From e-pedagogies to activity planners. How can it help a teacher? From e-pedagogies to activity planners. How can it help a teacher? Elena de Miguel, Covadonga López, Ana Fernández-Pampillón & Maria Matesanz Universidad Complutense de Madrid ABSTRACT Within the framework

Más detalles

Level 2 Spanish, 2008

Level 2 Spanish, 2008 90429 2 904290 For Supervisor s Level 2 Spanish, 2008 90429 Read and understand written language in Spanish in less familiar contexts Credits: Six 2.00 pm Tuesday 2 December 2008 Check that the National

Más detalles

Annual Title 1 Parent Meeting

Annual Title 1 Parent Meeting Annual Title 1 Parent Meeting Venus Independent School District August 26 & 28, 2014 1 What is Title I Title I is a K-12 program that provides additional academic support and learning opportunities for

Más detalles

Passaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470

Passaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470 Note: Instructions in Spanish immediately follow instructions in English (Instrucciones en español inmediatamente siguen las instrucciónes en Inglés) Passaic County Technical Institute 45 Reinhardt Road

Más detalles

REUNIÓN DE DIRECTORES DE LOS SNMH DEL ÁFRICA OCCIDENTAL (Banjul, Gambia del 1 al 5 febrero de 2010) Taller previo a la reunión sobre

REUNIÓN DE DIRECTORES DE LOS SNMH DEL ÁFRICA OCCIDENTAL (Banjul, Gambia del 1 al 5 febrero de 2010) Taller previo a la reunión sobre The Gambia REUNIÓN DE DIRECTORES DE LOS SNMH DEL ÁFRICA OCCIDENTAL (Banjul, Gambia del 1 al 5 febrero de 2010) Taller previo a la reunión sobre Movilización de Recursos y Apoyo Estratégico 1 y 2 de febrero

Más detalles

CITY SHARE Knowledge Management Methodology

CITY SHARE Knowledge Management Methodology CITY SHARE Knowledge Management Methodology La Herramienta de Gestión n del Conocimiento UNITAR desarrollo una herramienta de formación n para desarrollar las capacidades de actores locales en varias áreas

Más detalles

Juan José Barrera Cerezal Managing Director on Social Economy, Self- Employment and CSR

Juan José Barrera Cerezal Managing Director on Social Economy, Self- Employment and CSR Juan José Barrera Cerezal Managing Director on Social Economy, Self- Employment and CSR 1 SUSTAINABLE ECONOMY LAW Articles 1 and 2 of the Law The importance of the Law for promoting CSR in Spain Purpose

Más detalles

Creating your Single Sign-On Account for the PowerSchool Parent Portal

Creating your Single Sign-On Account for the PowerSchool Parent Portal Creating your Single Sign-On Account for the PowerSchool Parent Portal Welcome to the Parent Single Sign-On. What does that mean? Parent Single Sign-On offers a number of benefits, including access to

Más detalles

Health in Peru, 1991-2003. Prepared by Leigh Campoamor

Health in Peru, 1991-2003. Prepared by Leigh Campoamor Prepared by Leigh Campoamor Princeton University Library Princeton, NJ 2003 Scope Note Contents: This collection contains pamphlets, articles, and other miscellaneous items addressing a range of health-related

Más detalles

Gaia en las universidades españolas y los centros de inves3gación

Gaia en las universidades españolas y los centros de inves3gación Gaia en las universidades españolas y los centros de inves3gación Ana Ulla Miguel (GGG) Depto. de Física Aplicada, Universidade de Vigo The GGG group is presently composed of the following members: Dra.

Más detalles

Spanish Advanced Unit 4: Research, Understanding and Written Response

Spanish Advanced Unit 4: Research, Understanding and Written Response Write your name here Surname Other names Edexcel GCE Centre Number Candidate Number Spanish Advanced Unit 4: Research, Understanding and Written Response Tuesday 12 June 2012 Afternoon Time: 2 hours 30

Más detalles

Senior Information Sheet Hoja de Información para estudiantes en grado 12

Senior Information Sheet Hoja de Información para estudiantes en grado 12 Senior Information Sheet Hoja de Información para estudiantes en grado 12 (This information is useful for transcript, scholarship, financial aid and award consideration. This form appears in a bilingual

Más detalles

Nos adaptamos a sus necesidades We adapt ourselves to your needs

Nos adaptamos a sus necesidades We adapt ourselves to your needs Nos adaptamos a sus necesidades We adapt ourselves to your needs Welcome to Select Aviation The largest and most successful airline representation group in Spain, SELECT AVIATION (GSA) Airline Representatives

Más detalles

Adobe Acrobat Reader X: Manual to Verify the Digital Certification of a Document

Adobe Acrobat Reader X: Manual to Verify the Digital Certification of a Document dobe crobat Reader X: Manual de verificación de Certificación Digital de un documento dobe crobat Reader X: Manual to Verify the Digital Certification of a Document support@bioesign.com Desarrollado por:

Más detalles

UTILIZACIÓN DE UN BOLÍGRAFO DÍGITAL PARA LA MEJORA DE PROCEDIMIENTOS DE CAMPO EN UNA CENTRAL NUCLEAR.

UTILIZACIÓN DE UN BOLÍGRAFO DÍGITAL PARA LA MEJORA DE PROCEDIMIENTOS DE CAMPO EN UNA CENTRAL NUCLEAR. UTILIZACIÓN DE UN BOLÍGRAFO DÍGITAL PARA LA MEJORA DE PROCEDIMIENTOS DE CAMPO EN UNA CENTRAL NUCLEAR. Autor: Ruiz Muñoz, Rafael. Director: Muñoz García, Manuel. Entidad Colaboradora: Empresarios Agrupados.

Más detalles

www.deltadentalins.com/language_survey.html

www.deltadentalins.com/language_survey.html Survey Code: Survey 1 February 6, 2008 Dear Delta Dental Enrollee: Recent changes in California law will require that all health care plans provide language assistance to their plan enrollees beginning

Más detalles

News Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms

News Flash! Primary & Specialty Care Providers. Sharp Health Plan. Date: February 17, 2012. Subject: Member Grievance Forms I M P O R T A N T News Flash! A FAX Publication for Providers of Sharp Health Plan To: From: Primary & Specialty Care Providers Sharp Health Plan Date: February 17, 2012 Subject: Member Grievance Forms

Más detalles

I ENCUENTRO INTERUNIVERSITARIO HISPANO-ÁRABE HI SA RA. SEVILLA, ESPAÑA 17-18 de MAYO, 2016. www.hisara.org

I ENCUENTRO INTERUNIVERSITARIO HISPANO-ÁRABE HI SA RA. SEVILLA, ESPAÑA 17-18 de MAYO, 2016. www.hisara.org HI SA RA I ENCUENTRO INTERUNIVERSITARIO HISPANO-ÁRABE SEVILLA, ESPAÑA 17-18 de MAYO, 2016 www.hisara.org QUÉ ES HISARA? HISARA nace como plataforma que brindará la oportunidad a universidades, centros

Más detalles

2º Foro Innovadores Sociales

2º Foro Innovadores Sociales 2º Foro Innovadores Sociales What is the Forum? Innovative Social Forum is a Project from Cooperación Internacional ONG which seeks to sensitize youth on social inequalities, making them aware of their

Más detalles

Changes to Diocese of Beaumont Retirement Plans - Frequently Asked Questions. Cambios en los planes de jubilación de la diócesis de Beaumont

Changes to Diocese of Beaumont Retirement Plans - Frequently Asked Questions. Cambios en los planes de jubilación de la diócesis de Beaumont Changes to Diocese of Beaumont Retirement Plans - Frequently Asked Questions Cambios en los planes de jubilación de la diócesis de Beaumont Freezing/Closing of Defined Benefit (Pension) Plan Congelar/Finalizar

Más detalles

SH 68 Project. Fact Sheet

SH 68 Project. Fact Sheet SH 68 Project Fact Sheet Why SH 68 Is Needed SH 68 is a proposed 22 mile new road that will connect I-2/US 83 to I-69C/US 281. The proposed new road will connect with I-2/US 83 between Alamo and Donna

Más detalles

Lump Sum Final Check Contribution to Deferred Compensation

Lump Sum Final Check Contribution to Deferred Compensation Memo To: ERF Members The Employees Retirement Fund has been asked by Deferred Compensation to provide everyone that has signed up to retire with the attached information. Please read the information from

Más detalles

SPANISH ORAL LANGUAGE ASSESSMENT. Jill Jegerski Department of Modern Languages April 8, 2011

SPANISH ORAL LANGUAGE ASSESSMENT. Jill Jegerski Department of Modern Languages April 8, 2011 SPANISH ORAL LANGUAGE ASSESSMENT Jill Jegerski Department of Modern Languages April 8, 2011 INTRODUCTION Basic Spanish program at CSI Three-course Gen. Ed. sequence: SPN 113, 114, 213 Approximately 800

Más detalles

V. Appendix V: Experiment 5

V. Appendix V: Experiment 5 V. Appendix V: Experiment 5 171 172 173 Pre-Test Questions (Spanish version used in experiment): Antes de empezar, le pedimos que por favor conteste 5 breves preguntas. Cuál es su ID#? 1. Cuántos años

Más detalles

Centro Oficial de Trinity College London Desde 1989 el Instituto Dickens representa a Trinity College London en el Uruguay.

Centro Oficial de Trinity College London Desde 1989 el Instituto Dickens representa a Trinity College London en el Uruguay. Dickens Institute Centro Oficial de Trinity College London Desde 1989 el Instituto Dickens representa a Trinity College London en el Uruguay. Este centro de Exámenes Internacionales, reconocido en más

Más detalles

Agustiniano Ciudad Salitre School Computer Science Support Guide - 2015 Second grade First term

Agustiniano Ciudad Salitre School Computer Science Support Guide - 2015 Second grade First term Agustiniano Ciudad Salitre School Computer Science Support Guide - 2015 Second grade First term UNIDAD TEMATICA: INTERFAZ DE WINDOWS LOGRO: Reconoce la interfaz de Windows para ubicar y acceder a los programas,

Más detalles

High acceptance short term loans Fast Payday Loans - CLICK HERE

High acceptance short term loans Fast Payday Loans - CLICK HERE High acceptance short term loans. Was to have with appealing dollars, tried the book of the best cash advance 10032 personal loan albany ga httpwww. trhyales. czpersonal-loanalbany-ga. High acceptance

Más detalles

Ector County Independent School District. Parent Involvement Policy

Ector County Independent School District. Parent Involvement Policy 2012-2013 Ector County Independent School District Parent Involvement Policy The goal of Ector County independent School District is to promote a school-home community partnership that will help all students

Más detalles

More child support paid + more passed

More child support paid + more passed Child Support and W-2 are working together to better serve Wisconsin families. More child support is paid when families understand the rules. Recent child support policy changes are giving more money back

Más detalles

Reunión del Consejo del Plantel Escolar (conocido en inglés como SSC)

Reunión del Consejo del Plantel Escolar (conocido en inglés como SSC) Jon R. Gundry Superintendente del condado de las escuelas El Departamento de Educación Especial le invita a Reunión del Consejo del Plantel Escolar (conocido en inglés como SSC) Reunión Importante! Estudiantes,

Más detalles

AP Spanish Literature Summer Work

AP Spanish Literature Summer Work 26 de mayo, Bienvenido/a a AP Español Literatura! Felicitaciones! Tú has sido aceptado/a en el programa de AP Español - Literatura. Estoy segura de que habrá muchas preguntas. Puedes enviarme cualquier

Más detalles

Spanish Translation of AHRQ s Medical Office Survey on Patient Safety December 2011

Spanish Translation of AHRQ s Medical Office Survey on Patient Safety December 2011 Spanish Translation of AHRQ s Medical Office Survey on Patient Safety December 2011 This document explains the process that was used to develop a Spanish translation of the Agency for Healthcare Research

Más detalles

Ethnography of a Classroom Sample Questions (May need to be adjusted for lower grades)

Ethnography of a Classroom Sample Questions (May need to be adjusted for lower grades) Claremont Graduate University, Teacher Education Program Ethnography of a Classroom Sample Questions Parent/Family Interview Be sure to schedule enough time for interview minimum 30 minutes. If possible,

Más detalles

LAC-2009-09 Modificación 2.3.3.3. DIRECT ALLOCATIONS TO ISPs DISTRIBUCIONES INICIALES A ISPs

LAC-2009-09 Modificación 2.3.3.3. DIRECT ALLOCATIONS TO ISPs DISTRIBUCIONES INICIALES A ISPs LAC-2009-09 Modificación 2.3.3.3 DIRECT ALLOCATIONS TO ISPs DISTRIBUCIONES INICIALES A ISPs Current Policy 2.3.3.3. Direct Allocations to Internet Service Providers LACNIC may grant this type of allocation

Más detalles

Healthy food in Bucaramanga. Diego Andrés Castellanos Reyes. Julie Alejandra Rodríguez Torres. Universidad Pontificia Bolivariana

Healthy food in Bucaramanga. Diego Andrés Castellanos Reyes. Julie Alejandra Rodríguez Torres. Universidad Pontificia Bolivariana Healthy food in Bucaramanga Diego Andrés Castellanos Reyes Julie Alejandra Rodríguez Torres Universidad Pontificia Bolivariana 1 TABLE OF CONTENTS 1. ABSTRACT... 4 2. RESEACH INSTRUMENTS... 5 3. DATA ANALYSIS...

Más detalles

OSH: Integrated from school to work.

OSH: Integrated from school to work. SST: Integrada desde la escuela hasta el empleo. OSH: Integrated from school to work. ESPAÑA - SPAIN Mª Mercedes Tejedor Aibar José Luis Castellá López Instituto Nacional de Seguridad e Higiene en el Trabajo

Más detalles

Volatilidad: Noviembre 2010 Futuros Frijol de Soya

Volatilidad: Noviembre 2010 Futuros Frijol de Soya Observaciones Junio 09, 2010 1. La volatilidad tiene una tendencia a aumentar de Junio a Julio. 2. Este reporte sugiere que se debería considerar la implementación de estrategias largas con opciones en

Más detalles

English. www.cato.org

English. www.cato.org Liberty on the web Access to information furthers freedom. The Cato Institute maintains actively updated websites in four languages to advance the frontiers of freedom around the world. English www.cato.org

Más detalles

July 2011. Graduations & Learning After High School. Español/Spanish

July 2011. Graduations & Learning After High School. Español/Spanish July 2011 Graduations & Learning After High School Español/Spanish Last month our schools graduated 1,734 students from high school. These are students who met all the graduation standards from the State

Más detalles

Summer Reading Program. June 1st - August 10th, 2015

Summer Reading Program. June 1st - August 10th, 2015 June 1st - August 10th, 2015 Dear Educator, Attached you will find three flyer templates. You can use any of these templates to share your Group Number (GN) with your group participants. 1. 2. 3. The first

Más detalles

Community Service Learning in Cuba

Community Service Learning in Cuba Community Service Learning in Cuba What is Community Service Learning? Service Learning at Western aims to connect classroom with community in a way that is mutually beneficial to all participants: students,

Más detalles

Learning Compact. Schools would agree to provide children every opportunity to learn in a supportive, drug- and violence-free environment.

Learning Compact. Schools would agree to provide children every opportunity to learn in a supportive, drug- and violence-free environment. Learning Compact What is a learning compact? A learning compact is a voluntary agreement between the home and school. The agreement would define goals, expectations and shared responsibilities of schools

Más detalles

Este proyecto tiene como finalidad la creación de una aplicación para la gestión y explotación de los teléfonos de los empleados de una gran compañía.

Este proyecto tiene como finalidad la creación de una aplicación para la gestión y explotación de los teléfonos de los empleados de una gran compañía. SISTEMA DE GESTIÓN DE MÓVILES Autor: Holgado Oca, Luis Miguel. Director: Mañueco, MªLuisa. Entidad Colaboradora: Eli & Lilly Company. RESUMEN DEL PROYECTO Este proyecto tiene como finalidad la creación

Más detalles

Wellness Triathlon 2010 Bonus Activity

Wellness Triathlon 2010 Bonus Activity Wellness Triathlon 2010 Bonus Activity Educating the Community One Person at a Time The goal of this activity is to educate as many people about mental health and substance abuse in order to help reduce

Más detalles

Options for Year 11 pupils

Options for Year 11 pupils Options for Year 11 pupils from September and beyond James Slocombe Director of Studies Tom Parkinson Head of Secondary Today sobjectives Explain what choices your son/daughter has and how those choices

Más detalles

Aprende más sobre Acción Diferida para los llegados en la infancia. Learn more about Deferred Action for Childhood Arrivals

Aprende más sobre Acción Diferida para los llegados en la infancia. Learn more about Deferred Action for Childhood Arrivals Aprende más sobre Acción Diferida para los llegados en la infancia Learn more about Deferred Action for Childhood Arrivals 1 DACA: Acción diferida para los llegados en la infancia En 2012, el Presidente

Más detalles

Learning Masters. Fluent: Animal Habitats

Learning Masters. Fluent: Animal Habitats Learning Masters Fluent: Animal Habitats What I Learned List the three most important things you learned in this theme. Tell why you listed each one. 1. 2. 3. 22 Animal Habitats Learning Masters How I

Más detalles

ACTIVITIES 2014 CHILEAN MINING COMMISSION

ACTIVITIES 2014 CHILEAN MINING COMMISSION ACTIVITIES 2014 CHILEAN MINING COMMISSION Santiago, June 2014 Overview Introduction Organizations Main Events - year 2014 Some Details Constitution of the Board The current Board is constituted, composed

Más detalles

Que una mayoría de dos tercios de los miembros del TC/CS esté a favor.

Que una mayoría de dos tercios de los miembros del TC/CS esté a favor. ISO 9001:2015. Revisión final ENGLISH BELOW ISO 9001:2015 ISO 9001:2015 ha pasado a su última fase de revisión, la fase de aprobación. El pasado 5 de noviembre, la Organización ISO publicó una noticia

Más detalles

Simo Educación 2014. Foros de ciencia y tecnología. 16-17 octubre

Simo Educación 2014. Foros de ciencia y tecnología. 16-17 octubre Foros de ciencia y tecnología Salón de tecnología para la enseñanza 2014 Simo Educación 2014 Encuentros de Transferencia de Tecnología en Educación Technological Brokerage Event on Education 16-17 octubre

Más detalles

NATIONAL IMPLEMENTATION OF ACCESS & BENEFIT-SHARING FOR NON- COMMERCIAL ACADEMIC RESEARCH ARGENTINA

NATIONAL IMPLEMENTATION OF ACCESS & BENEFIT-SHARING FOR NON- COMMERCIAL ACADEMIC RESEARCH ARGENTINA NATIONAL IMPLEMENTATION OF ACCESS & BENEFIT-SHARING FOR NON- COMMERCIAL ACADEMIC RESEARCH ARGENTINA This form is an annex of the document Access & Benefit-Sharing in Latin America & the Caribbean, a science-

Más detalles